S674 Incidence of Gastrointestinal Hemorrhage in Hospitalized COVID-19 Patients and Subsequent Clinical Outcomes

Abstract

Introduction: SARS-CoV-2 infection (COVID-19) is known for its pathologic effects on micro-vasculature and is proposed to afflict the gastrointestinal tract via the ACE2 receptors. We hypothesize that there is a higher incidence and an increased risk of mortality among Covid-19 patients with gastrointestinal bleeding (GIB). Methods: This retrospective study included 2,711 patients ages 18 years or older who tested positive for Covid-19 between March 2020 through March 2021 at a public hospital in New York City. GIB was documented based on clinical criteria and a decrease in hemoglobin level. Patients were divided into two groups, GIB and non-GIB. We examined baseline characteristics of sex and age, as well as comorbidities including diabetes mellitus type 2, chronic kidney disease (CKD), chronic obstructive pulmonary disease (COPD), coronary artery disease (CAD), hypertension (HTN), heart failure (HF), and proton pump inhibitor (PPI) use. We used T-test for statistical analysis of age and Pearson's chi-squared test for the primary outcome of all-cause mortality and the secondary outcomes of acute kidney injury, vasopressor use, and mechanical ventilation. Results: Of 2,711 patients, 205 (incidence of 8.18%) developed GIB. Overall sample characteristics included mean age of 71.15 (SD = 16.36) and 63.36 (SD = 19.26) for GIB and non-GIB groups, respectively. Males comprised 54.6% of the GIB group and 54.1% of the non-GIB group. Baseline clinical characteristics except for sex significantly differed between groups (p< 0.05). The odds of all-cause mortality (OR: 2.604, 95% CI: 1.947, 3.482, p < 0.001) were significantly higher in the GIB group. For secondary outcomes, patients with GIB had increased unadjusted odds for acute kidney injury (OR: 3.238, 95% CI: 2.387, 4.392, p < 0.001), vasopressor use (OR: 3.004, 95% CI: 2.242, 4.023, p< 0.001), and mechanical ventilation (OR: 2.806, 95% CI: 2.079, 3.787, p< 0.001). Conclusion: GIB is associated with increased odds for all-cause mortality, mechanical ventilation, vasopressor use, and acute kidney injury compared to patients without GIB. Despite having largely differing baseline characteristics, these findings support studies that suggest a correlation between GI symptoms and Covid-19 disease severity. Future research with a larger sample size is needed. Subsequently, supportive care is key to decreasing morbidity and mortality amongst these patients.