Transfusion delay after hemoglobin trigger and in-hospital outcomes in patients with nonvariceal upper gastrointestinal bleeding

BACKGROUND: Red blood cell transfusion is an important component of supportive care in selected patients with nonvariceal upper gastrointestinal bleeding (NVUGIB). Although current guidelines emphasize restrictive transfusion thresholds, the clinical impact of transfusion delay after the hemoglobin trigger is less clear. This study examined whether delayed transfusion after a hemoglobin value≤7.0g/dL was associated with adverse in-hospital outcomes in patients with NVUGIB. METHODS: We conducted a retrospective cohort study of adult patients hospitalized with NVUGIB who reached a hemoglobin trigger of≤7.0g/dL. The trigger time was defined as the index time. A 3-hour landmark design was used to classify patients into early transfusion, defined as red blood cell transfusion initiated within 3hours after the trigger, and delayed transfusion, defined as no transfusion by the 3-hour landmark. The primary outcome was a composite adverse in-hospital outcome, including in-hospital mortality, rebleeding, or intensive care unit admission. Multivariable regression models were used to estimate associations between transfusion timing and outcomes. RESULTS: A total of 859 patients were included, including 458 in the early transfusion group and 401 in the delayed transfusion group. Delayed transfusion was associated with higher rates of rebleeding, intensive care unit admission, composite adverse outcome, and longer hospital stay. After full adjustment, delayed transfusion remained associated with increased odds of the composite outcome (OR 2.49, 95% CI 1.82-3.39), in-hospital mortality (OR 2.38, 95% CI 1.41-4.02), rebleeding (OR 1.56, 95% CI 1.05-2.31), and intensive care unit admission (OR 3.34, 95% CI 2.31-4.84). Delayed transfusion was also associated with longer length of stay. CONCLUSION: Among patients with NVUGIB who reached a hemoglobin threshold of≤7.0g/dL, delayed transfusion was associated with worse in-hospital outcomes. These findings suggest that timely transfusion after reaching the hemoglobin trigger may be clinically important.