The 30-day mortality rate in patients with critical peptic ulcer bleeding requiring massive transfusion is almost one in five (19.6%) despite best efforts from multidisciplinary teams.
A study of 5,482 cases from the Australian and New Zealand Massive Transfusion Registry found 270 cases (4.9%) were due to peptic ulcer bleeding.
Most patients were men (70%) and the median age was 69 years. The most common comorbidities were renal disease (18%) and diabetes (17%).
Patients received a median of seven units of red blood cells, four units of fresh frozen plasma and one unit of platelets within 24 hours.
Most patients (71%) also underwent a gastroscopy with therapeutic intervention.
The study found older patients and those with more comorbidities, especially liver disease or cancer, had a higher mortality rate. In comparison, blood product use or the types of procedural interventions did not influence mortality rate.
The study, led by Alfred Health gastroenterologist Dr Shara Ket, also noted that in the cases where cause of death was known, only 33% were directly attributed to the GI bleeding event.
Other causes of death were documented as liver disease (10%), cancer (20%), cardiovascular disease (7%), pulmonary disease (7%) and other causes (30%).
“Probably what it means is the bleed is the catalyst – the straw that breaks the camel’s back so to speak,” Dr Ket told the limbic.
“Because a lot of these people are really comorbid and quite elderly …and when they bleed so much it is such a large physiological strain it looks like they go into organ failure or have a heart attack, etc.”
The study concluded that massive transfusions in patients with critical peptic ulcer bleeding can be a life-saving measure.
“However, in this study, transfusion management, in terms of volumes of blood components transfused, did not differ between patients who survived and those who died. Questions remain about optimal transfusion strategies,” it said.
“Further research into evaluation of relative timing and ratios of RBC and non-RBC transfusion products on patient outcomes may provide further guidance on transfusion strategies.”