Introduction: The coronavirus disease 2019 (COVID-19) has been observed to affect the gastrointestinal (GI) system with symptoms such as nausea, vomiting, diarrhea, anorexia, and abdominal pain. There is currently limited literature regarding characteristics of gastrointestinal bleeds (GIB) in patients with COVID-19 admitted to the intensive care unit (ICU). We aimed to study clinical characteristics of GIB in COVID-19 patients admitted to the ICU.
Methods: We retrospectively studied COVID-19 patients admitted to the ICU at an academic tertiary care center between January 2020 and September 2020. Among these patients we identified those that had a diagnosis of GIB at time of admission or during hospitalization. All patients ≥ 18 years with overt GIB (melena, hematochezia, hematemesis) and acute anemia were included in this study. Baseline demographics, comorbidities, pharmacological therapies, types and characteristics of GIB, interventions and outcomes were collected. Variables were compared using chi-square and Fisher exact tests and logistic regressions.
Results: A total of 407 COVID-19 patients were admitted to the ICU during the study period. Of these, 100 patients had GIB. Mean age 64 years, 70% male, 48% Hispanic. 16 were cirrhotics. 74% were on anticoagulation. Upper GIB occurred in 76% of patients with most common cause being due to duodenal or gastric ulcer (46.7%). 52% of these were duodenal ulcers. Most common ulcer type was Forrest Classification III. Mean ulcer size was 15.39 ± 8.56 mm. Hemoclip with epinephrine injection was the most common intervention. Diverticular disease was the most common cause of lower GIB (42.2%). Mean hemoglobin was 8.13 g/dl and 49% of patients required blood transfusion. Overall mortality was 41%.
Discussion: This study highlights clinical characteristics of GIB in ICU patients with COVID-19. The majority had an upper GIB, mostly commonly from duodenal ulcers. Anticoagulation use was a major risk factor for GIB and almost half of patients required blood transfusion. We speculate that the utilization of higher doses of anticoagulation related to increased risk of coagulopathy and thrombotic events as well as systemic inflammation place COVID-19 patients at higher risk for GIB. It is important for clinicians to have a heightened awareness of the possible propensity of COVID-19 patients to have GIB and to utilize clinical judgment for individualized management. Further studies on GIB in COVID-19 patients admitted to ICU are required.
.jpg "Sameeha Khalid, DO photo")