(P-TS-110) Transfusion-Related Acute Lung Injury (TRALI) Among Inpatient U.S. Medicare Beneficiaries Ages 65 and Older, 2016-2023: A Claims-based Study
Background/Case Studies: TRALI is a leading cause of transfusion-related fatalities, presenting as respiratory distress with non-cardiogenic pulmonary edema. The study assessed TRALI occurrence, severity, and potential risk factors among Fee-for-Service Medicare beneficiaries, ages 65 and older, transfused in the inpatient setting during 2016-2023.
Study
Design/Methods: This hypothesis-generating study used large Medicare databases, with transfusions identified by recorded procedure and revenue center codes, and TRALI by diagnosis codes. We evaluated the unadjusted TRALI rates per 100,000 inpatient transfusion stays: overall, by 4 years pre- (2016-2019) and during pandemic (2020-2023), immunocompromised (IC) and COVID-19 status, calendar year, transfusion, and recipient characteristics. Case-severity measures included inpatient mortality and length of stay (LOS), among others. Fisher’s exact tests were performed to compare ratesby characteristics evaluated. Cochran-Armitage tests ascertained trends by year, age, and units.
Results/Findings: Of 7,570,724 inpatient transfusion stays, 4,155 had a TRALI diagnosis code, an overall rate of 54.9per 100,000 stays, with pre- and pandemic rates of 52.8 and 57.5. Rates for whites and non-whites were: 56.4 and 47.6 (p< 0.001). For IC vs. non-IC, rates were 78.1 vs. 47.7 [rate ratio 1.6 (95% CI 1.5-1.7)]. The annual TRALI rates ranged from 46.9 in 2016 to 61.3 in 2023(p< 0.001); for IC: from 63.6 to 101.6 (p< 0.001); and for non-IC: from 42.3 to 47.7 (p=0.051). The annual distribution of IC stays increased from 21.4% to 25.3%, respectively. Rates by units increased from 23.7 for 1 unit to 285.4 for >9 units (p< 0.001). By blood components, the highest rates were for platelets only (54.7); RBCs and plasma (114.2); platelets and plasma (135.6); RBCs and platelets (192.1); and RBCs, plasma, and platelets (379.7). Lowest rates were for autologous transfusions (10.7) and convalescent plasma only (37.1). TRALI rates by age declined from 68.5 for 65-69 to 36.3 for ≥85 (p< 0.001). TRALI cases had LOS≥11 days (52.4%) and inpatient mortality (30.3%). Conclusions: Our 8-year population-based investigation identified significantly increasing TRALI trends over time, overall and for IC patients. Higher TRALI rates were identified during vs. pre-pandemic and with greater number of units transfused, and lower risk with advancing age. This study showed higher TRALI rates for platelets transfused alone or in combination, and for IC vs. non-IC, suggesting the importance of blood components and underlying comorbidities. TRALI cases had longer LOS and high inpatient mortality. Future inferential evaluation is required to understand risk factors by pandemic and COVID-19 status.
