title: Red blood cell transfusion is associated with further bleeding and fresh-frozen plasma with mortality in nonvariceal upper gastrointestinal bleeding.
abstract: 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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Gastroenterology and Hepatology Unit, The Canberra Hospital.|Australian National University Medical School, Canberra, ACT, Australia.
authors.forename: Kavitha
authors.initials: K
authors.lastname: Subramaniam
authors.affiliation: Centre for Population Health Research.
authors.forename: Katrina
authors.initials: K
authors.lastname: Spilsbury
authors.affiliation: Centre for Population Health Research.|Department of Gastroenterology, Fremantle Hospital.|School of Medicine and Pharmacology (Fremantle Hospital Campus), The University of Western Australia, Fremantle, WA, Australia.|Department of Gastroenterology and Hepatology, Fiona Stanley Hospital.
authors.forename: Oyekoya T
authors.initials: OT
authors.lastname: Ayonrinde
authors.affiliation: Department of Gastroenterology, Fremantle Hospital.|Department of Gastroenterology and Hepatology, Fiona Stanley Hospital.
authors.forename: Faye
authors.initials: F
authors.lastname: Latchmiah
authors.affiliation: Centre for Population Health Research.
authors.forename: Syed A
authors.initials: SA
authors.lastname: Mukhtar
authors.affiliation: Centre for Population Health Research.
authors.forename: James B
authors.initials: JB
authors.lastname: Semmens
authors.affiliation: School of Medicine and Pharmacology (Fremantle Hospital Campus), The University of Western Australia, Fremantle, WA, Australia.|Department of Haematology, Royal Perth Hospital, Perth, WA, Australia.
authors.forename: Michael F
authors.initials: MF
authors.lastname: Leahy
authors.affiliation: Department of Gastroenterology, Fremantle Hospital.|Department of Gastroenterology and Hepatology, Fiona Stanley Hospital.|Curtin Health Innovation Research Institute and School of Biomedical Sciences, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia.|School of Veterinary and Life Sciences, Murdoch University, Murdoch, WA, Australia.
authors.forename: John K
authors.initials: JK
authors.lastname: Olynyk
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016913:Blood Component Transfusion / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data*; D018450:Disease Progression; D017707:Erythrocyte Transfusion / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000401:mortality* / Q000473:pathology* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010949:Plasma / Q000502:physiology*; D012189:Retrospective Studies; D016019:Survival Analysis; D055815:Young Adult