Outcomes of Acute Gastrointestinal Bleeding in Patients With COVID-19: A Case-Control Study

Iqbal, Umair; Patel, Priya; Pluskota, Christopher A; Berger, Andrea; Khara, Harshit S.; Confer, Bradley

doi:10.14740/gr1483

Cited by 9 publications

(6 citation statements)

References 18 publications

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“…Importantly, recent studies have shown that patients hospitalized with coronavirus disease 2019 (COVID-19) are at risk of a gastrointestinal (GI) bleed [2][3][4]. The reported incidence of GI bleeds was 2-3% in hospitalized patients with COVID-19 and was noted to be higher in ICU patients [3,[5][6]. The widespread use of anticoagulation and corticosteroids in these patients could lead to a significant GI bleed [7][8][9].…”

Section: Introductionmentioning

confidence: 99%

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

Abulawi¹,

Al-Tarbsheh²,

Leamon³

et al. 2022

Cureus

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BackgroundCoronavirus disease 2019 (COVID-19) is widely recognized as a disease that affects the respiratory system, although it can also present with significant extrapulmonary symptoms. Very few studies have suggested an increased risk of gastrointestinal (GI) bleeding. This study aimed to elucidate the incidence, etiology, risk factors, and outcomes of clinically significant GI bleeding requiring endoscopic intervention in patients with COVID-19. MethodsThis is a case-control (1:2) retrospective analysis of all hospitalized adult patients with COVID-19 infection admitted between March 1, 2020, and January 5, 2021, in which we compared patients with upper and lower GI bleeds to those without. Cases are defined as patients hospitalized with COVID-19 who had a GI bleed requiring intervention while controls are defined as patients hospitalized with COVID-19 who did not have a GI bleed. Of 1002 patients admitted to the Albany Medical Center with COVID-19 infection, there were 76 confirmed cases of GI bleeding. These patients were compared to a control group composed of randomly selected patients with COVID-19 infection who were admitted to Albany Medical Center over the same time period. We assessed patients for in-hospital mortality, ventilator-free days on day 28, ICU-free days on day 28, and hospital-free days on day 28. Additional information collected included demographic information, comorbid conditions, COVID-19 treatments received, endoscopy findings, endoscopic treatment received, and if the patients required a packed red blood cell transfusion. ResultsOut of 1007 patients hospitalized with COVID-19, 76 (8%) had a GI bleed requiring endoscopic intervention. Peptic ulcer disease in the stomach or duodenum was the most common finding. The use of steroids, antiplatelet agents, and anticoagulation was not associated with an increased risk of GI bleed in COVID-19 patients. The GI bleed group required ICU care in 37% (28/76) compared with 21% (32/152) in the control group, which was statistically significant (p=0.012; chi-square test). Length of hospital stay was longer in the GI bleed group (median 16 days IQR: 8 to 29 versus 7 days, IQR:4 to 16; p<0.001, Mann Whitney test). ConclusionLength of hospital stay and ICU level of care was higher in the GI bleed group of patients with COVID-19. ICU level of care was noted to be associated with an increased risk of GI bleeding. A GI bleed in COVID-19 patients could be from the virus's direct effect on the gut mucosa or stress-induced bleeding like any other severely sick ICU patient; however, this needs to be explored in future studies.

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Section: Introductionmentioning

confidence: 99%

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

Abulawi¹,

Al-Tarbsheh²,

Leamon³

et al. 2022

Cureus

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“…Therefore, the outcomes of GIB in COVID-19 patients differ from non-COVID-19 patients. This difference is recorded in the stay in the intensive care units (ICU), in the use of corticosteroid drugs, intubation, as well as in the causes of death, as these mainly concern the respiratory due to the COVID-19 infection [ 88 , 89 , 90 ]. No differences are observed in hemoglobin, in the administration of blood and crystalloid solutions, and the rate of rebleeding.…”

Section: Discussionmentioning

confidence: 99%

“…No differences are observed in hemoglobin, in the administration of blood and crystalloid solutions, and the rate of rebleeding. Also, the etiology of the bleeding and its clinical findings do not differ [ 89 , 90 ]. Finally, during the period of COVID-19, a significant decrease was observed in the number of patients coming to the hospital with GIB, which is attributed to their unwillingness to visit the hospital, due to COVID-19 [ 91 , 92 ].…”

Section: Discussionmentioning

confidence: 99%

The Prevalence of Gastrointestinal Bleeding in COVID-19 Patients: A Systematic Review and Meta-Analysis

Karlafti,

Tsavdaris,

Kotzakioulafi

et al. 2023

Medicina

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Introduction: Severe acute respiratory syndrome coronavirus 2 caused the coronavirus disease of 2019 (COVID-19), which rapidly became a pandemic, claiming millions of lives. Apart from the main manifestations of this infection concerning the respiratory tract, such as pneumonia, there are also many manifestations from the gastrointestinal tract. Of these, bleeding from the gastrointestinal tract is a significant complication quite dangerous for life. This bleeding is divided into upper and lower, and the primary pathophysiological mechanism is the entering of the virus into the host cells through the Angiotensin-converting enzyme 2 receptors. Also, other comorbidities and the medication of corticosteroids and anticoagulants are considered to favor the occurrence of gastrointestinal bleeding (GIB). Methods: This systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and the studies were searched in two different databases (Scopus and PubMed) from November 2019 until February 2023. All studies that reported GIB events among COVID-19 patients were included. Results: 33 studies were selected and reviewed to estimate the prevalence of GIB. A total of 134,905 patients with COVID-19 were included in these studies, and there were 1458 episodes of GIB. The prevalence of GIB, in these 33 studies, ranges from 0.47% to 19%. This range of prevalence is justified by the characteristics of the COVID-19 patients. These characteristics are the severity of COVID-19, anticoagulant and other drug treatments, the selection of only patients with gastrointestinal manifestations, etc. The pooled prevalence of gastrointestinal bleeding was estimated to be 3.05%, rising to 6.2% when only anticoagulant patients were included. Conclusions: GIB in COVID-19 patients is not a rare finding, and its appropriate and immediate treatment is necessary as it can be life-threatening. The most common clinical findings are melena and hematemesis, which characterize upper GIB. Treatment can be conservative; however, endoscopic management of bleeding with embolization is deemed necessary in some cases.

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“…These factors may increase the risk of bleeding and subsequent mortality in patients with UGIB. Furthermore, the COVID-19 pandemic may have interrupted healthcare systems, resulting in delayed or inadequate care for patients with UGIB [ 32 , 33 ].…”

Section: Discussionmentioning

confidence: 99%

Trends of Upper Gastrointestinal Bleeding Mortality in the United States Before and During the COVID-19 Era: Estimates From the Centers for Disease Control WONDER Database

Merza¹,

Masoud²,

Ahmed³

et al. 2023

Gastroenterol Res

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Background: There have been reports of increased upper gastrointestinal bleeding (UGIB) in patients with coronavirus disease 2019 . Still, only a few studies have examined the mortality rate associated with UGIB in the United States before and during COVID-19. Hereby, we explored the trends of UGIB mortality in the United States before and during COVID-19. The study's objective was to investigate whether the COVID-19 pandemic significantly impacted UGIB mortality rates in the USA. Methods:The decedents with UGIB were included. Age-standardized mortality rates were estimated with the indirect method using the 2000 US Census as the standard population. We utilized the deidentified data from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database. Linear regression analysis was performed to determine 2021 projected mortality rates based on trends between 2012 and 2019 to quantify the association of the pandemic with UGIB-related deaths. Results:The mortality rate increased from 3.3 per 100,000 to 4.3 per 100,000 among the population between 2012 and 2021. There was a significant increase in the overall mortality rate between each year and the following year from 2012 to 2019, ranging from 0.1 to 0.2 per 100,000, while the rise in the overall mortality rate between each year and 2021 ranges from 0.4 to 0.9 per 100,000. Conclusions:Our results showed that the mortality rate increased among the population between 2012and 2021, suggesting a possible influence of COVID-19 infection on the incidence and mortality of UGIB.

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Outcomes of Acute Gastrointestinal Bleeding in Patients With COVID-19: A Case-Control Study

Cited by 9 publications

References 18 publications

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

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

The Prevalence of Gastrointestinal Bleeding in COVID-19 Patients: A Systematic Review and Meta-Analysis

Trends of Upper Gastrointestinal Bleeding Mortality in the United States Before and During the COVID-19 Era: Estimates From the Centers for Disease Control WONDER Database

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