S3303 Outcomes of Gastrointestinal Bleeding During the COVID-19 Pandemic

Abstract

Introduction: The novel circumstances during the pandemic have led to many challenges for clinicians and patients, including cancellation of procedures, policy regulations and the reluctance of patients to seek medical attention, potentially leading to adverse outcomes. Patients with gastrointestinal bleeding (GIB) require early resuscitation and possible intervention. The aim of this study was to investigate differences in the outcomes of hospitalized patients who encountered GIB during the initial peak of Coronavirus 2019 (COVID-19) pandemic in March 2020, compared to the year prior. Methods: In this retrospective cohort study, patients with GIB who presented to our institution during the first two weeks of March 2019 and 2020 were identified using ICD-10 codes for GIB. The diagnosis of GIB was confirmed based on assessment of hemoglobin (Hb), diagnostic imaging, endoscopy or clinical evidence of gross hemorrhage. Analysis was conducted with the Welch T-test and Pearson's chi-square test utilizing R 4.1.0. Results: We identified 89 patients with GIB in 2019 and 76 in 2020. Of the 2020 cohort, 88.2% tested positive for COVID-19. Compared with 2019, patients in 2020 were significantly older (years) (62.1 vs 68.3, P < 0.01), required longer hospital length of stay (days) (11.3 vs 20.9, P < 0.01), had higher rate of mortality (12.5% vs 36%, P < 0.01), were less likely to have history of cirrhosis (25.8% vs 6.6%, P < 0.01), presented with a higher Hb (mL/dL) (9.9 vs 11.9, P < 0.001), were less likely to undergo EGD (58.4% vs 13.2%, P < 0.001), or colonoscopy (21.6% vs 4 %, P < 0.01). There was no significant difference between baseline Hb or nadir Hb, P >0.05. The most common primary causes of death in 2019 were decompensated liver failure (27.3%), followed by septic shock (18%) and cardiogenic shock (18%), compared to 2020 deaths, which were COVID-19 respiratory failure (67.9%), hemorrhagic shock (11.1%) and cardiogenic shock (7%). Conclusion: Despite presenting with higher Hb on admission, patients during the COVID-19 pandemic had a higher rate of mortality. The most common cause of death was respiratory failure secondary to COVID-19. Our results also suggested patients with GIB were less likely to undergo endoscopic evaluation during the pandemic. Given the limitations of our study, it’s difficult to say whether this was due to strict COVID-19 isolation precautions, cardiopulmonary instability making endoscopy high risk, or clinical assessment suggesting GIB was not the primary cause of patient decline.Table 1.: Primary causes of death in year 2019 and 2020.