S0605 The Risk of Gastrointestinal Bleeding in Hospitalized COVID-19 Patients

Abstract

INTRODUCTION: The novel coronavirus/COVID-19 or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was initially reported in China, and soon emerged as a global health issue. Its mostly known to affect the respiratory system but also affects other organ systems such as the gastrointestinal tract. The exact pathogenesis of SARS-COV-2 associated injury is not well understood but cytokine mediated endothelial injury resulting in microthrombi formation may be involved. Hence, these patients are started on anticoagulation preemptively. We investigated the incidence of gastrointestinal bleeding (GIB) in hospitalized patients with SARS-CoV-2 and its effect on mortality. METHODS: We conducted a retrospective study of the hospitalized patients with SARS-CoV-2 infection at our hospital. Nasopharyngeal swabs confirmed the diagnosis for SARS-CoV-2. We used electronic medical records (EMR) to identify patients with overt GIB. They were followed to review the mortality status. Other parameters including laboratory parameters and basic demographic features were also extracted. Univariate analysis was performed to determine the significant predictors for GIB and mortality. RESULTS: There were 1206 patients with SARS-CoV-2 infection during our study period. There were 37 (3.1%) patients who developed GIB, out of which 43% (n = 16) had a major bleed. Upper gastrointestinal tract was the most common site of bleeding (n = 30) and coffee ground emesis, the most common presentation. Patients on mechanical ventilation and therapeutic anti-coagulation were more likely to develop GIB (Table. 1) and so were patients with SARS-CoV-2 and elevated prothrombin time. The mortality for the SARS-CoV-2 infected patients was 34% (n = 412). Patients on therapeutic anti-coagulation had a higher mortality as comparted to those not on anti-coagulation (18.7 % vs 10%, P = 0.001). However, presence of GIB did not predict mortality of the patients hospitalized with SARS-CoV-2 (Table. 2). CONCLUSION: In SARS-CoV-2 infection, cytokine mediated microemboli involving the cardiovascular system, nervous system, and the gastrointestinal tract causing ischemia and necrosis of the involved tissue is a feared complication. Therefore therapeutic anticoagulation is recommended. In our study, incidence of GIB in these patients on anticoagulation and mechanical ventilation was increased. However, it did not contribute to overall mortality. Therefore, Anticoagulants can be safely given if clinically indicated in SARS-CoV-2 patients.Table 1.: Demonstrates baseline characteristic in patients with gastrointestinal bleedingTable 2.: Comparison of parameters based on mortality outcomes in patient with SARS-CoV-2 infection