Abstract：
Transfusion-related acute lung injury (TRALI) is a leading cause of transfusion-related mortality. A concern with passive surveillance to detect transfusion reactions is underreporting. Our aim was to obtain evidence-based estimates of TRALI incidence using meta-analysis of active surveillance studies and to compare these estimates with passive surveillance.
We performed a systematic review and meta-analysis of studies reporting TRALI rates. A search of Medline and Embase by a research librarian identified studies published between January 1, 1991 and January 20, 2023. Prospective and retrospective observational studies reporting TRALI by blood component (red blood cells [RBCs], platelets, or plasma) were identified and all inpatient and outpatient settings were eligible. Adult and pediatric, as well as general and specific clinical populations, were included. Platelets and plasma must have used at least one modern TRALI donor risk mitigation strategy. A random effects model estimated TRALI incidence by blood component for active and passive surveillance studies and heterogeneity was examined using meta-regression.
Eighty studies were included with approximately 176-million blood components transfused. RBCs had the highest number of studies (n = 66) included, followed by platelets (n = 35) and plasma (n = 34). Pooled TRALI estimates for active surveillance studies were 0.17/10,000 (95% confidence intervals [CI]: 0.03-0.43; I2 = 79%) for RBCs, 0.31/10,000 (95% CI: 0.22-0.42; I2 = <1%) for platelets, and 3.19/10,000 (95% CI: 0.09-10.66; I2 = 86%) for plasma. Studies using passive surveillance ranged from 0.02 to 0.10/10,000 among the various blood components.
In summary, these estimates may improve a quantitative understanding of TRALI risk, which is important for clinical decision-making weighing the risks and benefits of transfusion.
We performed a systematic review and meta-analysis of studies reporting TRALI rates. A search of Medline and Embase by a research librarian identified studies published between January 1, 1991 and January 20, 2023. Prospective and retrospective observational studies reporting TRALI by blood component (red blood cells [RBCs], platelets, or plasma) were identified and all inpatient and outpatient settings were eligible. Adult and pediatric, as well as general and specific clinical populations, were included. Platelets and plasma must have used at least one modern TRALI donor risk mitigation strategy. A random effects model estimated TRALI incidence by blood component for active and passive surveillance studies and heterogeneity was examined using meta-regression.
Eighty studies were included with approximately 176-million blood components transfused. RBCs had the highest number of studies (n = 66) included, followed by platelets (n = 35) and plasma (n = 34). Pooled TRALI estimates for active surveillance studies were 0.17/10,000 (95% confidence intervals [CI]: 0.03-0.43; I2 = 79%) for RBCs, 0.31/10,000 (95% CI: 0.22-0.42; I2 = <1%) for platelets, and 3.19/10,000 (95% CI: 0.09-10.66; I2 = 86%) for plasma. Studies using passive surveillance ranged from 0.02 to 0.10/10,000 among the various blood components.
In summary, these estimates may improve a quantitative understanding of TRALI risk, which is important for clinical decision-making weighing the risks and benefits of transfusion.
摘要：
背景：输血相关急性肺损伤（TRALI）是输血相关死亡的主要原因。对被动监测以检测输血反应的担忧是漏报。我们的目的是使用主动监测研究的荟萃分析获得TRALI发病率的循证估计，并将这些估计与被动监测进行比较。
方法：我们对报告TRALI发生率的研究进行了系统评价和荟萃分析。研究图书馆员对Medline和Embase的搜索确定了1991年1月1日至2023年1月20日之间发表的研究。前瞻性和回顾性观察性研究报告血液成分的TRALI（红细胞[红细胞]，血小板,或血浆）进行了鉴定，所有住院和门诊患者均符合条件。成人和儿科，以及一般和特定的临床人群，包括在内。血小板和血浆必须至少使用一种现代TRALI供体风险缓解策略。随机效应模型通过主动和被动监测研究的血液成分估计TRALI发生率，并使用meta回归检查异质性。
结果：80项研究纳入了大约1.76亿份输血成分。红细胞的研究数量最多(n=66)，其次是血小板（n=35）和血浆（n=34）。主动监测研究的汇总TRALI估计值为0.17/10,000（95％置信区间[CI]：0.03-0.43；I2=79％），血小板为0.31/10,000（95%CI：0.22-0.42；I2=<1%），血浆为3.19/10,000（95％CI：0.09-10.66；I2=86％）。在各种血液成分中，使用被动监测的研究范围为0.02至0.10/10,000。
结论：总之，这些估计可能会改善对TRALI风险的定量理解，这对于权衡输血的风险和收益的临床决策很重要。
方法：我们对报告TRALI发生率的研究进行了系统评价和荟萃分析。研究图书馆员对Medline和Embase的搜索确定了1991年1月1日至2023年1月20日之间发表的研究。前瞻性和回顾性观察性研究报告血液成分的TRALI（红细胞[红细胞]，血小板,或血浆）进行了鉴定，所有住院和门诊患者均符合条件。成人和儿科，以及一般和特定的临床人群，包括在内。血小板和血浆必须至少使用一种现代TRALI供体风险缓解策略。随机效应模型通过主动和被动监测研究的血液成分估计TRALI发生率，并使用meta回归检查异质性。
结果：80项研究纳入了大约1.76亿份输血成分。红细胞的研究数量最多(n=66)，其次是血小板（n=35）和血浆（n=34）。主动监测研究的汇总TRALI估计值为0.17/10,000（95％置信区间[CI]：0.03-0.43；I2=79％），血小板为0.31/10,000（95%CI：0.22-0.42；I2=<1%），血浆为3.19/10,000（95％CI：0.09-10.66；I2=86％）。在各种血液成分中，使用被动监测的研究范围为0.02至0.10/10,000。
结论：总之，这些估计可能会改善对TRALI风险的定量理解，这对于权衡输血的风险和收益的临床决策很重要。
