Correlation between clinical medication and adverse transfusion reactions

Correlation between clinical medication and adverse transfusion reactions | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Correlation between clinical medication and adverse transfusion reactions Enxiang Zhou, Yanwei Luo, Guocai Li, Fengxia Liu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5741809/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective The topic was to study the link between clinical medication and adverse transfusion reactions. Methods Patients who received transfusion were selected to include 461 cases as study subjects to study the association between clinical medication and adverse transfusion reactions. Results Analysis yielded the following results: 1. Adverse transfusion reactions were most common in the form of allergic reactions, followed by FNHTR(P < 0.001).2. The incidence of adverse transfusion reactions was highest in patients with plasma transfusion, at 57.23% (P < 0.001).3. There may be a greater correlation between drug adverse reactions and that of transfusion adverse reactions. 4. The incidence of adverse transfusion reactions was significantly lower (P < 0.05) in the group with phenylethylamide, which was only 73.8% of that in the unadministered group; the incidence of adverse transfusion reactions in the group with glucocorticoids and vasoactive medications was significantly higher (P < 0.05), which was close to 172.2% and 138.5% of that in the unadministered group, respectively. Discussion There is a link between clinical medication and adverse transfusion reactions, with the most significant relationship being with the use of glucocorticoids and vasoactive drugs, which can lead to an increased probability of adverse transfusion reactions. Health sciences/Medical research Health sciences/Risk factors Drug reaction Transfusion reaction Vasoconstrictor agents Glucocorticoids Figures Figure 1 1. Introduction Blood transfusion is one of the most common procedures in the medical process, and accordingly, it is important to avoid and mitigate adverse reactions during or after blood transfusion. 1 Adverse transfusion reactions (ATR) have so far been found to be related to a variety of factors, including blood group compatibility and blood composition. 2 At this stage of the latest drug research on the ATR, the most common are prophylactic drugs. These drugs are mainly used prior to transfusion to minimize possible allergic reactions during transfusion, i.e. anti-allergic drugs. The familiar ones are dexamethasone, ipecac, and phenelzine. They are used prophylactically at a rate of 50–80%, but drug efficacy has not been proven. 3,4 Even subsequent studies have demonstrated that these drugs actually have no preventative effect on ATR, so this has become a controversy that is still unresolved. 5,6 Recently, there have been a number of new developments exploring whether there may be a positive correlation between certain drugs and specific ATR in specific settings. For example, whether cefotaxime-sulbactam may induce acute intravascular haemolysis, whether tranexamicin may increase the risk of ATR in the perioperative period, whether immune checkpoint inhibitors may be associated with immune transfusion adverse events, and whether furaztoxin may cause pharmacological haemolysis in blood transfusion. may cause pharmacological haemolysis in blood transfusion, etc. 7–10 The World Health Organization once conducted statistics and found that about one in seven deaths worldwide were not caused by natural inherent diseases but by irrational use of drugs. This is closely related to adverse drug reactions. Adverse drug reactions (ADR) are unanticipated harmful reactions that occur during the use of medicines. 11 ADR in China are mainly due to antimicrobial drugs, which when administered intravenously tend to involve the digestive system, the skin mucosal system and the nervous system. Among them, skin adverse reactions are the most common, with clinical manifestations such as rash, itching, flushing, urticaria, and oedema. In addition, adverse drug reactions can indirectly affect other processes in medical treatment, such as transfusion, and hinder subsequent treatment. 12 The study of the link between clinical use of drugs and ATR can further expand the theoretical knowledge of the respective fields of drugs and blood transfusion, and provide a certain basis for subsequent experimental research, such as animal experiments, cellular experiments and even clinical experiments. After confirming the mechanisms and effects in subsequent experiments, it can also provide suggestions for the use of drugs in clinical transfusion patients. 2. Methods 2.1 General information 2.1.1 Inclusion criteria A total of 554 patients with blood transfusion experience in the 20 years from 2005 to 2024 were selected and the following criteria were established to ensure the accuracy of the data analysis. (Figure 1) Inclusion criteria: (1) a need for blood transfusion, which was required due to treatment; (2) the presence of clinical medication within two weeks prior to the transfusion; (3) a complete record of key information. Exclusion criteria: (1) mental disorders; (2) disorders of vital organ function; (3) concomitant uncontrolled infectious diseases; (4) persons with missing key information. 2.1.2 Basic information According to the inclusion criteria, 5 patients with mental disorders, 17 patients with disorders of vital organs, 2 patients with uncontrolled infectious diseases, and 69 patients with missing key information affecting the analysis were deleted, and 461 patients could be analyzed after processing. Among them, 178 patients, or 38.61 percent, had ATR, and 283 patients, or 61.39 percent, had no reactions. 2.2 Methods The transfusion records of the hospital for the period of August 2005-April 2024 were collected and organized, and 461 transfusion patients were selected as the study subjects. The items collected and recorded by patients included: basic information, transfusion information, ADR information, information on concomitant illnesses, information on coadministration of drugs. 2.3 Types of ATR and judgement criteria Criteria for judgement of types of ATR are specified with reference to the haematology class material, AABB Technical Manual, Chapter 22: Non-infectious Adverse Transfusion Reactions. (1) Allergic reactions: urticaria, pruritus, hypotension, respiratory distress, local oedema. (2) Febrile non-hemolytic transfusion reaction (FNHTR): fever, chills, headache, vomiting. (2) Transfusion- related acute lung injury (TRALI): hypoxemia, respiratory failure, hypotension, fever, pulmonary oedema. (3) Transfusion-associated circulatory overload (TACO): dyspnoea, cough, tachycardia, hypertension, headache. (5) Air embolism: dyspnoea, cough, chest pain, hypotension, arrhythmia. (6) Transfusion-associated graft-versus-host disease (GVHD): fever, rash, nausea, vomiting, diarrhoea, post-transplant. 2.4 Statistical analysis The collected data were processed and analyzed using SPSS 26.0 software and R 3.6.1 software. The data of measurement information were analyzed between groups by t-test if they conformed to normal distribution, and the results were expressed as (), and the data of count data were analysed between groups by chi-square test, Logistic regression and Poisson regression, and the results were expressed as the number of cases and the percentage of cases (n (%)). If the result is P<0.05, it means that the difference between groups is statistically significant. 2.5 Approval for human experiments The experiments were approved by Department of Blood Transfusion, Xiangya Third Hospital, Central South University, Hunan, China. All experiments were performed in accordance with relevant named guidelines and regulations. Informed consent was obtained from all participants and/or their legal guardians. 3. Results 3.1 Analysis of the types of ATR Of the 178 patients who experienced an ATR, the type of ATR was judged to be anaphylactic reaction in 134 cases (75.28%), FNHTR in 26 cases (14.61%), TRALI in 9 cases (5.06%), TACO in 7 cases (3.93%), air embolism in 1 case (0.56%), and TA-GVHD in 1 case (0.56%). Analyzed by chi-square test, a significant difference in the incidence of each type of ATR was found (P<0.001). The analysis shows that allergic transfusion reaction is the most common ATR, followed by FNHTR, while others are rare (P<0.001). It can be seen that ATR are most common with allergic reactions, followed by FNHTR, and others are less common (P<0.001). 3.2 Analysis of transfusion components Among the 461 patients who underwent blood transfusion, the transfused components were mainly suspended red blood cells (RBC), platelets (PLT), fresh frozen plasma and cold precipitate, and there were also simultaneous transfusions of multiple components. Statistically, the results of patients transfused with different blood components were as follows: (1) RBC: common types were suspended RBC, irradiated RBC and deleterious RBC. There were 197 patients transfused, accounting for 42.73%, and the incidence of adverse reactions to blood transfusion was 28.93%. (2) PLT: common types are single PLT and irradiated PLT. There were 145 transfused patients, accounting for 31.45%, and the incidence rate of ATR was 22.07%. (3) Plasma: common types are fresh frozen plasma. 173 cases of patients were transfused, accounting for 37.53%, and the incidence rate of transfusion adverse reactions was 57.23%. (4) Cold precipitation: 25 cases of patients were transfused, accounting for 5.42%, and the incidence rate of transfusion adverse reactions was 24%. Analyzed by chi-square test, it was found that there was a significant difference in the incidence rate of ATR for transfusion of different transfusion components (P<0.001). Patients transfused with plasma had the highest incidence of ATR and the greatest contact. 3.3 Analysis of ADR Out of 461 patients, 376 cases with recorded adverse drug reactions were found and the incidence of ADR was 25.80%. Among them, 271 cases had had ADR and the incidence of ADR was 24.35%; 105 cases had not had ADR and the incidence of ADR was 29.52%. There was no significant difference between the two. ADR occurring within one week before and after the date of transfusion were stipulated to be judged as having a similar date. According to statistics, there were 95 patients in the group with similar dates, accounting for 35.06% of the patients, and the incidence of ATR was 41.05%; the incidence of ATR in the group that was not similar was 15.34% (P<0.001). Presumptive drugs were used prior to transfusion. There were 199 patients (73.43%) in the use group of drugs associated with ADR, and the incidence of ATR was 27.14%; the incidence of ATR in the non-use group was 16.67%. (P=0.218) Analyzed by chi-square test, it was found that the incidence of ATR was higher in the groups with similar dates and those who had used medications related to ADR than their counterparts, and there was a significant difference in the group with similar dates (p<0.001). It can be surmised that there may be a greater association between the occurrence of ADR and the occurrence of ATR. 3.4 Baseline level analysis and Propensity Score Matching 3.4.1 Purpose and significance In the baseline level assessment, the method of t-test was used for the between-group analysis of the measurement data, and the method of chi-square test was used for the analysis of the components of the counting data. Propensity Score Matching (PSM) balances confounders by adjusting for cases in both groups. 13,14 Therefore a 1:1 PSM was performed on the data and baseline levels were compared before and after PSM. 3.4.2 Results Supplementary material Table SI shows the results of PSM. 3.4.3 Results of baseline level assessment The patients were divided into two groups, the control group (n=283) who did not experience ATR and the case group (n=178) who experienced ATR. There was no significant difference between the two groups in terms of gender, mean age, and mean length of stay (P>0.05). In terms of transfused blood components, the control group mainly consisted of red blood cells and platelets, and the case group mainly consisted of plasma, with a significant difference (P<0.05). In terms of concomitant diseases, there was a significant difference between the control group and the case group in terms of concomitant haematological diseases, neurological diseases, infectious shock and diabetes mellitus (P<0.05). In terms of concomitant medications, there was a significant difference between the control and case groups in the use of phenacetin, glucocorticoids, lovir-based antivirals, and vasoactive drugs (P<0.05). 3.4.4 Results of PSM Before performing PSM, there were significant differences (P<0.05) in nine factors: transfusion of blood components, concomitant haematological disorders, neurological disorders, infectious shock, diabetes mellitus, use of phenylethylamide, glucocorticoids, lovir antiviral drugs, and vasoactive medications, and after PSM, there was a significant difference in four factors: transfusion of blood components, concomitant haematological disorders, neurological disorders, and glucocorticoids use (P< 0.05). Comparison of standardized deviations before and after PSM also revealed that these 4 factors were not well balanced. 15 It can be seen that PSM has a balancing effect on confounding factors, but it cannot balance completely. (Table 1). 3.5 Analysis of clinical medication 3.5.1 Study drug selection Based on the results of the analysis at the baseline level, it was found that the use of phenacetin, glucocorticoids, lovir-based antivirals and vasoactive drugs had a significant effect on the occurrence of ATR (P<0.05). While the effect of the use of endocannabinoid antibiotics was not significant but P<0.1. Therefore, the use of five drugs, namely, endocannabinoid antibiotics, phenylethylamide, glucocorticoids, lovir antiviral drugs and vasoactive drugs were selected for further analysis. 3.5.2 Case-cohort study A case-cohort study in which patients were divided into two separate groups according to whether or not they were using a particular drug, and the incidence of ATR was compared between the two groups before and after adjustment for confounders, and a chi-square test was performed. (Table 2) The following results can be obtained from the table: (1) Before adjustment for confounders, there was a significant difference in the incidence of ATR between the use of phenylethylamide, glucocorticoids, antiviral drugs of the lovir class and vasoactive drugs (P<0.05); the incidence of ATR was higher in the group of drug users of endocannabinoid antibiotics, glucocorticoids and vasoactive drugs than the group of drug users of the unused group, whereas the incidence of ATR for the phenylethylamide and the antiviral drugs of the lovir class were lower in the used than the unused group. (2) After adjustment for confounders, the difference in the incidence of ATR between the use of phenacetin and lovir-based antivirals was no longer significant (P>0.05), whereas the incidence of ATR after adjustment for confounders was higher in the group in which lovir-based antivirals were shifted to use than in the group in which they were not used. 3.5.3 Nested Case-Control study In Nested Case-control study (NCC), patients are divided into control group and case group according to whether they had ATR and odds ratio (OR) of two groups are compared through logistic regression analysis (Table 3). 16 The following results can be obtained from the table: (1) Before adjusting for confounders, there was a large correlation between the use of endocannabinoid antibiotics, glucocorticoids, and vasoactive medications and the occurrence of ATR (OR>1). (2) After adjusting for confounders, there was a greater correlation between the use of endocannabinoid antibiotics, glucocorticoids, lovir antivirals, and vasoactive drugs and the incidence of ATR (OR>1). 3.5.4 Analysis of clinical medication type and dose These drugs were further grouped according to type and high or low dosage and the study was carried out by comparing the RR values of the two groups using different drugs. (Supplementary Material Table S2) The following results can be obtained from the table: (1) Within the group using endocannabinoid antibiotics, the use of high doses of the drug (>17,995 mg) was a risk factor for the occurrence of ATR(RR>1, p<0.05). (2) Within the group using phenacetin, the use of low doses of the drug (<2634 mg) was a protective factor for the occurrence of ATR (RR<1, p<0.05). (3) Within the glucocorticoid use group, the combined use of the types dexamethasone and methylprednisolone, as well as the use of the drugs in each dose, were risk factors for the occurrence of ATR (RR>1, p<0.05). (4) Within the lovir-based antiviral drugs use group, the combined use of the type ganciclovir was a protective factor for the occurrence of ATR within the group using lovir-based antiviral drugs (RR<1, p<0.05). Low dose use of the drug (<=679mg) was not meaningful in the analysis due to the small amount of data. (5) Within the group using vasoactive drugs, the combined use of types of norepinephrine and the use of drugs in high doses (>12.9 mg) were risk factors for the occurrence of ATR (RR>1, p<0.05). 3.5.5 Joint analysis of transfusion components and clinical medication Patients who were transfused with RBC, PLT and plasma were grouped according to whether they were combined with the above five drugs, and the clinical use of drugs and transfusion components were studied in a joint analysis by comparing the incidence of ATR in each group and the RR values between the different drugs. (Table 4) The following results can be obtained from the table: (1) The combined use of phenacetin, glucocorticoids and vasoactive drugs was a risk factor for the development of ATR in patients transfused with RBC (RR>1, p1, p1, p<0.05). 3.5.6 Joint analysis of ATR type and clinical medication Patients are firstly divided into groups based on different ATR types, and then subdivided based on concomitant drugs. ATR incidence and RR of drugs are compared for joint analysis of ATR type and clinical medication (Supplementary Material Table S3). Here are the results below according to the table. (1) Combined use of glucocorticoids was a risk factor for the development of anaphylactic reactions to blood transfusion (RR>1, p1, p<0.05). 4. Discussion By collecting statistics from all over the literature, it can be found that the most common ATR in China are allergic reactions and non-hemolytic febrile reactions (FNHTR), which together account for more than 90% of the total. 14,17 A search of literature associated with ATR reveals that there have been many drug-related studies, and they have been increasing in recent years. Including prophylactic medication before transfusion, relief after the occurrence of ATR and therapeutic medication are the most common, 18-28 and the study of drugs that may cause ATR, although less, has also developed in recent years. In response to the conclusions reached, the following conjectures were made about some of the links between clinical drug use and the correlation of ATR by reviewing various sources and literature: (1) The probability of an anaphylactic reaction is elevated in patients using glucocorticoids after transfusion of various blood components. Glucocorticoids, commonly including dexamethasone and methylprednisolone, are known to alleviate anaphylactic reactions. 29 But the probability in this study was instead elevated, and it is speculated that prophylactic medication for patients with a history of anaphylactic reactions may have been ineffective, resulting in a positive correlation between the use of glucocorticoids and the occurrence of transfusion-related adverse reactions in the data. It is also possible that this is related to the incompleteness of the data collected. (2) Patients using vasoactive drugs have an elevated probability of developing FNHTR following RBC transfusion. FNHTR occurs often due to the release of pyrogenic cytokines from the blood. 30,31 It has been suggested that the use of vasoactive drugs such as norepinephrine and epinephrine disrupts cytokine homeostasis, leading to a rise in certain cytokines; it has been speculated that the rise in some of these cytokines, such as IL-4, may be a contributing factor in the development of FNHTR. 32 The exact cause remains to be further confirmed. There are still some shortcomings in the research design of the subject: (1) The subject is a data analysis and the results are subject to experimental validation mechanisms and cannot be used directly as a clinical guide. (2) The results may not be accurate enough due to problems such as small amount of data, lack of completeness and accuracy of the data, lack of precision in the choice of analytical methods, and lack of detail in the analyses. (3) For the collection of data on adverse transfusion reactions, it is not possible to obtain complete information, resulting in less or imperfect data, such as incomplete records of symptoms and diagnoses related to ATR, which affects the judgement of the type of ATR and other information, so it is necessary to consider further improvement of the monitoring system for ATR. In summary, there is a link between clinical medication and ATR, with the most significant relationship between the use of glucocorticoids and vasoactive drugs, which can lead to an increased probability of ATR. However, the data analysis is not sufficient, the grouping is not clear, and further improvement as well as research mechanisms and experimental confirmation are needed to provide clinical advice; thus, more preventive drugs are used to avoid the use of drugs that may lead to ATR, to maximize the safety of blood transfusion, and to maintain the health of patients. 5. Conclusions ATR are most common with anaphylactic reactions, followed by FNHTR, and others are less common. Patients transfused with plasma had the highest incidence of ATR and the greatest link. There is a relationship between clinical use of medications and ATR, most notably the use of glucocorticoids and vasopressors, which can lead to an increased incidence of ATR reaching 172.2% and 138.5% of the unused drug group respectively. The combined use of types of dexamethasone, methylprednisolone and all doses of the drug used were risk factors mainly for the occurrence of anaphylactic reactions. The combined use of the type norepinephrine and high dose use of the drug (> 12.9mg) were risk factors for the occurrence of FNHTR. Declarations Data availability The datasets used and analysed during the current study available from the corresponding author on reasonable request. Acknowledgments This work was supported by the Hunan Provincial Natural Science Foundation Project (2024JJ5535，2024JJ5524). Author contributions Enxiang Zhou and Yanwei Luo wrote the main manuscript text, Fengxia Liu collected the data needed and Guocai Li helped to prepare the figure and tables. All authors reviewed the manuscript. Competing interests The authors declare no competing interests. References Healthcare Cost and Utilization Project (HCUP) Statistical Briefs [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US). PMID: 21413206 (2006) Feb–. Qi, Y. U., Xiaoxia, L. I. U., Hong, Z. H. O. U., Yuqing, W. U. & Shuxian, J. I. A. Adverse reactions to blood transfusion: A retrospective analysis of 814 cases in Qingdao area from 2020 to 2021. Chin. J. Blood Transfus. 35 (12), 1259–1262. 10.13303/j.cjbt.issn.1004-549x.2022.12.017 (2022). Heddle, N. M. et al. A randomized controlled trial comparing the frequency of acute reactions to plasma-removed platelets and prestorage WBC-reduced platelets. Transfusion 42 (5), 556–566. 10.1046/j.1537-2995.2002.00094.x (2002). Wang, S. E. et al. Acetaminophen and diphenhydramine as premedication for platelet transfusions: a prospective randomized double-blind placebo-controlled trial. Am. J. Hematol. 70 (3), 191–194. 10.1002/ajh.10119 (2002). Yu, S. et al. Role of anti-allergic agents on attenuating transfusion reactions in adults: A systematic review and meta-analysis. Transfus. Apher Sci. 60 (2), 103041. 10.1016/j.transci.2020.103041 (2021). Zhongyu, K. A. N. G., Chun, L. I. U., Wei, L. I. U. & Daihong, L. I. Meta analysis of the effect of pre-transfusion prophylactic medication on the incidence of adverse reactions to blood transfusion. Chin. J. Blood Transfus. 35 (06), 622–628. 10.13303/j.cjbt.issn.1004-549x.2022.06.008 (2022). Simons, F. E. et al.. World Allergy Organization anaphylaxis guidelines: summary. J Allergy Clin Immunol. ;127(3):587 – 93.e1-22. (2011). 10.1016/j.jaci.2011.01.038 Tinegate, H. et al. Guideline on the investigation and management of acute transfusion reactions. Prepared by the BCSH Blood Transfusion Task Force. Br. J. Haematol. 159 (2), 143–153. 10.1111/bjh.18789 (2012). Weinstock, C. et al. Successful use of eculizumab for treatment of an acute hemolytic reaction after ABO-incompatible red blood cell transfusion. Transfusion 55 (3), 605–610. 10.1111/trf.12882 (2015). Fredlund, H., Berséus, O., Björsell-Ostlilng, E. & Filbey, D. A retrospective study of acute plasma exchange in severe intravascular hemolysis. Eur. J. Haematol. 43 (3), 259–261. 10.1111/j.1600-0609.1989.tb00294.x (1989). Montané, E. & Santesmases, J. Adverse drug reactions. Med. Clin. (Barc) . 154 (5), 178–184. 10.1016/j.medcli.2019.08.007 (2020). English, Spanish. Conghai, T. A. N. G., Yanxue, H. U. A. N. G., Yixuan, L. I. N. & Min, Y. U. A. N. Analysis of Related Factors of Adverse Transfusion Reactions. J. Experimental Hematol. 28 (03), 972–976. 10.19746/j.cnki.issn1009-2137.2020.03.042 (2020). Hamilton, B. H. & Nickerson JA. Correcting for endogeneity in strategic management research[J]. Strategic Organ. 1 (1), 51–78. 10.1177/1476127003001001218 (2003). ROSENBAUM, P. A. U. L. R. & RUBIN, D. O. N. A. L. D. B. The central role of the propensity score in observational studies for causal effects. Biometrika 70, Issue 1 ,, 41–55. 10.1093/biomet/70.1.41 (April 1983). Schober, P., Mascha, E. J. & Vetter, T. R. Statistics From A (Agreement) to Z (z Score): A Guide to Interpreting Common Measures of Association, Agreement, Diagnostic Accuracy, Effect Size, Heterogeneity, and Reliability in Medical Research. Anesth. Analg . 133 (6), 1633–1641. 10.1213/ane.0000000000005773 (2021). Glanz, J. M. et al. Association Between Estimated Cumulative Vaccine Antigen Exposure Through the First 23 Months of Life and Non-Vaccine-Targeted Infections From 24 Through 47 Months of Age. JAMA 319 (9), 906–913. 10.1001/jama.2018.0708 (2018). Daiyu, T. A. N. G. & Xuerui, Z. H. A. O. Retrospective Analysis of 95 Cases Adverse Reactions to Clinical Blood Transfusion. Smart Healthc. 9 (25), 114–118. 10.19335/j.cnki.2096-1219.2023.25.027 (2023). Tingting, L. A. I. & Zhi, Z. E. N. G. FANG Le.To investigate the effect of dexamethasone on reducing adverse effects during or after blood transfusion. Guide of China Medicine,2018,16(27):42–43. 10.15912/j.cnki.gocm.2018.27.035 Simons, F. E. et al. World Allergy Organization anaphylaxis guidelines: summary. J. Allergy Clin. Immunol. 127 (3), 587–593. e1-22 (2011). Tinegate, H. et al. Guideline on the investigation and management of acute transfusion reactions. Prepared by the BCSH Blood Transfusion Task Force. Br. J. Haematol. 159 (2), 143–153. 10.1111/bjh.12017 (2012). Weinstock, C. et al. Successful use of eculizumab for treatment of an acute hemolytic reaction after ABO-incompatible red blood cell transfusion. Transfusion 55 (3), 605–610. 10.1111/trf.12882 (2015). Fredlund, H., Berséus, O., Björsell-Ostlilng, E. & Filbey, D. A retrospective study of acute plasma exchange in severe intravascular hemolysis. Eur. J. Haematol. 43 (3), 259–261. 10.1111/j.1600-0609.1989.tb00294.x (1989). Seager, O. A. et al. Massive acute hemodilution for incompatible blood reaction. JAMA 229 (7), 790–792. 10.1001/jama.1974.03230450024018 (1974). Kohan, A. I. et al. High-dose intravenous immunoglobulin in non-ABO transfusion incompatibility. Vox Sang . 67 (2), 195–198. 10.1111/j.1423-0410.1994.tb01659.x (1994). Friedlander, M. & Noble, W. H. Meperidine to control shivering associated with platelet transfusion reaction. Can. J. Anaesth. 36 (4), 460–462. 10.1007/bf03005348 (1989). Win, N., Sinha, S., Lee, E. & Mills, W. Treatment with intravenous immunoglobulin and steroids may correct severe anemia in hyperhemolytic transfusion reactions: case report and literature review. Transfus. Med. Rev. 24 (1), 64–67. 10.1016/j.tmrv.2009.09.006 (2010). Delaney, M. et al. Biomedical Excellence for Safer Transfusion (BEST) Collaborative. Transfusion reactions: prevention, diagnosis, and treatment. Lancet 388 (10061), 2825–2836. 10.1016/S0140-6736(15)01313-6 (2016). Yuan, X. et al. Shock ; 59 (4):603–611. doi: 10.1097/shk.0000000000002080 (2023). Hui, W. A. N. G. & Feihe, X. U. Analysis of the indications for glucocorticoids in hospitalized patients. Chin. J. Rural Med. Pharm. 28 (16), 40–. 10.19542/j.cnki.1006-5180.005402 (2021). Heddle, N. M. et al. The role of the plasma from platelet concentrates in transfusion reactions. N Engl. J. Med. 331 (10), 625–628. 10.1056/NEJM199409083311001 (1994). Brubaker, D. B. Clinical significance of white cell antibodies in febrile nonhemolytic transfusion reactions. Transfusion 30 (8), 733–737. 10.1046/j.1537-2995.1990.30891020335.x (1990). Agarwal, S. K. & Marshall, G. D. Jr Beta-adrenergic modulation of human type-1/type-2 cytokine balance. J. Allergy Clin. Immunol. 105 (1 Pt 1), 91–98. 10.1016/s0091-6749(00)90183-0 (2000). Tables Table 1 Comparing of SMD before and after PSM P before PSM P after PSM SMD before PSM SMD after PSM SMD declining extent Balancing effect * Transfusing RBC <0.001 <0.001 -0.1244 -0.4100 -229.6% Medium effect Transfusing PLT <0.001 <0.001 -0.5579 -0.2777 50.2% Small effect Transfusing plasm <0.001 <0.001 +0.8134 +0.6967 14.3% Large effect Hemopathy <0.001 0.001 -0.4921 -0.3595 26.9% Medium effect Nervous system disease <0.001 <0.001 +0.4126 +0.3852 6.6% Medium effect Sepsis shock 0.005 0.056 +0.2126 +0.1867 12.2% Small effect Diabetes 0.035 0.653 +0.1894 +0.0617 67.4% Trivial effect Phenylethylamide 0.041 0.706 +0.2221 -0.0543 75.6% Trivial effect Glucocorticoids <0.001 0.003 +0.5320 +0.3395 36.2% Medium effect ‘~clovir’ antiviral drug 0.046 0.201 -0.2570 +0.1400 45.5% Small effect Vasopressors 0.006 0.175 +0.2292 +0.1480 35.4% Small effect * refer to standard in the article of Patrick Schober 23 , according to SMD after PSM： SMD: <0.10, Trivial effect; 0.10-0.34, Small effect; 0.35-0.64, Medium effect; 0.65-1.19, Large effect; ≥1.20, Very large effect. Table 2 Case-cohort study Drug ATR incidence （% ） Overall Adjusted* Lactam antibiotics Concomitant without drug 33.85% 43.92% Concomitant with drug 42.01% 54.33% P 0.076 0.053 Phenylethylamide Concomitant without drug 41.62% 50.73% Concomitant with drug 30.71% 47.56% P 0.032 0.615 Glucocorticoids Concomitant without drug 26.89% 36.57% Concomitant with drug 51.12% 62.98% P <0.001 <0.001 ‘~clovir’ antiviral drug Concomitant without drug 40.24% 49.12% Concomitant with drug 23.91% 68.75% P 0.031 0.125 Vasopressors Concomitant without drug 36.58% 48.13% Concomitant with drug 60% 66.67% P 0.004 0.035 * Adjustment is achieved through balancing the confounders in the baseline table. Table 3 Nested Case-control study Drug Group ATR Non-ATR OR*(95%CI) OR (95%CI), adjusted# Lactam antibiotics Concomitant without drugs 65 127 Reference Reference Concomitant with drugs 113 156 1.46(0.97 to 2.22) 1.53(0.99 to 2.38) Phenylethylamide Concomitant without drugs 139 195 Reference Reference Concomitant with drugs 39 88 0.57(0.36 to 0.91) 0.75(0.45 to 1.26) Glucocorticoids Concomitant without drugs 64 174 Reference Reference Concomitant with drugs 114 109 3.86(2.55 to 5.94) 2.15(1.38 to 3.38) ‘~clovir’ antiviral drug Concomitant without drugs 167 248 Reference Reference Concomitant with drugs 11 35 0.30(0.14 to 0.62) 1.93(0.66 to 6.37) Vasopressors Concomitant without drugs 154 267 Reference Reference Concomitant with drugs 24 16 2.60(1.29 to 5.35) 1.85(0.92 to 3.83) * OR, Odds ratio, use of drug ratios in case group/use of drug ratios in control group # Adjustment is achieved through balancing the confounders in the baseline table. Table 4 Joint analysis of transfusion components and clinical medication RBC PLT Plasma Drug Group ATR RR p ATR RR p ATR RR p Lactam antibiotics Without drugs 25.00% 1.27 (0.80-2.01) 0.321 15.71% 1.78 (0.93-3.42) 0.083 65.38% 0.82 (0.64-1.06) 0.135 With drugs 31.62% 28.00% 53.72% Phenylethylamide Without drugs 26.04% 1.78 (1.11-2.86) 0.016 27.12% 0.69 (0.37-1.26) 0.225 56.49% 1.12 (0.77-1.62) 0.555 With drugs 46.43% 18.60% 63.16% Glucocorticoids Without drugs 23.02% 1.71 (1.11-2.64) 0.014 12.70% 2.31 (1.11-4.78) 0.025 35.42% 2.38 (1.79-3.18) <0.001 With drugs 39.44% 29.27% 84.42% ‘~clovir’ antiviral drug Without drugs 28.80% 1.16 (0.37-3.67) 0.804 27.12% 0.07 (0.00-1.04) 0.053 55.56% 1.47 (1.08-2.01) 0.015 With drugs 33.33% 0.00% 81.82% Vasopressors Without drugs 26.14% 2.00 (1.24-3.23) 0.004 21.43% 1.87 (0.61-5.72) 0.274 56.05% 1.23 (0.86-1.76) 0.264 With drugs 52.38% 40.00% 68.75% Additional Declarations No competing interests reported. Supplementary Files SupplementaryMaterial.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5741809","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":398874474,"identity":"9acb2155-c1ee-43b2-a4cb-32dc0f30fbc7","order_by":0,"name":"Enxiang Zhou","email":"","orcid":"","institution":"Central South University","correspondingAuthor":false,"prefix":"","firstName":"Enxiang","middleName":"","lastName":"Zhou","suffix":""},{"id":398874475,"identity":"9eb1c5cd-d480-4e93-bd71-9d6a693b1d26","order_by":1,"name":"Yanwei Luo","email":"","orcid":"","institution":"Third Xiangya Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yanwei","middleName":"","lastName":"Luo","suffix":""},{"id":398874476,"identity":"6ff0fb76-3514-46f8-bb16-8834a4ce59cd","order_by":2,"name":"Guocai Li","email":"","orcid":"","institution":"Third Xiangya Hospital","correspondingAuthor":false,"prefix":"","firstName":"Guocai","middleName":"","lastName":"Li","suffix":""},{"id":398874477,"identity":"af7ebd6a-d4d3-4d4d-9aa4-7d51d3dda98f","order_by":3,"name":"Fengxia Liu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABDklEQVRIie3Qv0sDMRTA8VcKcUk9xytK+y+8cqAU4fqvJGRwcxGkQ8GDwk26Vyj+BQ6ZOr9wYJdi14DTLU63uIgFBWM9l0KOjg75To8jn8sPgFDoX3ZgSEBvOxKMf7/FzYQLR5KarPYigAQ1gVa+B0ErBJU59s6ixwFtHtIRUtu8cEgvfaQ7k0Qyx2Q4exXmbqGkJqbOOagrH4lit4vMP6W2BVFnQQKJnx5zIJl5CIvdGrfLjbYmM19zcgeL3htJVBOB6ykVnYxamjhrJN3byj3yMw60ZaI4eVLyvmDJcI7KS3B5YcqPa+zjepW8VZN0dLiclrYap14CR6Ie4r+hvf2Vb/3PZWh3CIVCodBO3/UBYfy2nqNUAAAAAElFTkSuQmCC","orcid":"","institution":"Third Xiangya Hospital","correspondingAuthor":true,"prefix":"","firstName":"Fengxia","middleName":"","lastName":"Liu","suffix":""}],"badges":[],"createdAt":"2024-12-31 11:53:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5741809/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5741809/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":73518254,"identity":"856a3d43-3d76-4e56-989f-8d357651ff92","added_by":"auto","created_at":"2025-01-10 18:01:31","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":61732,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eInclusion criteria\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Inclusioncriteria.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5741809/v1/4f3d05eb82480fe136f80990.jpg"},{"id":76844375,"identity":"e0509cd4-994f-4654-af3e-b691b36e373a","added_by":"auto","created_at":"2025-02-21 10:38:55","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1206361,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5741809/v1/9071c4c1-e2eb-412d-ad95-f32ab0098cd7.pdf"},{"id":73518251,"identity":"c32736e8-accc-4cde-915c-2c1fc6018862","added_by":"auto","created_at":"2025-01-10 18:01:31","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":37238,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryMaterial.docx","url":"https://assets-eu.researchsquare.com/files/rs-5741809/v1/a8b1e5fb466919447448d6a6.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Correlation between clinical medication and adverse transfusion reactions","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eBlood transfusion is one of the most common procedures in the medical process, and accordingly, it is important to avoid and mitigate adverse reactions during or after blood transfusion.\u003csup\u003e1\u003c/sup\u003e Adverse transfusion reactions (ATR) have so far been found to be related to a variety of factors, including blood group compatibility and blood composition.\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eAt this stage of the latest drug research on the ATR, the most common are prophylactic drugs. These drugs are mainly used prior to transfusion to minimize possible allergic reactions during transfusion, i.e. anti-allergic drugs. The familiar ones are dexamethasone, ipecac, and phenelzine. They are used prophylactically at a rate of 50\u0026ndash;80%, but drug efficacy has not been proven.\u003csup\u003e3,4\u003c/sup\u003e Even subsequent studies have demonstrated that these drugs actually have no preventative effect on ATR, so this has become a controversy that is still unresolved.\u003csup\u003e5,6\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eRecently, there have been a number of new developments exploring whether there may be a positive correlation between certain drugs and specific ATR in specific settings. For example, whether cefotaxime-sulbactam may induce acute intravascular haemolysis, whether tranexamicin may increase the risk of ATR in the perioperative period, whether immune checkpoint inhibitors may be associated with immune transfusion adverse events, and whether furaztoxin may cause pharmacological haemolysis in blood transfusion. may cause pharmacological haemolysis in blood transfusion, etc.\u003csup\u003e7\u0026ndash;10\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe World Health Organization once conducted statistics and found that about one in seven deaths worldwide were not caused by natural inherent diseases but by irrational use of drugs. This is closely related to adverse drug reactions. Adverse drug reactions (ADR) are unanticipated harmful reactions that occur during the use of medicines.\u003csup\u003e11\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eADR in China are mainly due to antimicrobial drugs, which when administered intravenously tend to involve the digestive system, the skin mucosal system and the nervous system. Among them, skin adverse reactions are the most common, with clinical manifestations such as rash, itching, flushing, urticaria, and oedema. In addition, adverse drug reactions can indirectly affect other processes in medical treatment, such as transfusion, and hinder subsequent treatment.\u003csup\u003e12\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe study of the link between clinical use of drugs and ATR can further expand the theoretical knowledge of the respective fields of drugs and blood transfusion, and provide a certain basis for subsequent experimental research, such as animal experiments, cellular experiments and even clinical experiments. After confirming the mechanisms and effects in subsequent experiments, it can also provide suggestions for the use of drugs in clinical transfusion patients.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003ch2\u003e2.1 General information\u003c/h2\u003e\n\u003ch4\u003e2.1.1 Inclusion criteria\u003c/h4\u003e\n\u003cp\u003eA total of 554 patients with blood transfusion experience in the 20 years from 2005 to 2024 were selected and the following criteria were established to ensure the accuracy of the data analysis. \u0026nbsp;(Figure 1) \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eInclusion criteria:\u003c/p\u003e\n\u003cp\u003e(1) a need for blood transfusion, which was required due to treatment;\u003c/p\u003e\n\u003cp\u003e(2) the presence of clinical medication within two weeks prior to the transfusion;\u003c/p\u003e\n\u003cp\u003e(3) a complete record of key information.\u003c/p\u003e\n\u003cp\u003eExclusion criteria:\u003c/p\u003e\n\u003cp\u003e(1) mental disorders; (2) disorders of vital organ function;\u003c/p\u003e\n\u003cp\u003e(3) concomitant uncontrolled infectious diseases;\u003c/p\u003e\n\u003cp\u003e(4) persons with missing key information.\u003c/p\u003e\n\u003ch4\u003e2.1.2 Basic information\u003c/h4\u003e\n\u003cp\u003eAccording to the inclusion criteria, 5 patients with mental disorders, 17 patients with disorders of vital organs, 2 patients with uncontrolled infectious diseases, and 69 patients with missing key information affecting the analysis were deleted, and 461 patients could be analyzed after processing. Among them, 178 patients, or 38.61 percent, had ATR, and 283 patients, or 61.39 percent, had no reactions.\u003c/p\u003e\n\u003ch2\u003e2.2 Methods\u003c/h2\u003e\n\u003cp\u003eThe transfusion records of the hospital for the period of August 2005-April 2024 were collected and organized, and 461 transfusion patients were selected as the study subjects.\u003c/p\u003e\n\u003cp\u003eThe items collected and recorded by patients included: basic information, transfusion information, ADR information, information on concomitant illnesses, information on coadministration of drugs.\u003c/p\u003e\n\u003ch2\u003e2.3 Types of ATR and judgement criteria\u003c/h2\u003e\n\u003cp\u003eCriteria for judgement of types of ATR are specified with reference to the haematology class material, AABB Technical Manual, Chapter 22: Non-infectious Adverse Transfusion Reactions.\u003c/p\u003e\n\u003cp\u003e(1)\u0026nbsp;\u0026nbsp;Allergic reactions:\u003c/p\u003e\n\u003cp\u003eurticaria, pruritus, hypotension, respiratory distress, local oedema.\u003c/p\u003e\n\u003cp\u003e(2) Febrile non-hemolytic transfusion reaction (FNHTR):\u003c/p\u003e\n\u003cp\u003efever, chills, headache, vomiting.\u003c/p\u003e\n\u003cp\u003e(2)\u0026nbsp;\u0026nbsp;Transfusion- related acute lung injury (TRALI):\u003c/p\u003e\n\u003cp\u003ehypoxemia, respiratory failure, hypotension, fever, pulmonary oedema.\u003c/p\u003e\n\u003cp\u003e(3)\u0026nbsp;\u0026nbsp;Transfusion-associated circulatory overload (TACO):\u003c/p\u003e\n\u003cp\u003edyspnoea, cough, tachycardia, hypertension, headache.\u003c/p\u003e\n\u003cp\u003e(5) Air embolism: dyspnoea, cough, chest pain, hypotension, arrhythmia.\u003c/p\u003e\n\u003cp\u003e(6) Transfusion-associated graft-versus-host disease (GVHD):\u003c/p\u003e\n\u003cp\u003efever, rash, nausea, vomiting, diarrhoea, post-transplant.\u003c/p\u003e\n\u003ch2\u003e2.4 Statistical analysis\u003c/h2\u003e\n\u003cp\u003eThe collected data were processed and analyzed using SPSS 26.0 software and R 3.6.1 software. The data of measurement information were analyzed between groups by t-test if they conformed to normal distribution, and the results were expressed as (), and the data of count data were analysed between groups by chi-square test, Logistic regression and Poisson regression, and the results were expressed as the number of cases and the percentage of cases (n (%)). If the result is P\u0026lt;0.05, it means that the difference between groups is statistically significant.\u003c/p\u003e\n\u003ch2\u003e2.5 Approval for human experiments\u003c/h2\u003e\n\u003cp\u003eThe experiments were approved by Department of Blood Transfusion, Xiangya Third Hospital, Central South University, Hunan, China. All experiments were performed in accordance with relevant named guidelines and regulations. Informed consent was obtained from all participants and/or their legal guardians.\u0026nbsp;\u003c/p\u003e"},{"header":"3. Results","content":"\u003ch2\u003e3.1 Analysis of the types of ATR\u003c/h2\u003e\n\u003cp\u003eOf the 178 patients who experienced an ATR, the type of ATR was judged to be anaphylactic reaction in 134 cases (75.28%), FNHTR in 26 cases (14.61%), TRALI in 9 cases (5.06%), TACO in 7 cases (3.93%), air embolism in 1 case (0.56%), and TA-GVHD in 1 case (0.56%). Analyzed by chi-square test, a significant difference in the incidence of each type of ATR was found (P\u0026lt;0.001). The analysis shows that allergic transfusion reaction is the most common ATR, followed by FNHTR, while others are rare (P\u0026lt;0.001).\u003c/p\u003e\n\u003cp\u003eIt can be seen that ATR are most common with allergic reactions, followed by FNHTR, and others are less common (P\u0026lt;0.001).\u003c/p\u003e\n\u003ch2\u003e3.2 Analysis of transfusion components\u003c/h2\u003e\n\u003cp\u003eAmong the 461 patients who underwent blood transfusion, the transfused components were mainly suspended red blood cells (RBC), platelets (PLT), fresh frozen plasma and cold precipitate, and there were also simultaneous transfusions of multiple components. Statistically, the results of patients transfused with different blood components were as follows:\u003c/p\u003e\n\u003cp\u003e(1)\u0026nbsp;\u0026nbsp;RBC: common types were suspended RBC, irradiated RBC and deleterious RBC. There were 197 patients transfused, accounting for 42.73%, and the incidence of adverse reactions to blood transfusion was 28.93%.\u003c/p\u003e\n\u003cp\u003e(2)\u0026nbsp;\u0026nbsp;PLT: common types are single PLT and irradiated PLT. There were 145\u003c/p\u003e\n\u003cp\u003etransfused patients, accounting for 31.45%, and the incidence rate of ATR was 22.07%.\u003c/p\u003e\n\u003cp\u003e(3)\u0026nbsp;\u0026nbsp;Plasma: common types are fresh frozen plasma. 173 cases of patients were\u003c/p\u003e\n\u003cp\u003etransfused, accounting for 37.53%, and the incidence rate of transfusion adverse reactions was 57.23%.\u003c/p\u003e\n\u003cp\u003e(4)\u0026nbsp;\u0026nbsp;Cold precipitation: 25 cases of patients were transfused, accounting for 5.42%, and\u003c/p\u003e\n\u003cp\u003ethe incidence rate of transfusion adverse reactions was 24%.\u003c/p\u003e\n\u003cp\u003eAnalyzed by chi-square test, it was found that there was a significant difference in the incidence rate of ATR for transfusion of different transfusion components (P\u0026lt;0.001). Patients transfused with plasma had the highest incidence of ATR and the greatest contact.\u003c/p\u003e\n\u003ch2\u003e3.3 Analysis of ADR\u003c/h2\u003e\n\u003cp\u003eOut of 461 patients, 376 cases with recorded adverse drug reactions were found and the incidence of ADR was 25.80%. Among them, 271 cases had had ADR and the incidence of ADR was 24.35%; 105 cases had not had ADR and the incidence of ADR was 29.52%. There was no significant difference between the two.\u003c/p\u003e\n\u003cp\u003eADR occurring within one week before and after the date of transfusion were stipulated to be judged as having a similar date. According to statistics, there were 95 patients in the group with similar dates, accounting for 35.06% of the patients, and the incidence of ATR was 41.05%; the incidence of ATR in the group that was not similar was 15.34% (P\u0026lt;0.001). Presumptive drugs were used prior to transfusion. There were 199 patients (73.43%) in the use group of drugs associated with ADR, and the incidence of ATR was 27.14%; the incidence of ATR in the non-use group was 16.67%. (P=0.218)\u003c/p\u003e\n\u003cp\u003eAnalyzed by chi-square test, it was found that the incidence of ATR was higher in the groups with similar dates and those who had used medications related to ADR than their counterparts, and there was a significant difference in the group with similar dates (p\u0026lt;0.001). It can be surmised that there may be a greater association between the occurrence of ADR and the occurrence of ATR.\u003c/p\u003e\n\u003ch2\u003e3.4 Baseline level analysis and Propensity Score Matching\u003c/h2\u003e\n\u003ch4\u003e3.4.1 Purpose and significance\u003c/h4\u003e\n\u003cp\u003eIn the baseline level assessment, the method of t-test was used for the between-group analysis of the measurement data, and the method of chi-square test was used for the analysis of the components of the counting data.\u003c/p\u003e\n\u003cp\u003ePropensity Score Matching (PSM) balances confounders by adjusting for cases in both groups.\u003csup\u003e13,14\u003c/sup\u003e Therefore a 1:1 PSM was performed on the data and baseline levels were compared before and after PSM.\u003c/p\u003e\n\u003ch4\u003e3.4.2 Results\u003c/h4\u003e\n\u003cp\u003eSupplementary material Table SI shows the results of PSM.\u003c/p\u003e\n\u003ch4\u003e3.4.3 Results of baseline level assessment\u003c/h4\u003e\n\u003cp\u003eThe patients were divided into two groups, the control group (n=283) who did not experience ATR and the case group (n=178) who experienced ATR. There was no significant difference between the two groups in terms of gender, mean age, and mean length of stay (P\u0026gt;0.05).\u003c/p\u003e\n\u003cp\u003eIn terms of transfused blood components, the control group mainly consisted of red blood cells and platelets, and the case group mainly consisted of plasma, with a significant difference (P\u0026lt;0.05). In terms of concomitant diseases, there was a significant difference between the control group and the case group in terms of concomitant haematological diseases, neurological diseases, infectious shock and diabetes mellitus (P\u0026lt;0.05). In terms of concomitant medications, there was a significant difference between the control and case groups in the use of phenacetin, glucocorticoids, lovir-based antivirals, and vasoactive drugs (P\u0026lt;0.05).\u003c/p\u003e\n\u003ch4\u003e3.4.4 Results of PSM\u003c/h4\u003e\n\u003cp\u003eBefore performing PSM, there were significant differences (P\u0026lt;0.05) in nine factors: transfusion of blood components, concomitant haematological disorders, neurological disorders, infectious shock, diabetes mellitus, use of phenylethylamide, glucocorticoids, lovir antiviral drugs, and vasoactive medications, and after PSM, there was a significant difference in four factors: transfusion of blood components, concomitant haematological disorders, neurological disorders, and glucocorticoids use (P\u0026lt; 0.05). Comparison of standardized deviations before and after PSM also revealed that these 4 factors were not well balanced.\u003csup\u003e15\u003c/sup\u003e It can be seen that PSM has a balancing effect on confounding factors, but it cannot balance completely. (Table 1).\u003c/p\u003e\n\u003ch2\u003e3.5 Analysis of clinical medication\u003c/h2\u003e\n\u003ch4\u003e3.5.1 Study drug selection\u003c/h4\u003e\n\u003cp\u003eBased on the results of the analysis at the baseline level, it was found that the use of phenacetin, glucocorticoids, lovir-based antivirals and vasoactive drugs had a significant effect on the occurrence of ATR (P\u0026lt;0.05). While the effect of the use of endocannabinoid antibiotics was not significant but P\u0026lt;0.1. Therefore, the use of five drugs, namely, endocannabinoid antibiotics, phenylethylamide, glucocorticoids, lovir antiviral drugs and vasoactive drugs were selected for further analysis.\u003c/p\u003e\n\u003ch4\u003e3.5.2 Case-cohort study\u003c/h4\u003e\n\u003cp\u003eA case-cohort study in which patients were divided into two separate groups according to whether or not they were using a particular drug, and the incidence of ATR was compared between the two groups before and after adjustment for confounders, and a chi-square test was performed. (Table 2)\u003c/p\u003e\n\u003cp\u003eThe following results can be obtained from the table:\u003c/p\u003e\n\u003cp\u003e(1) Before adjustment for confounders, there was a significant difference in the incidence of ATR between the use of phenylethylamide, glucocorticoids, antiviral drugs of the lovir class and vasoactive drugs (P\u0026lt;0.05); the incidence of ATR was higher in the group of drug users of endocannabinoid antibiotics, glucocorticoids and vasoactive drugs than the group of drug users of the unused group, whereas the incidence of ATR for the phenylethylamide and the antiviral drugs of the lovir class were lower in the used than the unused group.\u003c/p\u003e\n\u003cp\u003e(2) After adjustment for confounders, the difference in the incidence of ATR between the use of phenacetin and lovir-based antivirals was no longer significant (P\u0026gt;0.05), whereas the incidence of ATR after adjustment for confounders was higher in the group in which lovir-based antivirals were shifted to use than in the group in which they were not used.\u003c/p\u003e\n\u003ch4\u003e3.5.3 Nested Case-Control study\u003c/h4\u003e\n\u003cp\u003eIn Nested Case-control study (NCC), patients are divided into control group and case group according to whether they had ATR and odds ratio (OR) of two groups are compared through logistic regression analysis (Table 3).\u003csup\u003e16\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eThe following results can be obtained from the table:\u003c/p\u003e\n\u003cp\u003e(1) Before adjusting for confounders, there was a large correlation between the use of endocannabinoid antibiotics, glucocorticoids, and vasoactive medications and the occurrence of ATR (OR\u0026gt;1).\u003c/p\u003e\n\u003cp\u003e(2) After adjusting for confounders, there was a greater correlation between the use of endocannabinoid antibiotics, glucocorticoids, lovir antivirals, and vasoactive drugs and the incidence of ATR (OR\u0026gt;1).\u003c/p\u003e\n\u003ch4\u003e3.5.4 Analysis of clinical medication type and dose\u003c/h4\u003e\n\u003cp\u003eThese drugs were further grouped according to type and high or low dosage and the study was carried out by comparing the RR values of the two groups using different drugs. (Supplementary Material Table S2)\u003c/p\u003e\n\u003cp\u003eThe following results can be obtained from the table:\u003c/p\u003e\n\u003cp\u003e(1) Within the group using endocannabinoid antibiotics, the use of high doses of the drug (\u0026gt;17,995 mg) was a risk factor for the occurrence of ATR(RR\u0026gt;1, p\u0026lt;0.05).\u003c/p\u003e\n\u003cp\u003e(2) Within the group using phenacetin, the use of low doses of the drug (\u0026lt;2634 mg) was a protective factor for the occurrence of ATR (RR\u0026lt;1, p\u0026lt;0.05).\u003c/p\u003e\n\u003cp\u003e(3) Within the glucocorticoid use group, the combined use of the types dexamethasone and methylprednisolone, as well as the use of the drugs in each dose, were risk factors for the occurrence of ATR (RR\u0026gt;1, p\u0026lt;0.05).\u003c/p\u003e\n\u003cp\u003e(4) Within the lovir-based antiviral drugs use group, the combined use of the type ganciclovir was a protective factor for the occurrence of ATR within the group using lovir-based antiviral drugs (RR\u0026lt;1, p\u0026lt;0.05). Low dose use of the drug (\u0026lt;=679mg) was not meaningful in the analysis due to the small amount of data.\u003c/p\u003e\n\u003cp\u003e(5) Within the group using vasoactive drugs, the combined use of types of norepinephrine and the use of drugs in high doses (\u0026gt;12.9 mg) were risk factors for the occurrence of ATR (RR\u0026gt;1, p\u0026lt;0.05).\u003c/p\u003e\n\u003ch4\u003e3.5.5 Joint analysis of transfusion components and clinical medication\u003c/h4\u003e\n\u003cp\u003ePatients who were transfused with RBC, PLT and plasma were grouped according to whether they were combined with the above five drugs, and the clinical use of drugs and transfusion components were studied in a joint analysis by comparing the incidence of ATR in each group and the RR values between the different drugs. (Table 4)\u003c/p\u003e\n\u003cp\u003eThe following results can be obtained from the table:\u003c/p\u003e\n\u003cp\u003e(1)\u0026nbsp;\u0026nbsp;The combined use of phenacetin, glucocorticoids and vasoactive drugs was a risk factor for the development of ATR in patients transfused with RBC (RR\u0026gt;1, p\u0026lt;0.05).\u003c/p\u003e\n\u003cp\u003e(2)\u0026nbsp;\u0026nbsp;The combined use of glucocorticoids was a risk factor for the development of\u003c/p\u003e\n\u003cp\u003eATR in patients transfused with PLT (RR\u0026gt;1, p\u0026lt;0.05).\u003c/p\u003e\n\u003cp\u003e(3)\u0026nbsp;\u0026nbsp;The combined use of glucocorticoids and lovir-based antiviral drugs was a risk\u003c/p\u003e\n\u003cp\u003efactor for the development of ATR in patients with plasma transfusion (RR\u0026gt;1, p\u0026lt;0.05).\u003c/p\u003e\n\u003ch4\u003e3.5.6 Joint analysis of ATR type and clinical medication\u003c/h4\u003e\n\u003cp\u003ePatients are firstly divided into groups based on different ATR types, and then subdivided based on concomitant drugs. ATR incidence and RR of drugs are compared for joint analysis of ATR type and clinical medication (Supplementary Material Table S3).\u003c/p\u003e\n\u003cp\u003eHere are the results below according to the table.\u003c/p\u003e\n\u003cp\u003e(1) Combined use of glucocorticoids was a risk factor for the development of anaphylactic reactions to blood transfusion (RR\u0026gt;1, p\u0026lt;0.05).\u003c/p\u003e\n\u003cp\u003e(2) Combined use of vasoactive drugs was a risk factor for the development of FNHTR (RR\u0026gt;1, p\u0026lt;0.05).\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eBy collecting statistics from all over the literature, it can be found that the most common ATR in China are allergic reactions and non-hemolytic febrile reactions (FNHTR), which together account for more than 90% of the total.\u003csup\u003e14,17\u003c/sup\u003e A search of literature associated with ATR reveals that there have been many drug-related studies, and they have been increasing in recent years. Including prophylactic medication before transfusion, relief after the occurrence of ATR and therapeutic medication are the most common,\u003csup\u003e18-28\u003c/sup\u003e and the study of drugs that may cause ATR, although less, has also developed in recent years. In response to the conclusions reached, the following conjectures were made about some of the links between clinical drug use and the correlation of ATR by reviewing various sources and literature:\u003c/p\u003e\n\u003cp\u003e(1) The probability of an anaphylactic reaction is elevated in patients using glucocorticoids after transfusion of various blood components. Glucocorticoids, commonly including dexamethasone and methylprednisolone, are known to alleviate anaphylactic reactions.\u003csup\u003e29\u003c/sup\u003e But the probability in this study was instead elevated, and it is speculated that prophylactic medication for patients with a history of anaphylactic reactions may have been ineffective, resulting in a positive correlation between the use of glucocorticoids and the occurrence of transfusion-related adverse reactions in the data. It is also possible that this is related to the incompleteness of the data collected.\u003c/p\u003e\n\u003cp\u003e(2) Patients using vasoactive drugs have an elevated probability of developing FNHTR following RBC transfusion. FNHTR occurs often due to the release of pyrogenic cytokines from the blood.\u003csup\u003e30,31\u003c/sup\u003e It has been suggested that the use of vasoactive drugs such as norepinephrine and epinephrine disrupts cytokine homeostasis, leading to a rise in certain cytokines; it has been speculated that the rise in some of these cytokines, such as IL-4, may be a contributing factor in the development of FNHTR.\u003csup\u003e32\u003c/sup\u003e The exact cause remains to be further confirmed.\u003c/p\u003e\n\u003cp\u003eThere are still some shortcomings in the research design of the subject:\u003c/p\u003e\n\u003cp\u003e(1) The subject is a data analysis and the results are subject to experimental validation mechanisms and cannot be used directly as a clinical guide.\u003c/p\u003e\n\u003cp\u003e(2) The results may not be accurate enough due to problems such as small amount of data, lack of completeness and accuracy of the data, lack of precision in the choice of analytical methods, and lack of detail in the analyses.\u003c/p\u003e\n\u003cp\u003e(3) For the collection of data on adverse transfusion reactions, it is not possible to obtain complete information, resulting in less or imperfect data, such as incomplete records of symptoms and diagnoses related to ATR, which affects the judgement of the type of ATR and other information, so it is necessary to consider further improvement of the monitoring system for ATR.\u003c/p\u003e\n\u003cp\u003eIn summary, there is a link between clinical medication and ATR, with the most significant relationship between the use of glucocorticoids and vasoactive drugs, which can lead to an increased probability of ATR. However, the data analysis is not sufficient, the grouping is not clear, and further improvement as well as research mechanisms and experimental confirmation are needed to provide clinical advice; thus, more preventive drugs are used to avoid the use of drugs that may lead to ATR, to maximize the safety of blood transfusion, and to maintain the health of patients.\u003c/p\u003e"},{"header":"5. Conclusions","content":"\u003cp\u003eATR are most common with anaphylactic reactions, followed by FNHTR, and others are less common. Patients transfused with plasma had the highest incidence of ATR and the greatest link.\u003c/p\u003e \u003cp\u003eThere is a relationship between clinical use of medications and ATR, most notably the use of glucocorticoids and vasopressors, which can lead to an increased incidence of ATR reaching 172.2% and 138.5% of the unused drug group respectively. The combined use of types of dexamethasone, methylprednisolone and all doses of the drug used were risk factors mainly for the occurrence of anaphylactic reactions. The combined use of the type norepinephrine and high dose use of the drug (\u0026gt;\u0026thinsp;12.9mg) were risk factors for the occurrence of FNHTR.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and analysed during the current study available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by \u0026nbsp;the Hunan Provincial Natural Science Foundation Project (2024JJ5535，2024JJ5524).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEnxiang Zhou and Yanwei Luo wrote the main manuscript text, Fengxia Liu collected the data needed and Guocai Li helped to prepare the figure and tables. All authors reviewed the manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eHealthcare Cost and Utilization Project (HCUP) Statistical Briefs [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US). PMID: 21413206 (2006) Feb\u0026amp;#8211.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eQi, Y. U., Xiaoxia, L. I. U., Hong, Z. H. O. U., Yuqing, W. U. \u0026amp; Shuxian, J. I. A. Adverse reactions to blood transfusion: A retrospective analysis of 814 cases in Qingdao area from 2020 to 2021. \u003cem\u003eChin. J. Blood Transfus.\u003c/em\u003e \u003cb\u003e35\u003c/b\u003e (12), 1259\u0026ndash;1262. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.13303/j.cjbt.issn.1004-549x.2022.12.017\u003c/span\u003e\u003cspan address=\"10.13303/j.cjbt.issn.1004-549x.2022.12.017\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHeddle, N. M. et al. A randomized controlled trial comparing the frequency of acute reactions to plasma-removed platelets and prestorage WBC-reduced platelets. \u003cem\u003eTransfusion\u003c/em\u003e \u003cb\u003e42\u003c/b\u003e (5), 556\u0026ndash;566. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1046/j.1537-2995.2002.00094.x\u003c/span\u003e\u003cspan address=\"10.1046/j.1537-2995.2002.00094.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2002).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang, S. E. et al. Acetaminophen and diphenhydramine as premedication for platelet transfusions: a prospective randomized double-blind placebo-controlled trial. \u003cem\u003eAm. J. Hematol.\u003c/em\u003e \u003cb\u003e70\u003c/b\u003e (3), 191\u0026ndash;194. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/ajh.10119\u003c/span\u003e\u003cspan address=\"10.1002/ajh.10119\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2002).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYu, S. et al. Role of anti-allergic agents on attenuating transfusion reactions in adults: A systematic review and meta-analysis. \u003cem\u003eTransfus. Apher Sci.\u003c/em\u003e \u003cb\u003e60\u003c/b\u003e (2), 103041. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.transci.2020.103041\u003c/span\u003e\u003cspan address=\"10.1016/j.transci.2020.103041\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhongyu, K. A. N. G., Chun, L. I. U., Wei, L. I. U. \u0026amp; Daihong, L. I. Meta analysis of the effect of pre-transfusion prophylactic medication on the incidence of adverse reactions to blood transfusion. \u003cem\u003eChin. J. Blood Transfus.\u003c/em\u003e \u003cb\u003e35\u003c/b\u003e (06), 622\u0026ndash;628. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.13303/j.cjbt.issn.1004-549x.2022.06.008\u003c/span\u003e\u003cspan address=\"10.13303/j.cjbt.issn.1004-549x.2022.06.008\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSimons, F. E. et al.. World Allergy Organization anaphylaxis guidelines: summary. J Allergy Clin Immunol. ;127(3):587\u0026thinsp;\u0026ndash;\u0026thinsp;93.e1-22. (2011). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jaci.2011.01.038\u003c/span\u003e\u003cspan address=\"10.1016/j.jaci.2011.01.038\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTinegate, H. et al. Guideline on the investigation and management of acute transfusion reactions. Prepared by the BCSH Blood Transfusion Task Force. \u003cem\u003eBr. J. Haematol.\u003c/em\u003e \u003cb\u003e159\u003c/b\u003e (2), 143\u0026ndash;153. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/bjh.18789\u003c/span\u003e\u003cspan address=\"10.1111/bjh.18789\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2012).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWeinstock, C. et al. Successful use of eculizumab for treatment of an acute hemolytic reaction after ABO-incompatible red blood cell transfusion. \u003cem\u003eTransfusion\u003c/em\u003e \u003cb\u003e55\u003c/b\u003e (3), 605\u0026ndash;610. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/trf.12882\u003c/span\u003e\u003cspan address=\"10.1111/trf.12882\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2015).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFredlund, H., Bers\u0026eacute;us, O., Bj\u0026ouml;rsell-Ostlilng, E. \u0026amp; Filbey, D. A retrospective study of acute plasma exchange in severe intravascular hemolysis. \u003cem\u003eEur. J. Haematol.\u003c/em\u003e \u003cb\u003e43\u003c/b\u003e (3), 259\u0026ndash;261. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/j.1600-0609.1989.tb00294.x\u003c/span\u003e\u003cspan address=\"10.1111/j.1600-0609.1989.tb00294.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (1989).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMontan\u0026eacute;, E. \u0026amp; Santesmases, J. Adverse drug reactions. \u003cem\u003eMed. Clin. (Barc)\u003c/em\u003e. \u003cb\u003e154\u003c/b\u003e (5), 178\u0026ndash;184. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.medcli.2019.08.007\u003c/span\u003e\u003cspan address=\"10.1016/j.medcli.2019.08.007\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2020). English, Spanish.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eConghai, T. A. N. G., Yanxue, H. U. A. N. G., Yixuan, L. I. N. \u0026amp; Min, Y. U. A. N. Analysis of Related Factors of Adverse Transfusion Reactions. \u003cem\u003eJ. Experimental Hematol.\u003c/em\u003e \u003cb\u003e28\u003c/b\u003e (03), 972\u0026ndash;976. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.19746/j.cnki.issn1009-2137.2020.03.042\u003c/span\u003e\u003cspan address=\"10.19746/j.cnki.issn1009-2137.2020.03.042\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHamilton, B. H. \u0026amp; Nickerson JA. Correcting for endogeneity in strategic management research[J]. \u003cem\u003eStrategic Organ.\u003c/em\u003e \u003cb\u003e1\u003c/b\u003e (1), 51\u0026ndash;78. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/1476127003001001218\u003c/span\u003e\u003cspan address=\"10.1177/1476127003001001218\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2003).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eROSENBAUM, P. A. U. L. R. \u0026amp; RUBIN, D. O. N. A. L. D. B. The central role of the propensity score in observational studies for causal effects. \u003cem\u003eBiometrika\u003c/em\u003e \u003cb\u003e70, Issue 1\u003c/b\u003e,, 41\u0026ndash;55. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/biomet/70.1.41\u003c/span\u003e\u003cspan address=\"10.1093/biomet/70.1.41\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (April 1983).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchober, P., Mascha, E. J. \u0026amp; Vetter, T. R. Statistics From A (Agreement) to Z (z Score): A Guide to Interpreting Common Measures of Association, Agreement, Diagnostic Accuracy, Effect Size, Heterogeneity, and Reliability in Medical Research. \u003cem\u003eAnesth. Analg\u003c/em\u003e. \u003cb\u003e133\u003c/b\u003e (6), 1633\u0026ndash;1641. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1213/ane.0000000000005773\u003c/span\u003e\u003cspan address=\"10.1213/ane.0000000000005773\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGlanz, J. M. et al. Association Between Estimated Cumulative Vaccine Antigen Exposure Through the First 23 Months of Life and Non-Vaccine-Targeted Infections From 24 Through 47 Months of Age. \u003cem\u003eJAMA\u003c/em\u003e \u003cb\u003e319\u003c/b\u003e (9), 906\u0026ndash;913. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1001/jama.2018.0708\u003c/span\u003e\u003cspan address=\"10.1001/jama.2018.0708\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2018).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDaiyu, T. A. N. G. \u0026amp; Xuerui, Z. H. A. O. Retrospective Analysis of 95 Cases Adverse Reactions to Clinical Blood Transfusion. \u003cem\u003eSmart Healthc.\u003c/em\u003e \u003cb\u003e9\u003c/b\u003e (25), 114\u0026ndash;118. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.19335/j.cnki.2096-1219.2023.25.027\u003c/span\u003e\u003cspan address=\"10.19335/j.cnki.2096-1219.2023.25.027\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2023).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTingting, L. A. I. \u0026amp; Zhi, Z. E. N. G. FANG Le.To investigate the effect of dexamethasone on reducing adverse effects during or after blood transfusion. Guide of China Medicine,2018,16(27):42\u0026ndash;43. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.15912/j.cnki.gocm.2018.27.035\u003c/span\u003e\u003cspan address=\"10.15912/j.cnki.gocm.2018.27.035\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSimons, F. E. et al. World Allergy Organization anaphylaxis guidelines: summary. \u003cem\u003eJ. Allergy Clin. Immunol.\u003c/em\u003e \u003cb\u003e127\u003c/b\u003e (3), 587\u0026ndash;593. e1-22 (2011).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTinegate, H. et al. Guideline on the investigation and management of acute transfusion reactions. Prepared by the BCSH Blood Transfusion Task Force. \u003cem\u003eBr. J. Haematol.\u003c/em\u003e \u003cb\u003e159\u003c/b\u003e (2), 143\u0026ndash;153. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/bjh.12017\u003c/span\u003e\u003cspan address=\"10.1111/bjh.12017\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2012).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWeinstock, C. et al. Successful use of eculizumab for treatment of an acute hemolytic reaction after ABO-incompatible red blood cell transfusion. \u003cem\u003eTransfusion\u003c/em\u003e \u003cb\u003e55\u003c/b\u003e (3), 605\u0026ndash;610. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/trf.12882\u003c/span\u003e\u003cspan address=\"10.1111/trf.12882\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2015).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFredlund, H., Bers\u0026eacute;us, O., Bj\u0026ouml;rsell-Ostlilng, E. \u0026amp; Filbey, D. A retrospective study of acute plasma exchange in severe intravascular hemolysis. \u003cem\u003eEur. J. Haematol.\u003c/em\u003e \u003cb\u003e43\u003c/b\u003e (3), 259\u0026ndash;261. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/j.1600-0609.1989.tb00294.x\u003c/span\u003e\u003cspan address=\"10.1111/j.1600-0609.1989.tb00294.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (1989).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSeager, O. A. et al. Massive acute hemodilution for incompatible blood reaction. \u003cem\u003eJAMA\u003c/em\u003e \u003cb\u003e229\u003c/b\u003e (7), 790\u0026ndash;792. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1001/jama.1974.03230450024018\u003c/span\u003e\u003cspan address=\"10.1001/jama.1974.03230450024018\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (1974).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKohan, A. I. et al. High-dose intravenous immunoglobulin in non-ABO transfusion incompatibility. \u003cem\u003eVox Sang\u003c/em\u003e. \u003cb\u003e67\u003c/b\u003e (2), 195\u0026ndash;198. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/j.1423-0410.1994.tb01659.x\u003c/span\u003e\u003cspan address=\"10.1111/j.1423-0410.1994.tb01659.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (1994).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFriedlander, M. \u0026amp; Noble, W. H. Meperidine to control shivering associated with platelet transfusion reaction. \u003cem\u003eCan. J. Anaesth.\u003c/em\u003e \u003cb\u003e36\u003c/b\u003e (4), 460\u0026ndash;462. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/bf03005348\u003c/span\u003e\u003cspan address=\"10.1007/bf03005348\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (1989).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWin, N., Sinha, S., Lee, E. \u0026amp; Mills, W. Treatment with intravenous immunoglobulin and steroids may correct severe anemia in hyperhemolytic transfusion reactions: case report and literature review. \u003cem\u003eTransfus. Med. Rev.\u003c/em\u003e \u003cb\u003e24\u003c/b\u003e (1), 64\u0026ndash;67. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.tmrv.2009.09.006\u003c/span\u003e\u003cspan address=\"10.1016/j.tmrv.2009.09.006\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2010).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDelaney, M. et al. Biomedical Excellence for Safer Transfusion (BEST) Collaborative. Transfusion reactions: prevention, diagnosis, and treatment. \u003cem\u003eLancet\u003c/em\u003e \u003cb\u003e388\u003c/b\u003e (10061), 2825\u0026ndash;2836. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/S0140-6736(15)01313-6\u003c/span\u003e\u003cspan address=\"10.1016/S0140-6736(15)01313-6\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2016).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYuan, X. et al. \u003cem\u003eShock\u003c/em\u003e ;\u003cb\u003e59\u003c/b\u003e(4):603\u0026ndash;611. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/shk.0000000000002080\u003c/span\u003e\u003cspan address=\"10.1097/shk.0000000000002080\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2023).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHui, W. A. N. G. \u0026amp; Feihe, X. U. Analysis of the indications for glucocorticoids in hospitalized patients. \u003cem\u003eChin. J. Rural Med. Pharm.\u003c/em\u003e \u003cb\u003e28\u003c/b\u003e (16), 40\u0026ndash;. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.19542/j.cnki.1006-5180.005402\u003c/span\u003e\u003cspan address=\"10.19542/j.cnki.1006-5180.005402\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHeddle, N. M. et al. The role of the plasma from platelet concentrates in transfusion reactions. \u003cem\u003eN Engl. J. Med.\u003c/em\u003e \u003cb\u003e331\u003c/b\u003e (10), 625\u0026ndash;628. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1056/NEJM199409083311001\u003c/span\u003e\u003cspan address=\"10.1056/NEJM199409083311001\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (1994).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBrubaker, D. B. Clinical significance of white cell antibodies in febrile nonhemolytic transfusion reactions. \u003cem\u003eTransfusion\u003c/em\u003e \u003cb\u003e30\u003c/b\u003e (8), 733\u0026ndash;737. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1046/j.1537-2995.1990.30891020335.x\u003c/span\u003e\u003cspan address=\"10.1046/j.1537-2995.1990.30891020335.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (1990).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAgarwal, S. K. \u0026amp; Marshall, G. D. Jr Beta-adrenergic modulation of human type-1/type-2 cytokine balance. \u003cem\u003eJ. Allergy Clin. Immunol.\u003c/em\u003e \u003cb\u003e105\u003c/b\u003e (1 Pt 1), 91\u0026ndash;98. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/s0091-6749(00)90183-0\u003c/span\u003e\u003cspan address=\"10.1016/s0091-6749(00)90183-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2000).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1 Comparing of SMD before and after PSM\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"757\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP before PSM\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP after PSM\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSMD\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ebefore PSM\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSMD\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eafter PSM\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSMD\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003edeclining extent\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBalancing effect\u003csup\u003e*\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003eTransfusing RBC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e-0.1244\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e-0.4100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e-229.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 133px;\"\u003e\n \u003cp\u003eMedium effect\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003eTransfusing PLT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e-0.5579\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e-0.2777\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e50.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 133px;\"\u003e\n \u003cp\u003eSmall effect\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003eTransfusing plasm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e+0.8134\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e+0.6967\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e14.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 133px;\"\u003e\n \u003cp\u003eLarge effect\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003eHemopathy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e-0.4921\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e-0.3595\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e26.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 133px;\"\u003e\n \u003cp\u003eMedium effect\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003eNervous system disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e+0.4126\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e+0.3852\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e6.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 133px;\"\u003e\n \u003cp\u003eMedium effect\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003eSepsis shock\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e0.056\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e+0.2126\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e+0.1867\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e12.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 133px;\"\u003e\n \u003cp\u003eSmall effect\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003eDiabetes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.035\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e0.653\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e+0.1894\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e+0.0617\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e67.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 133px;\"\u003e\n \u003cp\u003eTrivial effect\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003ePhenylethylamide\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.041\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e0.706\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e+0.2221\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e-0.0543\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e75.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 133px;\"\u003e\n \u003cp\u003eTrivial effect\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003eGlucocorticoids\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e+0.5320\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e+0.3395\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e36.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 133px;\"\u003e\n \u003cp\u003eMedium effect\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e\u0026lsquo;~clovir\u0026rsquo; antiviral drug\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.046\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e0.201\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e-0.2570\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e+0.1400\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e45.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 133px;\"\u003e\n \u003cp\u003eSmall effect\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003eVasopressors\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e0.175\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e+0.2292\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e+0.1480\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e35.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 133px;\"\u003e\n \u003cp\u003eSmall effect\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" style=\"width: 756px;\"\u003e\n \u003cp\u003e* refer to standard in the article of Patrick Schober\u003csup\u003e23\u003c/sup\u003e, according to SMD after PSM：\u003c/p\u003e\n \u003cp\u003eSMD: \u0026lt;0.10, Trivial effect; 0.10-0.34, Small effect; 0.35-0.64, Medium effect;\u003c/p\u003e\n \u003cp\u003e0.65-1.19, Large effect; \u0026ge;1.20, Very large effect.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2 Case-cohort study\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"595\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 217px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDrug\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eATR incidence\u003c/strong\u003e\u003cstrong\u003e（%\u003c/strong\u003e\u003cstrong\u003e）\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOverall\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdjusted*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd height=\"29\" style=\"width: 0px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd height=\"40\" style=\"width: 0px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 217px;\"\u003e\n \u003cp\u003eLactam antibiotics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eConcomitant without drug\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e33.85%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e43.92%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eConcomitant with drug\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e42.01%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e54.33%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0.076\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.053\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 217px;\"\u003e\n \u003cp\u003ePhenylethylamide\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eConcomitant without drug\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e41.62%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e50.73%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eConcomitant with drug\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e30.71%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e47.56%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0.032\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.615\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 217px;\"\u003e\n \u003cp\u003eGlucocorticoids\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eConcomitant without drug\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e26.89%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e36.57%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eConcomitant with drug\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e51.12%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e62.98%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 217px;\"\u003e\n \u003cp\u003e\u0026lsquo;~clovir\u0026rsquo; antiviral drug\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eConcomitant without drug\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e40.24%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e49.12%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eConcomitant with drug\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e23.91%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e68.75%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0.031\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.125\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 217px;\"\u003e\n \u003cp\u003eVasopressors\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eConcomitant without drug\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e36.58%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e48.13%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eConcomitant with drug\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e60%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e66.67%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.035\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" style=\"width: 595px;\"\u003e\n \u003cp\u003e* Adjustment is achieved through balancing the confounders in the baseline table.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3 Nested Case-control study\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"662\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDrug\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eATR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNon-ATR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOR*(95%CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOR (95%CI),\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eadjusted#\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 104px;\"\u003e\n \u003cp\u003eLactam antibiotics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eConcomitant without drugs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e127\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eConcomitant with drugs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e113\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e156\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1.46(0.97 to 2.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1.53(0.99 to 2.38)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 104px;\"\u003e\n \u003cp\u003ePhenylethylamide\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eConcomitant without drugs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e139\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e195\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eConcomitant with drugs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.57(0.36 to 0.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.75(0.45 to 1.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 104px;\"\u003e\n \u003cp\u003eGlucocorticoids\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eConcomitant without drugs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e174\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eConcomitant with drugs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e114\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e109\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e3.86(2.55 to 5.94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e2.15(1.38 to 3.38)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026lsquo;~clovir\u0026rsquo; antiviral drug\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eConcomitant without drugs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e167\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e248\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eConcomitant with drugs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.30(0.14 to 0.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1.93(0.66 to 6.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 104px;\"\u003e\n \u003cp\u003eVasopressors\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eConcomitant without drugs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e154\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e267\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eConcomitant with drugs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e2.60(1.29 to 5.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1.85(0.92 to 3.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" style=\"width: 662px;\"\u003e\n \u003cp\u003e* OR, Odds ratio, use of drug ratios in case group/use of drug ratios in control group\u003c/p\u003e\n \u003cp\u003e# Adjustment is achieved through balancing the confounders in the baseline table.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4 Joint analysis of transfusion components and clinical medication\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"754\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 180px;\"\u003e\n \u003cp\u003eRBC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 180px;\"\u003e\n \u003cp\u003ePLT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 186px;\"\u003e\n \u003cp\u003ePlasma\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDrug\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eATR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eATR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eATR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 85px;\"\u003e\n \u003cp\u003eLactam antibiotics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003eWithout drugs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e25.00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 75px;\"\u003e\n \u003cp\u003e1.27\u003c/p\u003e\n \u003cp\u003e(0.80-2.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 46px;\"\u003e\n \u003cp\u003e0.321\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e15.71%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 75px;\"\u003e\n \u003cp\u003e1.78\u003c/p\u003e\n \u003cp\u003e(0.93-3.42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 46px;\"\u003e\n \u003cp\u003e0.083\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e65.38%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.82\u003c/p\u003e\n \u003cp\u003e(0.64-1.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 53px;\"\u003e\n \u003cp\u003e0.135\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003eWith drugs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e31.62%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e28.00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e53.72%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 85px;\"\u003e\n \u003cp\u003ePhenylethylamide\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003eWithout drugs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e26.04%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 75px;\"\u003e\n \u003cp\u003e1.78\u003c/p\u003e\n \u003cp\u003e(1.11-2.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 46px;\"\u003e\n \u003cp\u003e0.016\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e27.12%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.69\u003c/p\u003e\n \u003cp\u003e(0.37-1.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 46px;\"\u003e\n \u003cp\u003e0.225\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e56.49%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 75px;\"\u003e\n \u003cp\u003e1.12\u003c/p\u003e\n \u003cp\u003e(0.77-1.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 53px;\"\u003e\n \u003cp\u003e0.555\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003eWith drugs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e46.43%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e18.60%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e63.16%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 85px;\"\u003e\n \u003cp\u003eGlucocorticoids\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003eWithout drugs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e23.02%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 75px;\"\u003e\n \u003cp\u003e1.71\u003c/p\u003e\n \u003cp\u003e(1.11-2.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 46px;\"\u003e\n \u003cp\u003e0.014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e12.70%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 75px;\"\u003e\n \u003cp\u003e2.31\u003c/p\u003e\n \u003cp\u003e(1.11-4.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 46px;\"\u003e\n \u003cp\u003e0.025\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e35.42%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 75px;\"\u003e\n \u003cp\u003e2.38\u003c/p\u003e\n \u003cp\u003e(1.79-3.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003eWith drugs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e39.44%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e29.27%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e84.42%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026lsquo;~clovir\u0026rsquo; antiviral drug\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003eWithout drugs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e28.80%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 75px;\"\u003e\n \u003cp\u003e1.16\u003c/p\u003e\n \u003cp\u003e(0.37-3.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 46px;\"\u003e\n \u003cp\u003e0.804\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e27.12%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003cp\u003e(0.00-1.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 46px;\"\u003e\n \u003cp\u003e0.053\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e55.56%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 75px;\"\u003e\n \u003cp\u003e1.47\u003c/p\u003e\n \u003cp\u003e(1.08-2.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 53px;\"\u003e\n \u003cp\u003e0.015\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003eWith drugs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e33.33%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e0.00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e81.82%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 85px;\"\u003e\n \u003cp\u003eVasopressors\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003eWithout drugs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e26.14%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 75px;\"\u003e\n \u003cp\u003e2.00\u003c/p\u003e\n \u003cp\u003e(1.24-3.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 46px;\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e21.43%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 75px;\"\u003e\n \u003cp\u003e1.87\u003c/p\u003e\n \u003cp\u003e(0.61-5.72)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 46px;\"\u003e\n \u003cp\u003e0.274\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e56.05%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 75px;\"\u003e\n \u003cp\u003e1.23\u003c/p\u003e\n \u003cp\u003e(0.86-1.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 53px;\"\u003e\n \u003cp\u003e0.264\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003eWith drugs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e52.38%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e40.00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e68.75%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Drug reaction, Transfusion reaction, Vasoconstrictor agents, Glucocorticoids","lastPublishedDoi":"10.21203/rs.3.rs-5741809/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5741809/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eObjective\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe topic was to study the link between clinical medication and adverse transfusion reactions.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e \u003cp\u003ePatients who received transfusion were selected to include 461 cases as study subjects to study the association between clinical medication and adverse transfusion reactions.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e \u003cp\u003eAnalysis yielded the following results: 1. Adverse transfusion reactions were most common in the form of allergic reactions, followed by FNHTR(P\u0026thinsp;\u0026lt;\u0026thinsp;0.001).2. The incidence of adverse transfusion reactions was highest in patients with plasma transfusion, at 57.23% (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001).3. There may be a greater correlation between drug adverse reactions and that of transfusion adverse reactions. 4. The incidence of adverse transfusion reactions was significantly lower (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) in the group with phenylethylamide, which was only 73.8% of that in the unadministered group; the incidence of adverse transfusion reactions in the group with glucocorticoids and vasoactive medications was significantly higher (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), which was close to 172.2% and 138.5% of that in the unadministered group, respectively.\u003c/p\u003e\u003cp\u003e\u003cb\u003eDiscussion\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThere is a link between clinical medication and adverse transfusion reactions, with the most significant relationship being with the use of glucocorticoids and vasoactive drugs, which can lead to an increased probability of adverse transfusion reactions.\u003c/p\u003e","manuscriptTitle":"Correlation between clinical medication and adverse transfusion reactions","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-01-10 18:01:26","doi":"10.21203/rs.3.rs-5741809/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"854dca02-2106-4b44-834d-4d0765e39f77","owner":[],"postedDate":"January 10th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":42496247,"name":"Health sciences/Medical research"},{"id":42496248,"name":"Health sciences/Risk factors"}],"tags":[],"updatedAt":"2025-02-21T10:38:33+00:00","versionOfRecord":[],"versionCreatedAt":"2025-01-10 18:01:26","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5741809","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5741809","identity":"rs-5741809","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}