Association Between Blood Transfusion Volume and Adverse Clinical Outcomes in Chronic Liver Disease: A Retrospective Observational Study.

Background Blood transfusion is frequently required in patients with chronic liver disease, particularly during episodes of gastrointestinal bleeding. However, excessive transfusion may increase portal venous pressure and adversely affect clinical outcomes. This study aimed to evaluate the association between transfusion volume and adverse clinical outcomes in patients with chronic liver disease. Objective This study aimed to assess the association between blood transfusion volume and adverse clinical outcomes, including rebleeding, hepatic encephalopathy, ascites, and prolonged hospital stay, among patients with chronic liver disease. Methods  This retrospective observational study was conducted at Assam Medical College, Dibrugarh, Assam, India, and utilized existing patient records collected between April 1, 2025, and March 31, 2026. A total of 240 adult patients with chronic liver disease who received blood transfusion during hospitalization were included. Patients were categorized into low-transfusion (≤2 units) and high-transfusion (>2 units) groups. Outcomes assessed included rebleeding, hepatic encephalopathy, ascites, and length of hospital stay. Categorical variables were analyzed using the chi-squared test, while continuous variables were compared using Student's t-test. Multivariate logistic regression analysis was performed to identify the independent predictors of rebleeding after adjustment for clinically relevant covariates. Results One hundred and thirty-eight (57.5%) received ≤2 units of blood transfusion, while 102 patients (42.5%) received >2 units. Rebleeding occurred more frequently in the high-transfusion group compared with the low-transfusion group (42 (41.2%) vs. 27 (19.6%); p<0.001). Hepatic encephalopathy was also more common among patients receiving >2 units (45 (44.1%) vs. 36 (26.1%); p=0.003). The mean hospital stay was significantly longer in the high-transfusion group (8.6±2.3 days vs. 5.9±1.8 days; p<0.001). On multivariate logistic regression analysis, transfusion volume >2 units independently predicted rebleeding (OR: 2.3; 95% CI: 1.1-4.8; p=0.02). Conclusions Higher transfusion volume was associated with increased rates of rebleeding, hepatic encephalopathy, and prolonged hospital stay in patients with chronic liver disease. These findings support careful transfusion practices and highlight the need for further prospective studies evaluating restrictive transfusion strategies.