Background

Transfusion-associated circulatory overload (TACO) is a major cause of transfusion-related morbidity and mortality in countries with well developed transfusion services. The International Society of Blood Transfusion, the International Haemovigilance Network, and AABB (formerly American Association of Blood Banks), have developed and validated a revised definition of TACO.

Methods

International Haemovigilance Network-member haemovigilance systems (Australia, Austria, Denmark, Finland, Greece, India, Ireland, Italy, Japan, Malta, Netherlands, New Zealand, Norway, Slovenia, United Kingdom and United States) provided cases of respiratory complications categorised by their systems, including clinical parameters listed in the 2017 draft definition (part 1). Individual transfusion professionals were then invited to assess 24 case descriptions according to the draft definition (part 2). Positive and negative agreement and inter-rater agreement (κ) were calculated. Based on validation results, cases were reanalysed and slight adjustments made to yield the final 2018 TACO definition.

Findings

In part 1, 16 (44%) of 36 haemovigilance systems provided 178 cases, including 126 TACO cases. By use of the 2018 definition, 96 (76%) of 126 cases of TACO were in positive agreement. 19 (37%) of 52 cases were recognised as non-TACO respiratory complications. In part 2 (47 experts from 20 countries), moderate all-case agreement (κ=0·43) and TACO-specific agreement (κ=0·54) were observed. Excluding cases missing some clinical information (eg, N terminal pro-brain natriuretic peptide, distinctive chest x-ray findings, and relationship with existing respiratory co-morbidities like pneumonia and chronic obstructive pulmonary disease) improved all-case agreement to κ=0·50 (moderate) and κ=0·65 (good) for TACO cases.

Interpretation

The two-part validation exercise showed that the revised 2018 TACO surveillance case definition captures 76% of cases endorsed as TACO by participating haemovigilance systems. This definition can become the basis for internationally consistent surveillance reporting and contribute towards increased awareness and mitigation of TACO. Further research will require reporting more complete clinical information to haemovigilance systems and should focus on improved distinction between TACO and other transfusion respiratory complications.

Funding

International Society of Blood Transfusion, International Haemovigilance Network, and AABB.

中文翻译：

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修订的国际输血相关循环超负荷监测病例定义：分类协议验证研究

背景

在具有完善输血服务的国家中，输血相关循环系统超负荷（TACO）是与输血相关的发病率和死亡率的主要原因。国际输血学会，国际血液警戒网络和AABB（以前的美国血库协会）已经制定并验证了TACO的修订定义。

方法

国际血液警戒网成员的血液警戒系统（澳大利亚，奥地利，丹麦，芬兰，希腊，印度，爱尔兰，意大利，日本，马耳他，荷兰，新西兰，挪威，斯洛文尼亚，英国和美国）提供了以下呼吸系统并发症的病例：其系统，包括2017年草案定义中列出的临床参数（第1部分）。然后，邀请各个输血专业人士根据草案定义对24例病例进行评估（第2部分）。计算正负协议和评分者间协议（κ）。根据验证结果，对案例进行重新分析，并进行细微调整以得出2018年TACO最终定义。

发现

在第1部分中，36个血液监控系统中有16个（占44％）提供了178例，其中包括126例TACO。根据2018年的定义，在126例TACO病例中，有96例（76％）持肯定态度。52例病例中有19例（37％）被确认为非TACO呼吸系统并发症。在第2部分（来自20个国家/地区的47位专家）中，观察到了中等程度的全案一致（κ= 0·43）和TACO特定一致（κ= 0·54）。排除缺少某些临床信息的病例（例如，N末端脑钠肽前体肽，独特的胸部X线检查结果以及与现有的呼吸系统合并症（如肺炎和慢性阻塞性肺疾病）的关系）可将所有病例的一致性提高到κ= 0· TACO病例为50（中度），κ= 0·65（好）。

解释

分为两部分的验证工作表明，经修订的2018年TACO监测病例定义涵盖了参与的血液警戒系统认可为TACO的病例的76％。此定义可以成为国际上一致的监视报告的基础，并有助于提高对TACO的认识和缓解。进一步的研究将需要向血液警戒系统报告更完整的临床信息，并应着重于改善TACO与其他输血呼吸系统并发症之间的区别。

资金

国际输血学会，国际血液警戒网和AABB。