Mortality following blood transfusion for non-variceal upper gastrointestinal bleeding

Abstract

Introduction Blood transfusion is integral to the management of non-variceal upper gastrointestinal bleeding (NV-UGIB), but its safety is being questioned in less severe cases. We, therefore aimed to measure 30-day and 2-year mortality after blood transfusion for NV-UGIB. Methods This was an observational analysis using routinely collected data at a single hospital in southwest Scotland affi liated to Glasgow University. Cox proportional hazards models were used to estimate the effect of blood transfusion on mortality while adjusting for age, Charlson comorbidity score, the complete Rockall score for acute upper gastrointestinal bleeding, admission status, drug intake, etc. The main outcome measure was death of any cause at 30 days and 2 years after NV-UGIB. Results 1340 patients presented with NV-UGIB, 808 males (60.3%), median age 67 years and 564 (42.1%) were transfused. The overall mortality was 5.3% at 30 days and 25.8% at 2 years regardless of transfusion. Mortality was higher in the transfused versus non-transfused patients (P < 0.001, log rank test), as shown in fi gure 1. Also, in patients with a haemoglobin level greater than 10.0 g/dl, and comparing subjects who were transfused with those who were not, 30-day mortality (95% confi dence intervals) was 11.5% (6.7-18.0) versus 3.6% (2.3-5.3), respectively, P < 0.001; and 2-year mortality (95% confi dence intervals) was 40% (32-49) versus 20% (17-23), P < 0.001. Adjusted for age, Charlson score, Rockall score and

The excess long-term mortality in peptic ulcer bleeding is explained by nonspecific comorbidity

“…Even though transfusion might have a negative influence on survival within the first few months, it is not self-evident that transfusion has an impact on long-term survival. To our knowledge, only one previous study has indicated that treatment with blood transfusion increases long-term mortality in patients with non-variceal upper gastrointestinal bleeding [15]. This study was, however, retrospective and characterized by inclusion of heterogeneous bleeding sources with diverting prognosis (PUB, erosive esophagitis, malignancy).…”

“…This is thought to be caused by an immunosuppressive effect of blood transfusion [12,13], which is believed to last for several years. Treatment with blood transfusion during or after coronary artery bypass surgery seems to reduce the long-term survival [14], and a similar finding has been reported for non-variceal upper gastrointestinal bleeding [15].…”

Upper gastrointestinal bleeding in hospital inpatients: the role of antithrombotic drugs

“…The work took place between 1 January 2008 and 31 December 2009 at University Hospital Crosshouse, Scotland (box 1). This work is part of our ongoing programme that investigates the epidemiology and management of upper GI bleeding 9 10…”

“…Patients who have endoscopic evidence of a portal hypertensive cause for their upper GI bleed (oesophageal varices, gastric varices or portal hypertensive gastropathy) were excluded from further analysis. Causes of NVGIB included gastric or duodenal ulcers or erosions, erosive gastritis, Mallory-Weiss lesions, erosive oesophagitis, idiopathic angiodysplasia and UGI tract tumours and malignancies 9 10. Patients with normal oesophago-gastro-duodenoscopy (OGD) following haematemesis would undergo angiography using CT if their bleeding persists and remains unexplained.…”

Acute upper gastrointestinal bleeding in a tertiary care hospital in South India - Have we Improved the outcomes?

“…All patients who had significant morbidity have had received either Packed Cells or Fresh Frozen Plasma. In a study of Taha et al on blood transfusion 25 in patients with moderately severe Nonvariceal UGIB, mortality was higher, following blood transfusion. Whether this reflects selection bias, or an effect of co-morbidity or an effect of transfusion necessitates further studies.…”