Teutsch Brigitta, Tóth Zsolt Abonyi, Ferencz Orsolya, Vörhendi Nóra, Simon Orsolya Anna, Boros Eszter, Pálinkás Dániel, Frim Levente, Tari Edina, Kalló Patrícia, Gagyi Endre Botond, Hussein Tamás, Váncsa Szilárd, Vass Vivien, Szentesi Andrea, Vincze Áron, Izbéki Ferenc, Hegyi Péter, Hágendorn Roland, Szabó Imre, Erőss Bálint
Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.
Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.
Sci Rep. 2024 Dec 28;14(1):31056. doi: 10.1038/s41598-024-82237-6.
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.
胃肠道出血（GIB）患者对急性失血表现出不同的耐受性。我们旨在研究相对血红蛋白降低（ΔHb%）对GIB结局的影响。对2019年至2022年期间纳入匈牙利GIB登记处的参与者进行了分析。主要结局定义为复合终点，包括住院期间与出血相关的死亡率和紧急干预的必要性。根据住院期间测得的最低血红蛋白（最低点血红蛋白）创建了四组，同时根据ΔHb%将其分为四个亚组。无论最低点血红蛋白如何，ΔHb%较高的参与者达到复合终点的概率更高。与分别降至70 - 80 g/L或60 - 70 g/L时ΔHb%降低0 - 10%相比，降至80 - 90 g/L时ΔHb%降低30 - 40%导致达到主要终点的可能性相似（10%对12%，p = 1.00；10%对10%，p = 1.00）。我们的结果表明，即使最低血红蛋白超过推荐的输血阈值，GIB中较高的血红蛋白降低也与不良结局率增加相关。研究输血阈值的新随机对照试验应将ΔHb%视为潜在的关键变量和危险因素。
