Alexander P. J. Vlaar

Background Transfusion‐associated circulatory overload (TACO) is an often underdiagnosed pulmonary transfusion complication. A biomarker could aid with the diagnosis. To date, B‐type natriuretic peptide (BNP) and N‐terminal prohormone B‐type natriuretic peptide (NT‐proBNP) seem the most promising biomarkers in the general hospital population. The aim was to evaluate NT‐proBNP as a biomarker for TACO in a critically ill patient population and explore syndecan‐1 and cytokines as other potential biomarkers. Study Design and Methods A retrospective study was performed using samples and clinical data collected during a prospective observational study. Adult patients admitted to the intensive care and transfused with a single red blood cell unit were included. TACO cases were retrospectively identified using a case definition based on the current TACO definition. The primary biomarker was NT‐proBNP, also we measured syndecan‐1 IL‐6, IL‐8, and IL‐10. All markers were measured directly before transfusion, 1 and 24 h after transfusion. Results Our cohort included 64 patients, 12 of which were identified as TACO patients. TACO patients had a lower PaO 2 /FiO 2 ratio and were more often ventilated following transfusion compared to non‐TACO patients. There was no significant difference in NT‐proBNP between pre‐ and post‐transfusion levels nor between TACO and non‐TACO patients. Syndecan‐1 was significantly elevated in TACO patients both pre‐ and post‐transfusion compared to non‐TACO patients. Discussion NT‐proBNP was not associated with TACO in this critically ill patient population. Interestingly, levels of syndecan‐1 were increased in TACO patients at baseline. More research is needed to clarify this association and its possibilities as a biomarker to predict patients at risk for TACO.