Lactate clearance predicts massive transfusion in upper gastrointestinal bleeding: a single-center retrospective...

Lactate clearance (LC) has emerged as a potential prognostic marker in critically ill patients. However, its role in predicting massive transfusion (MT) requirements in upper gastrointestinal bleeding (UGIB) patients remains unclear. This study aimed to evaluate the predictive value of LC for MT requirements in patients with UGIB.

This retrospective study included 452 patients diagnosed with UGIB between September 2021 and September 2023. Patients were divided into MT and non-MT groups, with MT defined as ≥ 10 units of red blood cell transfusion within 24 h or ≥ 4 units within 1 h. LC was calculated as [(Initial lactate - 1-hour lactate)/Initial lactate] × 100. Appropriate statistical analyses were performed to evaluate the predictive value of LC for MT.

A total of 33 patients (7.3%) required MT, whereas 419 (92.7%) did not. LC was significantly lower in the MT group (p < 0.001). ROC analysis revealed that LC had an area under the curve (AUC) of 0.840 (95% CI: 0.799-0.880), with a cutoff value of 30% (sensitivity: 87.9%, specificity: 74.0%). When combined with the Glasgow-Blatchford score (GBS), the diagnostic accuracy improved further (AUC = 0.880, 95% CI: 0.855-0.920).

Lower LC was associated with a higher likelihood of MT in UGIB patients. When combined with the GBS, LC may support early risk stratification during initial assessment. However, given the retrospective design, these findings should be interpreted cautiously and require external validation in prospective multicenter studies before clinical implementation.