The impact of red blood cell transfusion practices on inpatient mortality in variceal and non-variceal gastrointestinal bleeding patients: A 20-year US nationwide retrospective analysis

Background: Previous studies in upper gastrointestinal bleeding (UGIB) have reported inconsistent outcomes about packed red blood cell (PRBC) transfusion practices.
Aim: To assess whether PRBC transfusion is more likely to be dangerous in variceal bleeding than in non-variceal bleeding due to concern of over-transfusion leading to elevated portal pressure.
Methods: The authors used the Nationwide Inpatient Sample (1999–2018) and identified patients with upper GI bleeding using an algorithmic approach, categorizing bleeding from non-variceal or variceal sources. The primary outcome was all-cause inpatient mortality. To control for the severity of bleeding, propensity matching of baseline features, including age, gender, the presence of shock, the need for intensive care and co-morbidities were performed. PRBC transfusion, inpatient mortality and hospitalization rates were also examined for both populations.
Results: 10,228,524 UGIB discharges were included; 755,135 patients had variceal bleeding. After propensity matching, PRBC transfusion in variceal bleeders was associated with a 22% increase in inpatient mortality, whereas non-variceal bleeders had a 9% increase in inpatient mortality. Compared to non-variceal bleeders receiving blood transfusion, variceal bleeders had nearly 4-fold higher odds of inpatient mortality (propensity-matched odds ratio = 3.8; 95% confidence interval: 3.7–3.8; p < 0.001). Notably, PRBC transfusion rates in both groups have declined since 2011, although it has remained higher in variceal bleeders. Mortality for UGIB has been declining since 1999.

Conclusions: Although decreased over the last decade, packed red blood cell (PRBC) transfusion rates remain high for variceal bleeders. In addition, PRBC transfusion appears to be more detrimental in variceal bleeders than in non-variceal bleeders.

D. Radadiya, M.D., Division of Gastroenterology, Hepatology, and Motility, Department of Internal Medicine, University of Kansas School of Medicine, Kansas City, KS, USA,
E-Mail: dhruvil.radadiya3@gmail.com

DOI: 10.1111/apt.16965

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