NT-proBNP levels in the identification and classification of pulmonary transfusion reactions

for the NHLBI Recipient Epidemiology and Donor Evaluation Study-III (REDS-III)

Research output: Contribution to journalArticlepeer-review


Background: Consensus definitions for transfusion-related acute lung injury (TRALI) and transfusion-associated circulatory overload (TACO) have recently been revised; however, pulmonary transfusion reactions remain difficult to diagnose. We hypothesized that N-terminal pro-brain natriuretic peptide (NT-proBNP) levels could have utility in the identification and classification of pulmonary transfusion reactions. Study design and methods: We performed a secondary analysis of a case-control study of pulmonary transfusion reactions at four academic hospitals. We evaluated clinical data and measured NT-proBNP levels prior to and following transfusion in patients with TACO (n = 160), transfused acute respiratory distress syndrome (ARDS) [n = 51], TRALI [n = 12], TACO/TRALI [n = 7], and controls [n = 335]. We used Wilcoxon Rank-Sum tests to compare NT-proBNP levels, and classification and regression tree (CART) algorithms to produce a ranking of covariates in order of relative importance for differentiating TACO from transfused controls. Results: Pre-transfusion NT-proBNP levels were elevated in cases of transfused ARDS and TACO (both P <.001) but not TRALI (P =.31) or TACO/TRALI (P =.23) compared to transfused controls. Pre-transfusion NT-proBNP levels were higher in cases of transfused ARDS or TRALI with a diagnosis of sepsis compared to those without (P <.05 for both). CART analyses resulted in similar differentiation of patients with TACO from transfused controls for models utilizing either NT-proBNP levels (AUC 0.83) or echocardiogram results (AUC 0.80). Conclusions: NT-proBNP levels may have utility in the classification of pulmonary transfusion reactions. Prospective studies are needed to test the predictive utility of pre-transfusion NT-proBNP in conjunction with other clinical factors in identifying patients at risk of pulmonary transfusion reactions.

Original languageEnglish (US)
Pages (from-to)2548-2556
Number of pages9
Issue number11
StatePublished - Nov 2020

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Hematology


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