D0285 - Gastrointestinal Bleeding in COVID-19

Tuesday, October 25, 2022

10:00 AM – 12:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

MJ

Michelle Jones-Pauley, DO

Houston Methodist Hospital
Houston, TX

Michelle Jones-Pauley, DO, Rajdeepsingh Waghela, MD, Adriana Ordonez, BS, Neha Mathur, MD
Houston Methodist Hospital, Houston, TX

Introduction: Coronavirus-19 (COVID) is primarily a respiratory virus which is known to impact the gastrointestinal tract through propagation of a proinflammatory cytokine cascade. It is unknown if inflammation from COVID, acuity of illness due to COVID or other factors such as medications or co-morbidities increase the risk of bleeding in COVID-19 patients as compared to non-COVID infected patients.

Methods: This is a retrospective study performed between July 1, 2020 and January 30, 2021. A total of 395 patients were identified that met the inclusion criteria of the protocol. Patient charts were reviewed and data extracted. Fisher’s exact test or Chi-squared test were used to find the association between 2 categorical variables. Two-sample t-test or Wilcoxon rank-sum test were used to compare a continuous variable between the two groups. A p-value < 0.05 was considered statistically significant and Stata V17 was used to perform the analysis.

Results: The average age in the whole sample was 67.23 years old (Std. dev=14.68). Table 1 also shows that there was no statistical difference (p=0.94) in mean age between patients with COVID (mean: 67.32, Std. dev: 11.92) and non-COVID (mean: 67.19, Std. dev: 15.80). There was statistically significant association (p-value=0.010) between the comorbidity Diabetes and the COVID group. Specifically, there were more Diabetic patients (51.22%) in the COVID group than the non-COVID group (37.5%). The median INR in the non-COVID group was lower 1.20 (1.10-1.40) compared with the COVID group 1.30 (1.10-1.50; p=0.003). NSAID use was higher in non-COVID patients than in COVID patients (30 vs. 3, p=0.003). The rate of active bleeding among COVID patients was 36/123 (29%), versus 63/272 (23%) in non-COVID patients (p=0.21). Although the rate of active bleeding was higher in Non-COVID patients, the location of bleeding etiology was higher in the small bowel for COVID patients (13% vs. 8%).

Discussion: There was no statistically significant relationship found between rate of active bleeding in COVID and non-COVID patients. This could potentially be explained by the tendency to defer endoscopy early in the pandemic in COVID patients due to infectious control concerns. Additionally, there was also an inclination to conservatively manage critically ill patients. In the future, the rate of bleeding in COVID and non-COVID patients should be reviewed over a longer time frame of the pandemic, and the vaccination status of patients should also be considered.

	Total	Non-COVID	COVID	p-value
	N=395	N=272	N=123

Age (years)
Mean (Std. dev)	67.23 (14.68)	67.19 (15.80)	67.32 (11.92)	0.94
Median (IQR)	70.00 (59.00-77.00)	71.00 (59.00-78.00)	69.00 (63.00-74.00)
Comorbidities
HTN				0.24
no	122 (30.89%)	89 (32.72%)	33 (26.83%)
yes	273 (69.11%)	183 (67.28%)	90 (73.17%)
Diabetes				0.010
no	230 (58.23%)	170 (62.50%)	60 (48.78%)
yes	165 (41.77%)	102 (37.50%)	63 (51.22%)
Renal Disease†				0.19
no	290 (73.42%)	205 (75.37%)	85 (69.11%)
yes	105 (26.58%)	67 (24.63%)	38 (30.89%)
Liver Disease‡				0.95
no	341 (86.33%)	235 (86.40%)	106 (86.18%)
yes	54 (13.67%)	37 (13.60%)	17 (13.82%)
Admission Data
HR (in bpm)*
Mean (Std. dev)	83.15 (16.93)	81.78 (16.41)	86.12 (17.71)
Median (IQR)	80.50 (71.00-94.00)	80.00 (70.00-92.00)	82.00 (72.00-100.00)	0.045
Hb (g/dL)*
Mean (Std. dev)	8.56 (2.76)	8.67 (2.69)	8.33 (2.91)
Median (IQR)	7.90 (6.50-10.70)	8.20 (6.60-11.00)	7.50 (6.20-10.30)	0.15
Platelets (*k/uL)
Mean (Std. dev)	226.23 (110.47)	230.29 (112.93)	217.34 (104.76)
Median (IQR)	213.00 (153.00-288.00)	214.00 (156.00-292.00)	202.00 (144.00-287.00)	0.31
INR*
Mean (Std. dev)	1.56 (1.38)	1.47 (1.08)	1.75 (1.82)
Median (IQR)	1.20 (1.10-1.50)	1.20 (1.10-1.40)	1.30 (1.10-1.50)	0.003
Transfusion required				0.066
no	135 (34.18%)	101 (37.13%)	34 (27.64%)
yes	260 (65.82%)	171 (62.87%)	89 (72.36%)
NSAIDs				0.003
no	362 (91.65%)	242 (88.97%)	120 (97.56%)
yes	33 (8.35%)	30 (11.03%)	3 (2.44%)

Table: Patient’s characteristics by COVID-19 group. *Data was analyzed using Wilcoxon-rank sum. Data was missing for: Hb in 1 patient; INR in 94 patients; platelets in 2 patients; HR in 7 patients. †Renal disease was defined as ranging from chronic kidney disease stage 3 to end-stage renal disease requiring dialysis. ‡Liver disease was defined as a range of chronically elevated liver enzymes without fibrosis to decompensated cirrhosis.

Disclosures:

Michelle Jones-Pauley indicated no relevant financial relationships.

Rajdeepsingh Waghela indicated no relevant financial relationships.

Adriana Ordonez indicated no relevant financial relationships.

Neha Mathur indicated no relevant financial relationships.

Michelle Jones-Pauley, DO, Rajdeepsingh Waghela, MD, Adriana Ordonez, BS, Neha Mathur, MD. D0285 - Gastrointestinal Bleeding in COVID-19, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.