Red blood cell transfusion is associated with further bleeding and fresh-frozen plasma with mortality in nonvariceal upper gastrointestinal bleeding
MetadataShow full item record
BACKGROUND: Blood products are commonly transfused for patients with nonvariceal upper gastrointestinal bleeding (NVUGIB). While concerns exist about further bleeding and mortality in subsets of patients receiving red blood cell (RBC) transfusion, the impact of non-RBC blood products has not previously been systematically investigated. The aim of the study was to investigate the associations between blood products transfusion, further bleeding, and mortality after acute NVUGIB. STUDY DESIGN AND METHODS: A retrospective cohort study examined further bleeding and 30-day and 1-year mortality in adult patients who underwent gastroscopy for suspected acute NVUGIB between 2008 and 2010 in three tertiary hospitals in Western Australia. Survival analysis was performed. RESULTS: A total of 2228 adults (63% male) with 2360 hospital admissions for NVUGIB met the inclusion criteria. Median age at presentation was 70 years (range, 19–99 years). Thirty-day mortality was 4.9% and 1-year mortality was 13.9%. Transfusion of 4 or more units of RBCs was associated with greater than 10 times the odds of further bleeding in patients with a hemoglobin level of more than 90 g/L (odds ratio, 11.9; 95% confidence interval [CI], 3.1-45.7; p ≤ 0.001), but was not associated with mortality. Administration of 5 or more units of fresh-frozen plasma (FFP) was associated with increased 30-day (hazard ratio, 2.8; 95% CI, 1.3-5.9; p = 0.008) and 1-year (hazard ratio, 2.6; 95% CI, 1.3-5.0; p = 0.005) mortality after adjusting for coagulopathy, comorbidity, Rockall score, and other covariates. CONCLUSION: In this large, multicenter study of NVUGIB, RBC transfusion was associated with further bleeding but not mortality, while FFP transfusion was associated with increased mortality in a subset of patients.
This is the peer reviewed version of the following article: Subramaniam, K. and Spilsbury, K. and Ayonrinde, O. and Latchmiah, F. and Mukhtar, S.A. and Semmens, J. and Leahy, M. et al. 2016. Red blood cell transfusion is associated with further bleeding and fresh-frozen plasma with mortality in nonvariceal upper gastrointestinal bleeding. Transfusion. 56 (4): pp. 816-826, which has been published in final form at http://doi.org/10.1111/trf.13446. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving at http://olabout.wiley.com/WileyCDA/Section/id-820227.html#terms
Showing items related by title, author, creator and subject.
Aubron, C.; Kandane-Rathnayake, R.; Andrianopoulos, N.; Westbrook, A.; Engelbrecht, S.; Ozolins, I.; Bailey, M.; Murray, L.; Cooper, D.; Wood, E.; McQuilten, Z.; Westbrook, A.; Pettilä, V.; Nichol, A.; Bailey, M.; Wood, E.; Syres, G.; Phillips, L.; Street, A.; French, C.; Murray, L.; Orford, N.; Santamaria, J.; Bellomo, R.; Nichol, A.; Street, A.; Vallance, S.; McArthur, C.; McGuiness, S.; Newby, L.; Simmonds, C.; Parke, R.; Buhr, H.; Bellomo, R.; Goldsmith, D.; O'Sullivan, K.; Mercer, I.; Gazzard, R.; Tauschke, C.; Hill, D.; Fletcher, J.; Boschert, C.; Koch, G.; Ernest, D.; Eliott, S.; Howe, B.; Hawker, F.; Ellem, K.; Duff, K.; Henderson, S.; Mehrtens, J.; Milliss, D.; Wong, H.; Arora, S.; O'Bree, B.; Shepherd, K.; Ihle, B.; Ho, S.; Ihle, B.; Graan, M.; Bernsten, A.; Ryan, E.; Botha, J.; Vuat, J.; Orford, N.; Kinmonth, A.; Fraser, M.; Richards, B.; Tallott, M.; Whitbread, R.; Freebairn, R.; Thomas, L.; Parr, M.; Micallef, S.; Deshpande, K.; Wood, J.; Williams, Teresa; Tai, J.; Boase, A.; Arora, S.; Galt, P.; King, B.; Price, R.; Tomlinson, J.; Cole, L.; Seppelt, I.; Weisbrodt, L.; Gresham, R.; Nikas, M.; Laing, J.; Bell, J.; McHugh, G.; Hancock, D.; Kirkham, S.; Shehabi, Y.; Campbell, M. (2018)© 2018 International Society of Blood Transfusion Background and objectives: The timing of blood administration in critically ill patients is first driven by patients' needs. This study aimed to define the epidemiology ...
Predictors of perioperative blood transfusions in patients with chronic kidney disease undergoing elective knee and hip arthroplastyGraves, A.; Yates, P.; Hofmann, Axel; Farmer, Shannon; Ferrari, P. (2014)Background: Lower preoperative haemoglobin and older age pose a risk for perioperative allogeneic blood transfusions (ABT). The presence of chronic kidney disease (CKD) is associated with low haemoglobin, greater bleeding ...
Blood use in patients receiving intensive chemotherapy for acute leukemia or hematopoietic stem cell transplantation: the impact of a health system–wide patient blood management programLeahy, M.; Trentino, K.; May, C.; Swain, S.; Chuah, H.; Farmer, Shannon (2017)© 2017 AABB BACKGROUND: Little is published on patient blood management (PBM) programs in hematology. In 2008 Western Australia announced a health system–wide PBM program with PBM staff appointments commencing in November ...