CLINICAL OUTCOME OF COVID-19 PATIENTS WITH GASTROINTESTINAL BLEEDING ADMITTED IN A TERTIARY GOVERNMENT HOSPITAL

M.A.B. Buenaventura, MD; M.A.V. Chu, MD;L.B. Gatchalian, MD; M.Talingdan-Te, MD; S.D. Preza-Carmona, MD
Section of Gastroenterology, Department of Internal Medicine , East Avenue Medical Center, East Avenue, Diliman, Quezon City, Philippines

Significance: COVID-19 is dramatically growing worldwide and declared an official pandemic by WHO last March 11, 2020. No specific treatment is currently available and different classes of drug have been used in hospitalized patients such as antiviral agents, glucocorticoids, monoclonal antibodies and even antimalarial drugs. Risk and incidence of upper gastrointestinal bleeding (UGIB) in COVID-19 patients come hand in hand with the proposed treatment for moderate to severe infection. Thus, this study aims to assess the incidence, management and outcome of gastrointestinal bleeding in COVID-19 patients. Likewise, to evaluate the association between gastrointestinal bleeding and mortality in these patients.

Methodology: The study design is a retrospective cohort research through a retrospective chart review. 200 COVID 19 patients admitted in a tertiary hospital, diagnosed with moderate, severe and critical classification were included. Clinical profile and outcome was measured using frequencies, mean, and median. Descriptive statistics was used to summarize the demographic and clinical characteristics of the patients. Continuous variables were compared using Mann-Whitney U test. Pearson’s Chi-square test were used to examine categorical parameters. Multivariate logistic regression was used to analyze relationship of mortality, GI Bleeding and other parameters.

Results: 200 in-patients with COVID-19 confirmed were eligible for this analysis. Selected outcome measures were compared between mortality groups among patients with GI bleeding. There were a total of 98 patients with GI bleeding during the course of admission. 58 patients or 59% died during the hospital stay while 41% were subsequently discharged. Anticoagulation therapy was given as prophylaxis in 84 out 98 patients. This was subsequently stopped once bleeding started. Among GI bleeding patients, those who did not receive anticoagulation have higher mortality of 86% compared to those given anticoagulation. Prophylactic anticoagulation is associated with lower mortality rate in c19 patients, even in patients with subsequent GI bleeding during their course of stay. Multivariate logistic regression analysis was used to predict mortality. The result revealed that GI bleeding (OR – 24.6, p-value<0.001), anticoagulation (OR – 0.3, p-value=0.023), and mechanical ventilation (OR – 3.1, p-value=0.020) are significant predictors of mortality.

Conclusion: In this study, the incidence of GI bleeding in COVID 19 patients is 49%. Risk factors leading to GI bleeding are severe Covid 19 infection, anticoagulant use and respiratory failure. The identified factors affecting GI bleeding in COVID 19 patients that may contribute to the mortality were the following; elderly population with comorbid, COVID classification as Severe to Critical cases even with the use of high dose PPI high, antivirals, steroid, vasopressor, and anticoagulant prophylactic dose medications.

Keywords: COVID and GI Bleeding, Anticoagulant COVID 19, Predictors of Mortality in Covid19 patients.

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