Patient'S Performance Status Should Dictate Transfusion Strategy In Nonvariceal Acute Upper Gastrointestinal Bleeding (Nv-Augib): A Prospective Multicenter Cohort Study

Background: Non-variceal acute UGI bleeding (NV-AUGIB) is a frequent indication for transfusion, but the best hemoglobin threshold and target values for transfusion in relation to the patients' performance status are unknown.Objective: To identify threshold and target hemoglobin levels for transfusion favoring survival of patients with NV-AUGIB stratified by ASA score.Design: Prospective cohort study.Setting: 50 hospitals of the Italian National Health Service.Participants: 2758 consecutive patients with NV-AUGIB admitted to 50 Italian hospitals from January 1st, 2014 to December 31st, 2015. Five hemoglobin cut-offvalues were evaluated. Results: 30-days mortality: overall: 5.4%; ASA 1-2 patients: 2.5%; ASA 3-4 patients: 10.8%. Mortality was higher when hemoglobin at admission was <= 7 g/dL in ASA 1-2 patients, and when it was <= 8 g/dL in ASA 3-4 patients. The hemoglobin levels after transfusion favouring survival were >= 8 g/dL in ASA 1-2, p <0.0001 and 9-10 g/dL in ASA 3-4 patients; p = 0.00 02.Conclusions: In patients with NV-AUGIB the physical performance status should dictate the transfusion strategy. In ASA 1-2 patients, admission hemoglobin values <= 7 g/dL should prompt transfusion, aiming at a target value of 8-9 g/dL; the corresponding figures for ASA 3-4 patients are: admission hemoglobin level <= 8 g/dL and target value of 9-10 g/dL. (C) 2020 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.