Impact of Red Pack Cell Transfusion Before or After Endoscopy on Mortality in Patients with Upper Gastrointestinal Bleeding: A Multicenter Cohort Study

TL;DR

This study finds that transfusing blood before endoscopy may reduce mortality in patients with severe anemia and upper gastrointestinal bleeding.

Contribution

The study provides evidence that transfusion timing relative to endoscopy impacts mortality in UGIB patients with severe anemia.

Findings

Pre-endoscopy transfusion was associated with a 6% absolute reduction in 30-day mortality.

Patients with hemoglobin <7 g/dL showed a 27% mortality reduction with pre-endoscopy transfusion.

Better outcomes were observed when endoscopy occurred 6-12 hours after admission in severely anemic patients.

Abstract

Background: The impact of transfusion timing relative to endoscopy in upper gastrointestinal bleeding (UGIB) remains unclear. Aim: To assess whether transfusion performed before versus after endoscopy affects 30-day mortality in UGIB. Methods: We conducted a post hoc analysis of a multicenter cohort study including 3324 UGIB patients consecutively admitted in hospital. Propensity score matching adjusted for clinical and procedural variables. Results: Among 2017 transfused patients, 34.7% received Red Blood Cells (RBC) before endoscopy. Patients who received transfusions before endoscopy were older, had more severe comorbidities, and presented with a worse physical and hemodynamic status. This study also explored whether transfusion timing relative to endoscopy affects clinical outcomes in patients stratified by baseline hemoglobin levels. While pre-endoscopy transfusion was not significantly associated with reduced 30-day mortality in the overall population, we observed an advantage in patients transfused before the endoscopy when the Hb value was <7 g/dL. Pre-endoscopy transfusion was associated with a 6% absolute reduction in 30-day mortality (p < 0.06), with a greater benefit observed in patients with Hb < 7 g/dL (−27%) and <8 g/dL (−21%). Moreover, for this group of patients more favorable outcome was observed when the endoscopy was performed between 6 and 12 h from admission. These findings suggest that transfusion timing should be integrated into individualized UGIB management and may impact future clinical guidelines. Conclusions: In patients with severe anemia and UGIB, transfusion before endoscopy may reduce mortality. Timing to transfusion should be considered alongside hemodynamic and procedural factors in future guidelines.

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