Poor Outcomes in Patients with Cirrhosis and COVID-19

Shalimar, S.; Elhence, Anshuman; Vaishnav, Manas; Kumar, Ramesh; Pathak, Piyush; Soni, Kapil Dev; Aggarwal, Richa; Soneja, Manish; Jorwal, Pankaj; Kumar, Arvind; Khanna, Puneet; Singh, Akhil Kant; Biswas, Ashutosh; Nischal, Neeraj; Dhar, Lalit; Choudhary, Aashish; Rangarajan, Krithika; Acharya, Pragyan; Gunjan, Deepak; Saraya, Anoop; Mahapatra, Soumya Jagannath; Trikha, Anjan; Garg, Pramod Kumar

doi:10.21203/rs.3.rs-40220/v1

Cited by 4 publications

(9 citation statements)

References 12 publications

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“…[28,29] Of all the patients included in the present study, outcomes of 13 patients have been described in our previous publication. [1] A recent study from the United States reported outcomes of patients with COVID-19 pneumonia and GI bleed managed conservatively. [10] This study included 6 patients with likely ulcerrelated bleeding and mean GBS of 13.5.…”

Section: Outcomes Of Ugi Bleedmentioning

confidence: 99%

“…Recent data suggest that the overall prevalence of chronic liver disease (CLD) among COVID-19 patients is around 3-4%. [1] Patients with CLD and cirrhosis are at higher risk of mortality from COVID-19, especially those with acute-on-chronic liver failure. [1,2] The clinical presentation of COVID-19 in patients with CLD and cirrhosis, apart from respiratory symptoms, may include acute decompensation (AD) with gastrointestinal (GI) bleeding.…”

Section: Introductionmentioning

confidence: 99%

“…[1] Patients with CLD and cirrhosis are at higher risk of mortality from COVID-19, especially those with acute-on-chronic liver failure. [1,2] The clinical presentation of COVID-19 in patients with CLD and cirrhosis, apart from respiratory symptoms, may include acute decompensation (AD) with gastrointestinal (GI) bleeding. [1] The severe acute respiratory syndrome coronavirus-2 (SARS CoV-2) spreads via droplet and fomites.…”

Section: Introductionmentioning

confidence: 99%

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Outcome of Conservative Therapy in COVID-19 Patients Presenting with Gastrointestinal Bleeding

Shalimar

Vaishnav

Elhence

et al. 2020

Preprint

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Background: There is a paucity of data on the management of gastrointestinal(GI) bleeding in patients with COVID-19 amid concerns about the risk of transmission during endoscopic procedures.We aimed to study the outcomes of conservative treatment for GI bleeding in patients with COVID-19. Methods: In this retrospective analysis, 24 of 1342(1.8%) patients with COVID-19, presenting with GI bleeding from 22ndApril to 22ndJuly 2020, were included. Results: The mean age of patients was 45.8+/-12.7 years; 17(70.8%) were males; upper GI(UGI) bleeding: lower GI(LGI) 23:1. Twenty-two(91.6%) patients had evidence of cirrhosis- 21 presented with UGI bleeding while one had bleeding from hemorrhoids. Two patients without cirrhosis were presumed to have non-variceal bleeding. The medical therapy for UGI bleeding included vasoconstrictors- somatostatin in 17(73.9%) and terlipressin in 4(17.4%) patients. All patients with UGI bleeding received proton pump inhibitors and antibiotics. Packed red blood cells(PRBCs), fresh frozen plasma and platelets were transfused in 14(60.9%), 3(13.0%) and 3(13.0%), respectively. The median PRBCs transfused was 1(0-3) unit(s). The initial control of UGI bleeding was achieved in all 23 patients and none required an emergency endoscopy. At 5-day follow-up, none rebled or died. Two patients later rebled, one had intermittent bleed due to gastric antral vascular ectasia, while another had rebleed 19 days after discharge. Three(12.5%) cirrhosis patients succumbed to acute hypoxemic respiratory failure during hospital stay. Conclusion: Conservative management strategies including pharmacotherapy, restrictive transfusion strategy, and close hemodynamic monitoring can successfully manage GI bleeding in COVID-19 patients and reduce need for urgent endoscopy.

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Section: Outcomes Of Ugi Bleedmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Outcome of Conservative Therapy in COVID-19 Patients Presenting with Gastrointestinal Bleeding

Shalimar

Vaishnav

Elhence

et al. 2020

Preprint

Self Cite

View full text Add to dashboard Cite

show abstract

“…Recent data suggest that the overall prevalence of chronic liver disease (CLD) among COVID-19 patients is around 3–4%. 1 Patients with CLD and cirrhosis are at higher risk of mortality from COVID-19, especially those with acute-on-chronic liver failure (ACLF). 1 , 2 The clinical presentation of COVID-19 in patients with CLD and cirrhosis, apart from respiratory symptoms, may include acute decompensation (AD) with gastrointestinal (GI) bleeding.…”

Section: Introductionmentioning

confidence: 99%

“… 1 , 2 The clinical presentation of COVID-19 in patients with CLD and cirrhosis, apart from respiratory symptoms, may include acute decompensation (AD) with gastrointestinal (GI) bleeding. 1 …”

Section: Introductionmentioning

confidence: 99%

Outcome of Conservative Therapy in Coronavirus disease-2019 Patients Presenting With Gastrointestinal Bleeding

Shalimar

Vaishnav

Elhence

et al. 2021

Journal of Clinical and Experimental Hepatology

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Background/Objective: There is a paucity of data on the management of gastrointestinal (GI) bleeding in patients with Coronavirus disease-2019 (COVID-19) amid concerns about the risk of transmission during endoscopic procedures. We aimed to study the outcomes of conservative treatment for GI bleeding in patients with COVID-19. Methods: In this retrospective analysis, 24 of 1342 (1.8%) patients with COVID-19, presenting with GI bleeding from 22nd April to 22nd July 2020, were included. Results: The mean age of patients was 45.8 ± 12.7 years; 17 (70.8%) were males; upper GI (UGI) bleeding: lower GI (LGI) 23:1. Twenty-two (91.6%) patients had evidence of cirrhosis-21 presented with UGI bleeding while one had bleeding from hemorrhoids. Two patients without cirrhosis were presumed to have non-variceal bleeding. The medical therapy for UGI bleeding included vasoconstrictors-somatostatin in 17 (73.9%) and terlipressin in 4 (17.4%) patients. All patients with UGI bleeding received proton pump inhibitors and antibiotics. Packed red blood cells (PRBCs), fresh frozen plasma (FFPs) and platelets were transfused in 14 (60.9%), 3 (13.0%) and 3 (13.0%), respectively. The median PRBCs transfused was 1 (0-3) unit(s). The initial control of UGI bleeding was achieved in all 23 patients and none required an emergency endoscopy. At 5-day follow-up, none rebled or died. Two patients later rebled, one had intermittent bleed due to gastric antral vascular ectasia, while another had rebleed 19 days after discharge. Three (12.5%) cirrhosis patients succumbed to acute hypoxemic respiratory failure during hospital stay. Conclusion: Conservative management strategies including pharmacotherapy, restrictive transfusion strategy, and close hemodynamic monitoring can successfully manage GI bleeding in COVID-19 patients and reduce need for urgent endoscopy. The decision for proceeding with endoscopy should be taken by a multidisciplinary team after consideration of the patient's condition, response to treatment, resources and the risks involved, on a case to case basis.

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