| Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access |
| Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc |
| Journal website https://www.gastrores.org |
Original Article
Volume 15, Number 1, February 2022, pages 13-18
Outcomes of Acute Gastrointestinal Bleeding in Patients With COVID-19: A Case-Control Study
Tables
| Total GI bleed patients (N = 72) | COVID-19 (N = 18) | Non-COVID-19 controls (N = 54) | P-value | |
|---|---|---|---|---|
| *Use of steroids was significantly higher in COVID-19 patients. COVID-19: coronavirus disease 2019; GI: gastrointestinal; SD: standard deviation; INR: international normalized ratio; IQR: interquartile range; m.v.: matching variable; PPI: proton pump inhibitor; NSAIDs: non-steroidal anti-inflammatory drugs. | ||||
| Age at admission, mean (SD) | 69.7 (11.74) | 68.8 (13.31) | 70.0 (11.29) | m.v. |
| Sex, n (%) | m.v. | |||
| Male, n (%) | 48 (66.7%) | 12 (66.7%) | 36 (66.7%) | m.v. |
| Hemoglobin at presentation, mean (SD) | 8.7 (2.87) | 8.9 (2.82) | 8.6 (2.91) | 0.7639 |
| INR, median (IQR) | 1.3 (1.1 - 1.9) | 1.4 (1.2 - 2.1) | 1.3 (1.1 - 1.8) | 0.1286 |
| Steroids, n (%) | 23 (31.9%) | 15 (83.3%) | 8 (14.8%) | < 0.0001* |
| Anticoagulation, n (%) | 0.3549 | |||
| Prophylactic dose | 14 (19.4%) | 5 (27.8%) | 9 (16.7%) | |
| Therapeutic dose | 28 (38.9%) | 8 (44.4%) | 20 (37.0%) | |
| None | 30 (41.7%) | 5 (27.8%) | 25 (46.3%) | |
| PPI use, n (%) | 68 (94.4%) | 18 (100.0%) | 50 (92.6%) | 0.5313 |
| Octreotide use, n (%) | 9 (12.5%) | 2 (11.1%) | 7 (13.0%) | 0.8274 |
| Hematochezia, n (%) | 28 (38.9%) | 7 (38.9%) | 21 (38.9%) | 1.0000 |
| Melena, n (%) | 38 (52.8%) | 11 (61.1%) | 27 (50.0%) | 0.4408 |
| Coffee ground emesis, n (%) | 7 (9.7%) | 3 (16.7%) | 4 (7.4%) | 0.2439 |
| Hematochezia, melena, or coffee grounds emesis, n (%) | 65 (90.3%) | 18 (100.0%) | 47 (87.0%) | 0.1523 |
| NSAIDs, n (%) | 38 (52.8%) | 10 (55.6%) | 28 (51.9%) | 0.7774 |
| Hypertension, n (%) | 48 (66.7%) | 13 (72.2%) | 35 (64.8%) | 0.5186 |
| Cirrhosis, n (%) | 11 (15.3%) | 1 (5.6%) | 10 (18.5%) | 0.2083 |
| Diabetes, n (%) | 25 (34.7%) | 5 (27.8%) | 20 (37.0%) | 0.4776 |
| History of GI bleed, n (%) | 24 (33.3%) | 4 (22.2%) | 20 (37.0%) | 0.2275 |
| Total GI bleed patients (N = 72) | COVID-19 (N = 18) | Non-COVID-19 controls (N = 54) | P-value | |
|---|---|---|---|---|
| *There was no statistically significant difference in mortality between COVID-19 patients and non-COVID-19 patient. ICU admission and length of stay were higher in COVID-19 patients. COVID-19: coronavirus disease 2019; GI: gastrointestinal; IQR: interquartile range; AVM: arteriovenous malformations; APC: argon plasma coagulation; OTSC: over the scope clip; ICU: intensive care unit; PUD: peptic ulcer disease; GE: gastroesophageal; CVA: cerebrovascular accident; AML: acute myeloid leukemia; GBS: Glasgow Blatchford Score; AGIB: acute gastrointestinal bleeding. | ||||
| Endoscopy done, n (%) | 46 (63.9%) | 6 (33.3%) | 40 (74.1%) | 0.0059 |
| Intervention, n (%) | 18 (25.0%) | 4 (22.2%) PUD = 2 (one patient required hemospray and other required epinephrine injection and clips for hemostasis). Small bowel AVM in one patient which required APC. Solitary ulcer at hepatic flexure which required OTSC. | 14 (25.9%) APC for small bowel AVMs in one patient, biopsy of GE junction mass. Hemostatic clips, bipolar coagulation, epinephrine injection and hemospray for PUD, variceal banding in two patients, sigmoid colon biopsy for suspected ischemia. | 0.7683 |
| Repeat endoscopy (among patients with initial endoscopy), n (%) | 14 (30.4%) | 2 (33.3%) | 12 (30.0%) | 0.8145 |
| ICU, n (%) | 33 (45.8%) | 15 (83.3%) | 18 (33.3%) | 0.0042* |
| Blood transfusion, n (%) | 43 (59.7%) | 11 (61.1%) | 32 (59.3%) | 0.8946 |
| Transfusion units, median (IQR) | 2.0 (0.0 - 4.0) | 2.0 (0.0 - 5.0) | 2.0 (0.0 - 3.0) | 0.6831 |
| Inpatient or 30-day mortality, n (%) | 17 (23.6%) | 7 (38.9%) | 10 (18.5%) | 0.0549* |
| Causes of mortality | Septic shock, sepsis, COVID-19 pneumonia, acute hypoxic respiratory failure, AGIB | AGIB, hemorrhagic shock, septic shock, ischemic bowel, multiorgan failure, CVA, AML, metastatic renal cell carcinoma | ||
| Rebleeding during admission among patients with sufficient observation time, n (%) | 8 (11.9%) | 2 (14.3%) | 6 (11.3%) | 0.6837 |
| Pressors, n (%) | 22 (30.6%) | 8 (44.4%) | 14 (25.9%) | 0.1404 |
| Length of stay (days), median (IQR) | 7.0 (4.0 - 18.5) | 21.5 (7.0 - 39.0) | 6.0 (4.0 - 13.0) | 0.0021* |
| GBS, median (IQR) | 11.0 (9.0 - 13.0) | 13.0 (9.0 - 13.0) | 11.0 (9.0 - 13.0) | 0.9564 |
| Readmission within 30 days of discharge among patients who survived past discharge day, n (%) | 8 (13.8%) | 3 (25.0%) | 5 (10.9%) | 0.4927 |