PURPOSE:The diagnostic workup of TRALI requires an exclusion of TACO. Brain natriuretic peptide (BNP) and N-terminal pro-brain natriuretic (NT-proBNP) accurately diagnosed TACO in preliminary studies that did not include patients with TRALI. In order to determine the diagnostic value of BNP and NT-pro-BNP in the differentiation between TACO and TRALI, we conducted a prospective cohort study of patients who developed pulmonary edema after transfusion in four intensive care units of a tertiary-care hospital.
METHODS:In this prospective cohort study two critical care experts blinded to serum levels of BNP and NT-proBNP determined the diagnosis of TRALI, TACO, and possible TRALI based on the consensus conference definitions. The accuracy of BNP and NT-proBNP was assessed based on the area under the receiver operating curve (AUC).
RESULTS:Of 115 patients who developed acute pulmonary edema after transfusion, 34 were identified with TRALI, 31 with possible TRALI, and 50 with TACO. Median BNP was 375pg/mL (interquartile range [IQR], 122.5 to 780.5pg/mL) in TRALI, 446pg/mL (IQR, 128 to 743.3pg/mL) in possible TRALI and 559pg/mL (IQR, 287.8 to 1347.8pg/mL) in TACO patients (p=0.038). The NT-proBNP levels among patients with TRALI, possible TRALI and TACO differed significantly with a median value of 1558.5pg/mL (IQR, 628.5 to 5114pg/mL), 2349pg/mL (IQR, 919 to 4610pg/mL) and 5197pg/mL (IQR, 1695 to 15714pg/mL) (p=0.0036), respectively. The accuracy of BNP and NT-pro-BNP to diagnose TACO was moderate with an area under curve (AUC) of 0.63 (95% confidence interval [CI] 0.51 to 0.74) and 0.70 (95% CI 0.59 to 0.80).
CONCLUSION:Natriuretic peptides are of limited diagnostic value in a differential diagnosis of pulmonary edema after transfusion in the critically ill patients.
CLINICAL IMPLICATIONS:Clinicians and transfusion specialists can not solely rely on elevated BNP or NT-pro-BNP to exclude TRALI in patients presenting with dyspnea and hypoxemia after transfusion. However, BNP and NT-pro-BNP testing may still be useful for risk stratification, perhaps combined with other key clinical parameters.
DISCLOSURE:Guangxi Li, No Financial Disclosure Information; No Product/Research Disclosure Information