NEW evidence suggests that early changes in lactate levels may help identify patients with upper gastrointestinal bleeding (UGIB) who are at high risk of requiring massive transfusion, offering a simple tool to support early clinical decision-making in emergency settings.
Upper gastrointestinal bleeding remains a common and potentially life-threatening presentation, where early identification of patients likely to deteriorate is critical. While lactate clearance (LC) is increasingly recognised as a prognostic marker in critically ill patients, its role in predicting transfusion requirements in UGIB has been less clear. This retrospective study set out to evaluate whether LC could help predict the need for massive transfusion (MT) during initial assessment.
Assessing Lactate Clearance in UGIB
The study included 452 patients diagnosed with UGIB at a single centre between September 2021 and September 2023. Massive transfusion was defined as the administration of at least 10 units of red blood cells within 24 hours, or at least 4 units within 1 hour. Lactate clearance was calculated using the percentage reduction between initial lactate and 1-hour lactate measurements.
Of the cohort, 33 patients (7.3%) required massive transfusion. These patients had significantly lower lactate clearance compared with those who did not require MT, indicating impaired physiological recovery despite early resuscitation.
Strong Predictive Performance
Receiver operating characteristic analysis demonstrated that lactate clearance had good predictive accuracy for massive transfusion, with an area under the curve of 0.84. A clearance threshold of 30% provided high sensitivity and specificity, suggesting that patients failing to clear lactate early are at substantially higher risk of severe bleeding.
Importantly, combining lactate clearance with the Glasgow-Blatchford score further improved diagnostic performance, increasing the area under the curve to 0.88. This finding highlights the potential value of integrating dynamic biochemical markers with established clinical risk scores.
Implications for Early Risk Stratification
The authors suggest that lactate clearance may serve as a rapid, objective marker to support early triage decisions in UGIB, particularly in identifying patients who may benefit from aggressive monitoring, early blood product mobilisation, or escalation of care.
However, they caution that the retrospective, single-centre design limits generalisability. External validation in prospective, multicentre studies will be required before lactate clearance can be routinely incorporated into UGIB management pathways.
Nonetheless, the findings add to growing interest in dynamic physiological markers to guide early decision-making in acute gastrointestinal bleeding, where minutes can be critical and accurate risk stratification remains a clinical priority.
Reference
Yortanlı BC et al. Lactate clearance predicts massive transfusion in upper gastrointestinal bleeding: a single-center retrospective study. BMC Gastroenterol. 2026;DOI: 10.1186/s12876-026-04644-5.
