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.