Adherence to patient blood management strategy in patients with gastrointestinal bleeding: a prospective nationwide multicenter study.

Autor:	Tejedor-Tejada J; Department of Gastroenterology and Hepatology, Hospital Universitario Rio Hortega, Valladolid., Ballester MP; Department of Gastroenterology, Hospital Clínico Universitario de Valencia, Valencia., Del Castillo-Corzo FJ; Department of Gastroenterology, Hospital Don Benito-Villanueva de la Serena, Badajoz., García-Mateo S; Department of Gastroenterology, Hospital Clínico Universitario Lozano Blesa, Zaragoza., Domper-Arnal MJ; Department of Gastroenterology, Hospital Clínico Universitario Lozano Blesa, Zaragoza., Parada-Vazquez P; Department of Gastroenterology, Complejo Hospitalario Universitario de Pontevedra, Pontevedra., Saiz-Chumillas RM; Department of Gastroenterology, Hospital Universitario de Burgos, Burgos., Jiménez-Moreno MA; Department of Gastroenterology, Hospital Universitario de Burgos, Burgos., Hontoria-Bautista G; Department of Gastroenterology, Hospital Universitario de Burgos, Burgos., Bernad-Cabredo B; Department of Gastroenterology, Hospital Universitario de Burgos, Burgos., Gómez C; Department of Gastroenterology, Hospital Clínico Universitario de Valencia, Valencia., Capilla M; Department of Gastroenterology, Hospital Clínico Universitario de Valencia, Valencia., Fernández-De La Varga M; Department of Gastroenterology, Hospital Universitario y Politécnico La Fe, Valencia., Ruiz-Belmonte L; Department of Gastroenterology, Hospital Universitario Miguel Servet, Zaragoza., Lapeña-Muñoz B; Department of Gastroenterology, Hospital San Pedro, Logroño., Calvo Iñiguez M; Department of Gastroenterology, Hospital San Pedro, Logroño., Fraile-González M; Department of Gastroenterology, Hospital San Pedro, Logroño., Flórez-Díez P; Department of Gastroenterology, Hospital Universitario Central de Asturias, Oviedo., Morales-Alvarado VJ; Department of Gastroenterology, Hospital General de Granollers, Barcelona., Delgado-Guillena PG; Department of Gastroenterology, Hospital General de Granollers, Barcelona., Cañamares-Orbis P; Department of Gastroenterology, Hospital General San Jorge, Huesca., Saez-González E; Department of Gastroenterology, Hospital Universitario y Politécnico La Fe, Valencia., García-Morales N; Department of Gastroenterology, Complejo Hospitalario Universitario de Vigo, Vigo., Montoro M; Department of Gastroenterology, Hospital General San Jorge, Huesca., Murcia-Pomares Ó; Department of Gastroenterology, Hospital General Universitario de Alicante, Alicante, Spain.
Jazyk:	angličtina
Zdroj:	European journal of gastroenterology & hepatology [Eur J Gastroenterol Hepatol] 2024 Sep 23. Date of Electronic Publication: 2024 Sep 23.
DOI:	10.1097/MEG.0000000000002843
Abstrakt:	Introduction: Patient blood management (PBM) adherence in clinical practice is unclear. This real-world practice study assessed the management of patients with gastrointestinal (GI) bleeding after the implementation of the PBM strategy. Methods: This was a nationwide multicenter and prospective study involving consecutive adults with GI bleeding between March 2019 and March 2021. Patients were examined according to hemoglobin (Hb) level at admission (<7 g/dl, n = 93; 7-8 g/dl, n = 47; 8-9 g/dl, n = 61; and >9 g/dl, n = 249). Study outcomes measures were morbidity and mortality during hospitalization and at 3- and 6-month follow-up. Appropriate anemia or iron deficiency management was considered when adherence to PBM policy was higher than 75%. Results: A total of 450 patients (57.6% men, median age: 74 years, interquartile range: 63-82) were included. Overall, 55.1% and 59.3% of patients received transfusion and iron supplementation, respectively. The rates of appropriate transfusion and iron supplementation adherence were 90.9% (range: 86.9-93.5%, P = 0.109) and 81.8% (range: 78.5-85.1%, P = 0.041), depending on Hb level, respectively. No associations were observed between adherence to the PBM strategy and length of stay (P = 0.263) or risk of further bleeding (P = 0.742). Patients who were transfused [hazard ratio (HR): 0.79, 95% confidence interval (CI): 0.27-0.85] and iron supplemented (HR: 0.91, 95% CI: 0.38-1.41), however, appropriately achieved a lower risk of death. Age (HR: 1.12, 95% CI: 1.12-1.25) and further bleeding (HR: 39.08, 95% CI: 4.01-181.24) were poor prognostic factors. No serious adverse events were reported. Conclusions: In this nationwide study, there is a high level of adherence and safety of PBM for the treatment of GI bleeding. Adherence to the PBM strategy improved outcomes in patients with GI bleeding. (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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