Taha Ali S, McCloskey Caroline, Craigen Theresa, Angerson Wilson J, Shah Amir A, Morran Christopher G
Department of Gastroenterology, Crosshouse Hospital, Kilmarnock, UK.
Department of Medicine, University of Glasgow, Scotland, UK.
Frontline Gastroenterol. 2011 Oct;2(4):218-225. doi: 10.1136/fg.2011.004572. Epub 2011 Jul 16.
Blood transfusion remains an integral step in the management of acute non-variceal upper gastrointestinal bleeding (NV-UGIB), but its safety is being increasingly questioned in less severe cases. The authors aimed to measure 30-day and 2-year mortalities after blood transfusion for NV-UGIB.
Cox proportional hazards models were used to estimate the association of blood transfusion with mortality while adjusting for age, Charlson comorbidity score, the complete Rockall score for acute UGIB, admission status and medication intake prior to bleeding.
Death from any cause at 30 days and 2 years after NV-UGIB.
1340 patients presented with NV-UGIB< (808 men (60.3%), median age 67 years) of whom 564 (42.1%) were transfused. The overall mortality was 5.3% at 30 days and 26.0% at 2 years in all patients. Comparing subjects with a haemoglobin concentration greater than 10.0 g/dl who were transfused with those who were not, 30-day mortalities (95% CIs) were 11.5% (6.7 to 18.0) versus 3.6% (2.3 to 5.3), respectively, p<0.001, and 2-year mortalities (95% CIs) were 40% (32 to 49) versus 20% (17 to 23), p<0.001. After adjusting for age, Charlson score, Rockall score and haemoglobin, the HRs (95% CIs) for death after transfusion were 1.88 (1.00 to 3.55) (p=0.051) at 30 days and 1.71 (1.28 to 2.28), (p<0.001) at 2 years.
In patients with moderately severe NV-UGIB, mortality is higher following blood transfusion. Whether this reflects selection bias, an effect of comorbidity or an effect of transfusion requires urgent prospective study.
输血仍是急性非静脉曲张性上消化道出血（NV-UGIB）治疗中不可或缺的一步，但在病情较轻的情况下，其安全性受到越来越多的质疑。作者旨在测定NV-UGIB输血后的30天和2年死亡率。
使用Cox比例风险模型估计输血与死亡率之间的关联，同时对年龄、Charlson合并症评分、急性UGIB的完整Rockall评分、入院状态和出血前用药情况进行校正。
NV-UGIB后30天和2年的任何原因导致的死亡。
1340例患者出现NV-UGIB（808例男性（60.3%），中位年龄67岁），其中564例（42.1%）接受了输血。所有患者30天的总死亡率为5.3%，2年的总死亡率为26.0%。比较血红蛋白浓度大于10.0 g/dl且接受输血的患者与未接受输血的患者，30天死亡率（95%CI）分别为11.5%（6.7至18.0）和3.6%（2.3至5.3），p<0.001，2年死亡率（95%CI）分别为40%（32至49）和20%（17至23），p<0.001。在校正年龄、Charlson评分、Rockall评分和血红蛋白后，输血后30天死亡的HR（95%CI）为1.88（1.00至3.55）（p=0.051），2年时为1.71（1.28至2.28），（p<0.001）。
在中度严重的NV-UGIB患者中，如果输血，死亡率会更高。这是反映了选择偏倚、合并症的影响还是输血的影响，需要进行紧急前瞻性研究。
