S679 Outcomes of Acute Gastrointestinal Bleeding in Patients With COVID-19: A Case Control Study

Abstract

Introduction: COVID-19 patients are at high risk of acute gastrointestinal (AGIB) bleeding due to higher use of steroids, mechanical ventilation and use of anti-coagulation. Limited studies are available that evaluated the differences in outcomes of AGIB in COVID-19 patients with non-COVID-19 patients. The purpose of the study was to describe the characteristics and outcomes of COVID-19 positive patients with AGIB compared to matched controls with AGIB without COVID-19. Methods: This was a case control study including patients admitted from March 2020 to February 2021 with the diagnosis of AGIB. Patients were divided into two groups, COVID-19 positive and non-COVID patients. Our primary outcomes were in-hospital or 30 days mortality and length of stay. Secondary outcomes were rate of rebleeding, need for ICU level of care and need for blood transfusion. We performed matching without replacement by age (± 10 years) and sex. Patient’s characteristics are summarized using means and standard deviations or medians and interquartile ranges for continuous variables and frequency counts and percentages for categorical variables. The association between outcomes and AGIB in COVID-19 positive patients was estimated using conditional logistic regression models and odds ratios (OR) and 95% confidence intervals (CI) are reported. SAS. 9.4 was used for analysis. Results: Eighteen COVID-19 positive patients and 54 matched non-COVID-19 patients were included. Mean age was 69.7 years and 66.7% were male. Melena was the most common presentation and there was no significant difference in the hemoglobin on presentation between the two groups. The COVID-19 positive patients less frequently had endoscopies performed (33.3% vs 74.1%, p = 0.0059) and had greater steroid use (83.3% vs 14.8%, p < 0.0001) compared to non-COVID-19 patients. COVID-19 patients were more likely to have had an ICU stay (OR 20.41; 95% CI 2.59, 160.69; p=0.004) and had longer hospital length of stays (OR 1.08; 95% CI 1.03, 1.13; p=0.002). Mortality, readmission within 30 days, need for blood transfusion, and having rebleeding during the admission did not differ for COVID-19 and non-COVID-19 patients. Conclusion: COVID-19 patients with AGIB are more likely to require ICU admission and had longer length of stay. Despite significantly lower rate of endoscopic procedures performed in COVID-19 patients need for blood transfusion, mortality and rebleeding were not significantly different.