SAN DIEGO—In patients with upper gastrointestinal bleeding, early blood product transfusion is independently associated with improved clinical outcomes, even in the absence of early endoscopic intervention, reducing the risk for inpatient mortality and myocardial infarction, according to findings presented at DDW 2025.
Nearly 11,000 individuals die from complications of GI bleeding each year. Timely resuscitation and endoscopic evaluation are critical for optimizing hospitalization outcomes. Although guidelines recommend resuscitation with red blood cell transfusion and early endoscopy (Am J Gastroenterol 2021; 116[5]:899-917), the effect of the timing of transfusion has not been established.
Investigators from SUNY Downstate Health Sciences University, in New York City, performed a retrospective review of nearly 15,000 hospitalizations from the National Inpatient Sample to determine how the timing of packed red blood cell (PRBC) transfusion affects outcomes (abstract Sa1338).
“The results of this study highlight the importance of timely resuscitation with PRBC transfusion, as we demonstrated that even with a delay in endoscopy, early blood product transfusion has a significant impact on mortality and hospitalization outcomes,” Tamta Chkhikvadze, MD, who presented the results, told Gastroenterology & Endoscopy News.
Almost 15,000 Patients
The analysis included 14,865 adults with ICD-10 codes for upper GI bleeding and associated procedural codes for interventions of esophagogastroduodenoscopy and transfusion of PRBCs alone or with plasma. The intervention groups were divided by timing: early EGD (=24 hours) and delayed EGD (>24 hours), with further subgrouping by timing of blood product transfusions (early, =24 hours; delayed, >24 hours).
“Our data in different subgroups of patients with upper GI bleeding, divided by the timing of blood transfusion and endoscopy, demonstrated that the group with both delayed PRBC transfusion and delayed EGD had the worst outcomes compared to the reference group of patients with early blood transfusions and early EGD,” said Dr. Chkhikvadze, a GI fellow at SUNY Downstate.
Concerning Odds Ratios
In a multivariate analysis, the reference group was patients who received both early PRBC transfusion and early EGD. Compared with the optimally treated group, patients with delays in both PRBC transfusion and EGD had the worst outcomes, with odds ratios (ORs) of 4.57 (95% CI, 3.64-5.75) for inpatient mortality and 2.05 (95% CI, 1.70-2.48) for myocardial infarction. In comparison, even in the setting of delayed EGD, the ORs for patients with early transfusion were 1.39 (95% CI, 1.09-1.77) for inpatient mortality and 1.61 for myocardial infarction (95% CI, 1.35-1.93). A focused sub-analysis comparing early PRBC transfusion with delayed EGD versus delayed PRBC transfusion with delayed EGD demonstrated markedly lower mortality in the early-transfused group (3.4% vs. 11.2%; P<0.0001).
In addition, patients with delayed EGD had a 61% higher hospital bill and stayed for an average of more than five days longer.
The findings suggest that the timing of transfusion is a critical, modifiable factor that can influence prognosis, even in the absence of early endoscopic intervention. “Timely hemodynamic resuscitation should be prioritized in upper GI bleeding management, particularly in resource-limited settings or when endoscopy is delayed,” Dr. Chkhikvadze said.
Why Is This Happening?
David Wan, MD, a gastroenterologist at Weill Cornell Medicine, in New York City, with a research interest in GI bleeding, said the findings “raise important questions” and suggest that the delayed management of upper GI bleeding is “more common than people appreciate” and has significant consequences. “I assumed that the large majority of patients received an EGD within 24 hours, which is the standard of care, but in this study, it was delayed for nearly half of patients. The question is why?” he said. “Of course, there can be mitigating factors, such as patients presenting over the weekend and a lack of available scope time. Additionally, patients may be unstable and not fit for endoscopy.”
Of note, delays in blood transfusions were found to be a critical factor, he continued, although according to Dr. Wan, a 24-hour window is too liberal. “The hope would be to give the unstable patient blood immediately upon presentation,” he maintained. “Even for a stable patient with significantly low hemoglobin, you would hope they would receive a blood transfusion well within 24 hours.” Nonetheless, he added, “the significant number of delayed transfusions and its association with increased mortality is concerning and highlights an important area for improvement.”
—Caroline Helwick
Drs. Chkhikvadze and Wan reported no relevant financial disclosures.
This article is from the June 2025 print issue.