Gastrointestinal Bleeding in COVID-19 Patients: A Systematic Review with Meta-Analysis

Abstract

The novel coronavirus disease 2019 (COVID-19) has been reported to affect the gastrointestinal system with a variety of symptoms, including bleeding. The prevalence of bleeding in these patients remains unclear. The aim of this meta-analysis is to estimate the rate of gastrointestinal bleeding in COVID-19 patients and its association with mortality. MEDLINE and Embase were searched through December 20, 2020. Studies reporting COVID-19 patients with and without gastrointestinal bleeding were included. Estimated prevalence with 95% confidence intervals (CI) was pooled; heterogeneity was expressed as I2. Metaregression analysis was performed to assess the impact of confounding covariates. Ten studies met the inclusion criteria and were included in the analysis. A total of 91887 COVID-19 patients were considered, of whom 534 reported gastrointestinal bleeding (0.6%) [409 (76.6%) upper and 121 (22.7%) lower gastrointestinal bleeding (UGIB and LGIB, resp.)]. The overall pooled gastrointestinal bleeding rate was 5% [95% CI 2–8], with high heterogeneity (I2 99.2%); “small study effect” was observed using the Egger test ( p = 0.049 ). After removing two outlier studies, the pooled bleeding rate was 2% [95% CI 0–4], with high heterogeneity (I2 99.2%), and no “small study effect” ( p = 0.257 ). The pooled UGIB rate was 1% (95% CI 0–3, I2 98.6%, p = 0.214 ), whereas the pooled LGIB rate was 1% (95% CI 0–2, I2 64.7%, p = 0.919 ). Metaregression analysis showed that overall estimates on gastrointestinal bleeding were affected by studies reporting different sources of bleeding. No significant association between gastrointestinal bleeding and mortality was found. In this meta-analysis of published studies, individuals with COVID-19 were found to be at risk for gastrointestinal bleeding, especially upper gastrointestinal bleeding.

Clinical Characteristics of Hospitalized COVID-19 Patients Who Have Gastrointestinal Bleeds Requiring Intervention: A Case-Control Study

“…At this point, it is not clear which is the dominant mechanism for the increased incidence of GI bleeds in COVID-19 patients. Marasco G et al believe it may be because of critical illness and stress-induced ulcers, as reflected by a higher percentage of GI bleeding occurring in patients who are hospitalized with critical status in the ICU [ 14 ]. In our study, most of the bleeding happened after a few days of hospitalization, which suggests that bleeding is more likely due to factors related to critical illness or treatment-related rather than primary viral-induced mucosal injury.…”

Co-Infections and Superinfections in COVID-19 Critically Ill Patients Are Associated with CT Imaging Abnormalities and the Worst Outcomes

“…Several complications can arise during ICU stay, from both COVID-19 extensive lung damage and extra-pulmonary involvement, as well as those secondary to mechanical supporting systems [ 2 , 3 , 4 , 5 , 6 ]. Among these, bacterial and fungal co-infections and superinfections (or secondary infections) play an important role in COVID-19 disease and have been associated with increased morbidity and mortality, especially in critically ill patients [ 7 , 8 , 9 , 10 , 11 ].…”

Coronavirus Disease in the Abdomen

“…4 ) as well as GI bleeding, including hematochezia and melena [ 16 , 30 , 31 ]. Upper GI bleeding, defined as arising proximal to the ligament of Treitz, is more common than lower GI bleeding and has been reported to respond to conservative management in most of the patients (∼60%) [ 32 , 33 ]. The presence of active GI bleeding in COVID-19 patients and localization of the anatomic source may be diagnosed by radiologists using multiphase CT angiography for active GI bleeding and CT enterography for occult or suspected small bowel bleeding [ 34 ].…”