Thirty-day Mortality Among Jehovah's Witness Patients with Gastrointestinal Bleeding Who Decline Blood Transfusion: A Retrospective Cohort Study

INTRODUCTION: Patients with acute gastrointestinal bleeding (GIB) who decline allogeneic blood transfusion present a major management challenge, and comparative outcome data are limited. METHODS: We conducted a multicenter retrospective propensity score-matched cohort study across 9 hospitals in the MedStar Health network in Maryland, Washington, DC, and northern Virginia from October 2014 through October 2024. We compared 131 Jehovah's Witness (JW) patients hospitalized with upper and/or lower GIB who declined blood transfusion throughout the index hospitalization with 131 matched non-JW controls. The primary outcome was 30-day all-cause mortality. Secondary outcomes included intermediate care unit admission, intensive care unit admission, vasopressor use, length of stay, and 30-day readmission for recurrent GIB. RESULTS: Thirty-day mortality did not differ significantly between groups (OR 0.68, 95% CI 0.30-1.47; p = 0.327). JW patients had higher odds of intermediate care admission (OR 3.41, 95% CI 1.46-8.95; adjusted p = 0.028), but there were no significant between-group differences in ICU admission, vasopressor use, length of stay, or 30-day readmission. Both groups reached the same median nadir hemoglobin of 6.6 g/dL. JW patients were discharged with lower hemoglobin levels and were more likely to receive bloodless medicine consultation and adjunctive anemia-directed therapy. DISCUSSION: In this matched multicenter cohort, declining allogeneic transfusion was not associated with worse short-term outcomes among patients hospitalized with acute GIB, although closer monitoring and more intensive bloodless management were often required.