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COVID-19 severity is associated with the risk of gastrointestinal bleeding
Shuji Hibiya1, Takashi Fujii2, Toshimitsu Fujii3
1Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan.
Insights
The severity of coronavirus disease 2019 (COVID-19) increases the risk of gastrointestinal bleeding. Patients with severe or critical COVID-19 face a significantly higher risk, particularly for lower gastrointestinal bleeding.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Critical Care Medicine
Background:
- The relationship between COVID-19 severity and gastrointestinal (GI) bleeding remains unclear.
- Understanding this association is crucial for managing hospitalized patients.
Purpose of the Study:
- To investigate if COVID-19 severity is a risk factor for GI bleeding.
- To quantify the risk of GI bleeding in relation to COVID-19 severity.
Main Methods:
- Retrospective cohort study of 12,044 hospitalized COVID-19 patients (Jan 2020-Dec 2021).
- COVID-19 severity classified using National Institute of Health criteria.
- Multivariable logistic regression analyzed the association between COVID-19 severity and GI bleeding occurrence.
Main Results:
- 55 patients (0.5%) experienced GI bleeding.
- Severe COVID-19 (OR: 3.013) and critical COVID-19 (OR: 15.632) significantly increased GI bleeding risk.
- Severe COVID-19 elevated the risk of lower GI bleeding (OR: 10.349) but not upper GI bleeding.
Conclusions:
- COVID-19 severity is linked to an increased risk of GI bleeding.
- Lower GI bleeding is particularly associated with severe COVID-19.
- Patients with severe or critical COVID-19 require cautious management due to elevated GI bleeding risk.
Objective:
The association between the severity of COVID-19 and gastrointestinal (GI) bleeding is unknown. This study aimed to determine whether the severity of COVID-19 is a risk factor for GI bleeding.
Design:
A multicentre, retrospective cohort study was conducted on hospitalised patients with COVID-19 between January 2020 and December 2021. The severity of COVID-19 was classified according to the National Institute of Health severity classification. The primary outcome was the occurrence of GI bleeding during hospitalisation. The main analysis compared the relationship between the severity of COVID-19 and the occurrence of GI bleeding. Multivariable logistic regression analysis was performed to evaluate the association between the severity of COVID-19 and the occurrence of GI bleeding.
Results:
12 044 patients were included. 4165 (34.6%) and 1257 (10.4%) patients had severe and critical COVID-19, respectively, and 55 (0.5%) experienced GI bleeding. Multivariable analysis showed that patients with severe COVID-19 had a significantly higher risk of GI bleeding than patients with non-severe COVID-19 (OR: 3.013, 95% CI: 1.222 to 7.427). Patients with critical COVID-19 also had a significantly higher risk of GI bleeding (OR: 15.632, 95% CI: 6.581 to 37.130). Patients with severe COVID-19 had a significantly increased risk of lower GI bleeding (OR: 10.349, 95% CI: 1.253 to 85.463), but the risk of upper GI bleeding was unchanged (OR: 1.875, 95% CI: 0.658 to 5.342).
Conclusion:
The severity of COVID-19 is associated with GI bleeding, and especially lower GI bleeding was associated with the severity of COVID-19. Patients with severe or critical COVID-19 should be treated with caution as they are at higher risk for GI bleeding.
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