Massive transfusion in upper gastrointestinal bleeding: a new scoring system

Area of Science:

• Gastroenterology
• Hematology
• Critical Care Medicine

Background:

• Massive transfusion protocols are crucial for managing severe upper gastrointestinal bleeding (UGIB).
• Predictive tools for identifying patients needing massive transfusion in UGIB are lacking.
• Early identification facilitates timely interventions and resource allocation.

Purpose of the Study:

• To develop and validate a scoring system for predicting massive transfusion in UGIB patients.
• To improve patient care and resource management through early risk stratification.
• To address the gap in identifying patients requiring massive transfusion.

Main Methods:

• Defined massive transfusion as ≥10 units of red blood cells within 24 hours.
• Utilized a 10-year, six-hospital database for a developmental cohort (24,736 patients) and a validation cohort (27,449 patients).
• Applied logistic regression to derive and validate a risk score, assessing accuracy using the area under the receiver operating characteristic (AUROC) curve.

Main Results:

• Five factors independently predicted massive transfusion: band form >0, INR >1.5, shock (pulse >100 or SBP <100), hemoglobin <8.0 g/dL, and endoscopic therapy.
• The scoring system demonstrated high predictive accuracy in both developmental (AUROC: 0.831) and validation (AUROC: 0.822) cohorts.
• Approximately 3.9% of UGIB patients required massive transfusion.

Conclusions:

• The developed scoring system accurately predicts the need for massive transfusion in UGIB patients.
• This tool can enhance clinical decision-making and optimize patient management.
• The findings highlight the importance of early identification for life-saving interventions in severe UGIB.