Upper gastrointestinal system bleedings in COVID-19 patients: Risk factors and management/a retrospective cohort study

COVID-19 and Upper Gastrointestinal Bleeding; Etiology, Risk Factors, and Outcomes: A Case-Control Study

Background

COVID-19-associated gastrointestinal (GI) symptoms are often self-limiting; however, gastrointestinal bleeding (GIB) is a critical complication in patients with COVID-19. The present study investigates the etiology, risk factors, esophagogastroduodenoscopy (EGD) findings, and outcomes associated with upper gastrointestinal bleeding (UGIB) in hospital inpatients with COVID-19.

Methods

In this retrospective case-control study, 127 patients with COVID-19 in Kerman, Iran, were diagnosed using reverse transcription polymerase chain reaction (RT-PCR) and subsequently divided into case and control groups from January 2022 to July 2022.

Results

This study evaluated 64 patients with COVID-19 with UGIB and 63 patients without. The case group reported previous history of GIB and cirrhosis at 17.2% and 12.5%, respectively (P=0.001 and P=0.01). Melena (37.5%) and peptic ulcer (21.87%) were the most common UGIB symptom and EGD findings, respectively. In the comparison of the case group with the control group, the duration of the patient's stay in the intensive care unit (ICU) (11.58±1.13 vs. 8.29±1.06 days), the need for invasive mechanical ventilation (IMV) (17.2% vs. 8.1%), and the mortality rate (26.6% vs. 18.9%) were recorded (P=0.03, 0.124, and 0.07, respectively).

Conclusion

Patients with COVID-19 and UGIB have a more prevalent ICU stay compared with those without. Melena and peptic ulcer were the most common presentations and EGD findings in these patients. Additionally, liver cirrhosis and a history of previous GIB increased the risk of GIB in patients with COVID-19.

Prevalence and outcomes of upper gastrointestinal bleeding in COVID-19: A systematic review and meta-analysis

Upper gastrointestinal bleeding (UGIB) in COVID-19 presents challenges in patient management. Existing studies lack comprehensive review due to varied designs, samples, and demographics. A meta-analysis can provide valuable insights into the incidence, features, and outcomes of UGIB in COVID-19. A comprehensive literature search was carried out using several databases. We considered all appropriate observational studies from all over the world. Mantel-Haenszel odds ratios and associated 95% confidence intervals (CIs) were produced to report the overall effect size using random effect models. Besides, Random effects models were used to calculate the overall pooled prevalence. Funnel plots, Egger regression tests, and Begg-Mazumdar's rank correlation test were used to appraise publication bias. Data from 21 articles consisting of 26,933 COVID-19 patients were considered. The pooled estimate of UGIB prevalence in patients admitted with COVID-19 across studies was 2.10% (95% CI, 1.23-3.13). Similarly, the overall pooled estimate for severity, mortality, and rebleeding in COVID-19 patients with UGIB was 55% (95% CI, 37.01-72.68), 29% (95% CI, 19.26-40.20) and 12.7% (95% CI, 7.88-18.42) respectively. Further, UGIB in COVID-19 patients was associated with increased odds of severity (OR = 3.52, 95% CI 1.80-6.88, P = 0.001) and mortality (OR = 2.16, 95% CI 1.33-3.51, P = 0.002) compared with patients without UGIB. No significant publication bias was evident in the meta-analysis. The results of our study indicate that UGIB in individuals with COVID-19 is linked to negative outcomes such as severe illness, higher mortality rates, and an increased risk of re-bleeding. These findings highlight the significance of identifying UGIB as a significant complication in COVID-19 cases and emphasise the importance of timely clinical assessment and proper treatment.