Hemoglobin decrease predicts untoward outcomes better than severity of anemia
Patients with gastrointestinal bleeding (GIB) exhibit varying tolerances to acute blood loss. We aimed to investigate the effect of relative Hb decrease (ΔHb%) on GIB outcomes. Participants enrolled in the Hungarian GIB Registry between 2019 and 2022 were analyzed. The primary outcome, defined as a composite endpoint, included in-hospital bleeding-related mortality and the need for urgent intervention. Four groups were created based on the lowest Hb measured during hospitalization (nadirHb), along with four subgroups categorized by ΔHb%. Regardless of the nadirHb, participants with higher ΔHb% had a higher probability of reaching the composite endpoint. A 30-40% ΔHb% decrease to a nadirHb of 80-90 g/L resulted in a similar likelihood of reaching the primary endpoint as a 0-10% ΔHb% to 70-80 g/L or 60-70 g/L, respectively (10% vs. 12%, p = 1.00; 10% vs. 10%, p = 1.00). Our results showed that a higher Hb decrease in GIB is associated with an increased untoward outcome rate even when the lowest hemoglobin exceeds the recommended transfusion thresholds. New randomized controlled trials investigating transfusion thresholds should consider ΔHb% as a potential key variable and risk factor.
Authors
- Szilárd Váncsa (ORCID: https://orcid.org/0000-0002-9347-8163)
- Brigitta Teutsch (ORCID: https://orcid.org/0000-0002-9530-7886)
- Levente Frim (ORCID: https://orcid.org/0000-0003-0097-6663)
- Nóra Vörhendi (ORCID: https://orcid.org/0000-0001-6972-1154)
- Edina Tari (ORCID: https://orcid.org/0000-0002-8540-0614)
- Áron Vincze (ORCID: https://orcid.org/0000-0003-2217-7686)
- Dániel Pálinkás (ORCID: https://orcid.org/0000-0001-5578-1754)
- Imre Szabó (ORCID: https://orcid.org/0000-0002-3091-5864)
- Eszter Boros (ORCID: https://orcid.org/0000-0002-4186-6586)
- Andrea Szentesi (ORCID: https://orcid.org/0000-0003-2097-6927)
- Orsolya Anna Simon (ORCID: https://orcid.org/0000-0001-7265-9427)
- Ferenc Izbéki (ORCID: https://orcid.org/0000-0001-7767-4319)
- Endre Botond Gagyi
- Patrícia Kalló
- Tamás Hussein
- Roland Hágendorn (ORCID: https://orcid.org/0000-0002-9984-2309)
- Bálint Erőss (ORCID: https://orcid.org/0000-0003-3658-8427)
- Orsolya Ferencz
- Zoltán Tóth (ORCID: https://orcid.org/0000-0002-3394-3238)
- Péter Hegyi (ORCID: https://orcid.org/0009-0006-0969-5031)
- Vivien Vass (ORCID: https://orcid.org/0009-0004-6099-426X)
Institutions
- Semmelweis University (HU)
- Central Military Hospital (NL)
- Fejér Megyei Szent György Egyetemi Oktató Kórház (HU)
- University of Veterinary Medicine (HU)
- University of Pecs (HU)
Publication Details
- Journal
- Scientific Reports
- Published
- 2024-12-28
- DOI
- https://doi.org/10.1038/s41598-024-82237-6
- Citations
- 2
- Primary Topic
- Blood transfusion and management
- Type
- article
- Field-Weighted Citation Impact
- 0.45
Funders
- Innovációs és Technológiai Minisztérium
- Nemzeti Kutatási, Fejlesztési és Innovaciós Alap