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Previous studies in upper gastrointestinal (GI) bleeding have reported inconsistent outcomes about packed red blood cell (PRBC) transfusion practices.To assess whether PRBC transfusion is more likely to be dangerous in variceal bleeding than in non-variceal bleeding due to concern of over-transfusion leading to elevated portal pressure.We used the Nationwide Inpatient Sample (1999-2018). We identified patients with upper GI bleeding using an algorithmic approach, categorising bleeding from non-variceal or variceal sources. Our primary outcome was all-cause inpatient mortality. To control for the severity of bleeding, we performed propensity matching of baseline features, including age, gender, the presence of shock, the need for ICU care and co-morbidities. We also examined PRBC transfusion, inpatient mortality and hospitalisation rates for both populations.We included 10,228,524 upper GI bleeding discharges; 755,135 patients had variceal bleeding. After propensity matching, PRBC transfusion in variceal bleeders was associated with a 22% increase in inpatient mortality, whereas non-variceal bleeders had a 9% increase in inpatient mortality. Compared to non-variceal bleeders receiving blood transfusion, variceal bleeders had nearly four-fold higher odds of inpatient mortality (propensity-matched OR: 3.8; 95% CI: 3.7-3.8; p 0.001). Notably, PRBC transfusion rates in both groups have declined since 2011, although it has remained higher in variceal bleeders. Mortality for upper GI bleeding has been declining since 1999.Although decreased over the last decade, PRBC transfusion rates remain high for variceal bleeders. In addition, PRBC transfusion appears to be more detrimental in variceal bleeders than in non-variceal bleeders.

BACKGROUND AND AIM Acute kidney injury (AKI) is used as a marker of severity in Clostridium difficile infection (CDI) patients. We estimated the true effect of AKI in inpatient mortality of CDI patients, as there are no large-scale, population-based, propensity-matched studies evaluating AKI's effect in this patient cohort. METHODS A retrospective observational study utilizing the National Inpatient Sample from years 2003 to 2012, including all adults with CDI, excluding cases missing data on age, inpatient mortality or gender. Trends and CDI-related complications as mortality predictors were assessed using survey-weighted multivariable regression. We estimated AKI's independent effect by propensity-matching, post-stratifying by chronic kidney disease status, allowing for multiple comorbidity adjustment. RESULTS A total of 2 859 599 patients with CDI were included, of which 896 122 (31.3%) had principal diagnosis of CDI. AKI prevalence was 22%. Mortality rate was 8.4%, while among AKI patients was higher (18.2%). In multivariable regression, AKI was associated with higher mortality (odds ratio [OR] = 3.16, 95% confidence interval [CI]: 3.02-3.30; P