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Upper gastrointestinal system bleedings in COVID-19 patients: Risk factors and management/a retrospective cohort
Ümit Alakuş1, Umut Kara2, Cantürk Taşçı3
1Department of General Surgery, Division of Gastroenterologic Surgery, University of Health Sciences, Gülhane Training and Research Hospital, Ankara-Turkey.
Insights
Upper gastrointestinal bleeding (UGIB) is uncommon in COVID-19 patients but significantly increases mortality, especially with steroid use. Conservative management is often sufficient, reducing the need for endoscopy during the pandemic.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Critical Care Medicine
Background:
- COVID-19 can cause coagulopathy, increasing bleeding risk.
- Treatments like low molecular weight heparin (LMWH) and steroids may exacerbate bleeding.
- Understanding UGIB in COVID-19 is crucial for patient outcomes.
Purpose of the Study:
- To determine the frequency of upper gastrointestinal bleeding (UGIB) in COVID-19 patients.
- To identify risk factors, including medications and comorbidities.
- To evaluate the impact of UGIB on patient outcomes and management strategies.
Main Methods:
- Retrospective analysis of hospitalized COVID-19 patients (March-December 2020).
- Inclusion of patients with UGIB symptoms/signs.
- Comparison of demographic, clinical, medication, endoscopic, and mortality data between survivors and non-survivors.
Main Results:
- UGIB occurred in 0.8% of 5484 COVID-19 patients.
- The average age of bleeding patients was 70.1 years; 73% were male.
- Steroid treatment (rate and duration) was significantly higher in non-survivors.
Conclusions:
- UGIB is less frequent but more fatal in COVID-19 patients.
- Steroid use further elevates mortality risk.
- Conservative management is often adequate, suggesting a need to reduce unnecessary endoscopies during pandemics.
Background:
Upper gastrointestinal system bleeding (UGIB) that occurs with the effect of coagulopathy due to COVID-19 disease itself and drugs such as LMWH and steroids used in the treatment negatively affects the outcomes. In this study, we aimed to examine the frequency of gastrointestinal system bleeding in COVID-19 patients, risk factors, effect on outcomes, and management.
Methods:
Institutional center (a third-level pandemic center) database was searched for patients hospitalized for COVID-19 between March 11, 2020, and December 17, 2020, retrospectively. Patients with UGIB symptoms/signs were included in the study. Age, gender, body mass index (kg/m2), hospital department where bleeding was diagnosed, previous bleeding history, comorbidities, and medication were steroid, anticoagulant, low weight molecule heparin, and proton-pomp inhibitor, endoscopic findings/treatment, transfusion, and mortality rates were evaluated. Patients were divided into two groups as survivors and non-survivors and parameters were compared.
Results:
Forty-five of a total 5484 patients under COVID-19 treatment had upper gastrointestinal bleeding (0.8%). The average age of the patients was 70.1 years and 73% bleeders were male. Nineteen patients (44%) underwent endoscopy. The most common etiologies of bleeding were gastric/duodenal ulcer (n=9), erosive gastritis (n=4), and hemorrhagic gastritis (n=3). Active bleeding re-quiring intervention was detected in only one patient; therapeutic band ligation was applied to only 1 (2%) of all patients. The most common etiologies of bleeding were gastric/duodenal ulcer (n=9), erosive gastritis (n=4), and hemorrhagic gastritis (n=3). In terms of statistical significance, it was observed that the rate of steroid treatment (77% vs. 39%) and the number of days of steroid treatment were higher in non-survivor group.
Conclusion:
UGIB is less common in COVID-19 patients compared to other hospitalized patients. However, it significantly increases mortality. Mortality risk increases even more in patients using steroids. These risks should be considered in patients under COVID-19 treatment. The majority of the bleeding patients does not require endoscopic treatment and should be managed conser-vatively. It is worth considering reducing unnecessary endoscopies in the pandemic.
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