The Incidence and Mortality Impact of Gastrointestinal Bleeding in Hospitalized COVID-19 Patients

Abstract

Background: Patients requiring hospitalization to critical care units are at a higher risk for gastrointestinal (GI) bleeding. Although severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) infection is predominantly a pulmonary disease, other serious manifestations including thromboembolic phenomenon are reported. Acute respiratory distress syndrome (ARDS) requiring mechanical ventilation, use of steroids and anticoagulation are all known to increase the risk of GI bleeding significantly. Aim: To study the incidence of GI bleeding and its impact on mortality in patients admitted with SARS-CoV-2. Methods: We retrospectively reviewed all patients admitted with SARS-CoV-2 from February 1, 2020 to April 15, 2020. We collected data including demographics, comorbid conditions, laboratory parameters, steroid and anticoagulant use. Coffee ground emesis, hematemesis, melena and hematochezia were defined as GI bleeding. All-cause mortality was reviewed for all patients included in the study. The relationship between GI bleeding and mortality was studied using logistic regression. Results: We had a total of 1206 patients hospitalized with SARS-CoV-2 infection with an all-cause mortality of 34% (n = 411). The overall incidence of GI bleeding was 3.1% (n = 37) with no significant difference between the patients who survived versus died during hospitalization (1.3% vs 1.5%, p = 0.77). Logistic regression analysis did not identify GI bleeding as an independent predictor of mortality. Therapeutic doses of anticoagulation were administered in 13.3% (n = 161) of patients, of which 6.8% (n = 11) developed GI bleeding. Patients were more likely to develop GI bleeding with use of therapeutic doses of anticoagulation (29.7% vs 12.8%, p = 0.003), steroids (37.8% vs 18.5%, p = 0.003) and mechanical ventilation (48.6% vs 30.4%, p = 0.018). Conclusion:Patients hospitalized with SARS-CoV-2 infection are at risk of gastrointestinal bleeding. Therapeutic doses of anticoagulation, mechanical ventilation and steroid use are significant risk factors for GI bleeding. However, GI bleeding did not significantly alter the mortality rates in SARS-CoV-2-infected patients.

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

“…However, one single-center study from Bronx Lebanon Hospital showed an increased risk of GI bleeds in COVID-19 patients with the use of steroids and anticoagulation. There are several limitations to their study, including selection bias, sample size, and definition for GI bleed [ 2 ]. Few studies also looked at the effect of GI bleeding on the outcomes in this specific population such as length of hospital stay, complications, mortality, etc.…”

“…However, multiple studies have shown that SARS-COV-2 is associated with extrapulmonary complications, including in the gastrointestinal system. 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].…”

Upper gastrointestinal bleeding in coronavirus disease 2019 patients

“…In the multicentric series by Martin et al [17 && ] and by Gonza `les Gonza `les R. et al [31] there was no difference in mortality between COVID-19 patients with and without UGIB (20% vs 16%, P ¼ 0.61 and OR ¼ 1.14, 95% CI ¼ 0.59-2.19 respectively. Another study showed similar mortality rate in COVID-19 patients with and without gastrointestinal bleeding (43% vs 34%, respectively, P ¼ 0.23) but without specify the origin of bleeding (upper or lower) [46]. The Spanish multicentric study showed only an increased risk of COVID-19 patients with UGIB to have ICU admission.…”

Characteristics of Patients Admitted with and without COVID-19 and Gastrointestinal Bleeding During the Early Pandemic: A Retrospective Review

“…This study analyzes the clinical and culprit lesion characteristics of patients admitted with COVID and GIB during the beginning of the global pandemic. Most gastroenterology studies produced during the initial phases of the COVID pandemic focused on gastrointestinal symptoms and mortality data regarding GIB [2][3][4][5][6][7]. However, few studies have compared COVID patients with GIB to the non-COVIDinfected population admitted with GIB, and few have evaluated the severity of GIB outside the upper gastrointestinal tract.…”