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Clinical Features and Factors Associated with Occult Gastrointestinal Bleeding in COVID-19 Patients
Xi Zhao1, Meihui Tao1, Chaoyue Chen1
1Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
Insights
COVID-19 patients experiencing occult gastrointestinal bleeding (GIB) had worse outcomes. Lower albumin, higher prothrombin time, and severe disease independently predicted GIB in these patients.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Internal Medicine
Background:
- The global increase in COVID-19 cases has been accompanied by gastrointestinal complications.
- Occult gastrointestinal bleeding (GIB) is a recognized, though less common, manifestation in some COVID-19 patients.
- Understanding the clinical features and risk factors for GIB in COVID-19 is crucial for patient management.
Purpose of the Study:
- To investigate the clinical characteristics and gastroscopic findings of COVID-19 patients with occult GIB.
- To identify factors associated with the occurrence of occult GIB in patients with COVID-19.
Main Methods:
- A retrospective observational study of 368 COVID-19 patients with positive fecal or gastric occult blood tests.
- Comparison of clinical features between patients with and without occult GIB.
- Logistic regression analysis to determine independent risk factors for occult GIB.
Main Results:
- 11.7% of COVID-19 patients exhibited occult GIB, with 81.4% of these occurring in severe cases.
- Patients with occult GIB had elevated CRP, prothrombin time, and D-dimer, with decreased lymphocyte and albumin levels.
- Independent predictors for GIB included low albumin levels, prolonged prothrombin time, and severe COVID-19 disease.
Conclusions:
- Occult GIB in COVID-19 patients is associated with a poorer prognosis.
- Decreased serum albumin, prolonged prothrombin time, and severe disease status are significant risk factors for occult GIB in COVID-19.
- Further research into the mechanisms and optimal management of GIB in COVID-19 is warranted.
Background:
There has been an increasing number of COVID-19 patients around the world. Since some patients developed with gastrointestinal bleeding, our study focused on the clinical features and gastroscopic findings of these patients, and factors associated with occult gastrointestinal bleeding.
Patients And Methods:
In this retrospective, observational study, we collected 368 COVID-19 patients who performed fecal or gastric occult blood from Wuhan Tongji Hospital, Jin Yin-tan Hospital, and Wuhan Union Hospital between February 1, 2020 and March 6, 2020. Clinical features were compared between patients with or without occult gastrointestinal bleeding, and gastroscopic findings of seven patients were described. Logistic regression analyses were performed to explore the factors associated with occult gastrointestinal bleeding.
Results:
In total, 43 (11.7%) patients presented occult gastrointestinal bleeding, whereas 35 (81.4%) of severe cases. CRP level, prothrombin time and D-dimer were higher, while lymphocyte count and albumin levels were decreased in patients with occult gastrointestinal bleeding. Gastroscopy in seven COVID-19 patients showed mucosal congestion, erosion or scattered bleeding at different sites. Albumin levels (OR, 0.856 [95% CI 0.793-0.924]; p < 0.001), prothrombin time (OR, 1.267 [1.089-1.475]; p = 0.002) on admission and severe disease (OR, 4.157 [1.765-9.791]; p = 0.001) were independent factors associated with GIB in COVID-19 patients, while antiviral drugs and glucocorticoid therapy were not associated with it.
Conclusion:
COVID-19 patients with occult gastrointestinal bleeding suffered from worse prognosis. Patients with decreased serum albumin levels or prolonged prothrombin time, and severe cases were at higher risk of occult gastrointestinal bleeding.
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