Incidence, Risk Factors and Mortality Associated with Major Bleeding Events in Hospitalized COVID-19 Patients

Area of Science:

• Internal Medicine
• Infectious Diseases
• Critical Care Medicine

Background:

• Hospitalized COVID-19 patients face a high risk of thrombotic events, necessitating thromboprophylaxis.
• Thromboprophylaxis increases the risk of bleeding, yet data on bleeding events and risk factors in this population are limited.

Purpose of the Study:

• To investigate the incidence, predictors, and clinical outcomes of major bleeding in hospitalized COVID-19 patients.

Main Methods:

• Retrospective cohort study of 4014 hospitalized COVID-19 patients between March 2020 and March 2021.
• Analysis included documentation of bleeding events, risk factor assessment using multivariate logistic regression, and comparison of mortality rates.

Main Results:

• Major bleeding occurred in 3.2% of patients (129/4014), with 40.1% presenting at admission and 59.9% occurring during hospitalization.
• Independent predictors of major bleeding included intensive care unit (ICU) treatment, atrial fibrillation, higher white blood cell count, lower hemoglobin, and a history of bleeding.
• Major bleeding was associated with significantly increased in-hospital mortality (59.7% vs. 34.8%, p < 0.001), with a median time of 5 days from bleeding to death if it occurred during hospitalization.

Conclusions:

• Bleeding events are frequent in hospitalized COVID-19 patients, with a substantial proportion presenting upon admission.
• Major bleeding is a significant predictor of mortality in COVID-19 patients, underscoring the need for risk stratification and timely intervention.
• Recognizing patients at risk for major bleeding and implementing prompt management strategies are critical for improving clinical outcomes in hospitalized COVID-19 patients.