Outcomes Of Upper Gastrointestinal Bleeding Research Articles

Causes and outcomes of upper gastrointestinal bleeding in referral hospitals in Rwanda: a prospective study

INTRODUCTION: Upper gastrointestinal (GI) bleeding is a common emergency that results in significant morbidity and mortality. In Rwanda, data on causes and outcomes are lacking. The aim of this study was to identify the causes and outcomes of upper gastrointestinal bleeding in patients referred to tertiary referral centers.
 METHODS: This is an observational prospective study for which we enrolled all patients who presented with presumed upper gastrointestinal bleeding and underwent upper gastrointestinal endoscopy. We studied causes and outcomes during 3 months of follow-up after initial presentation from February 2019 to September 2019.
 RESULTS: We enrolled 194 participants. The mean age was 49.6 ± 17.66 years. The common causes of upper GI bleeding were peptic ulcer disease in 82 (43.3%) patients, esophageal varices 32 (16.5%), gastric malignancies 22 (11.3%), and gastritis 21 (10.8%). The upper GI endoscopy was reported to be normal in only 20 cases (10.3%). The mortality and rebleeding rates after 3 months were 37 (19.07%) and 70 (36%) respectively. The esophageal varices were associated with increased rebleeding (OR: 10.791, P value <0.001), while gastric cancer was associated with increased mortality (OR: 4.405, P value 0.008).
 CONCLUSION: Upper gastrointestinal bleeding is a considerable problem in Rwandan teaching hospitals. Our findings are in agreement with the reported causes of upper GI bleeding worldwide. From this study, we consider that variceal hemorrhage and peptic ulcer may have the potential to be better managed.

Risk factors and outcomes of upper gastrointestinal bleeding in hospitalized patients in a tertiary care hospital.

To determine different aetiologies and outcomes of upper gastrointestinal bleeding in hospitalised patients. The retrospective cohort study was conducted at the Aga Khan University Hospital, Karachi, and comprised data from December 2019 to April 2021 related to adult patients of either gender with nongastrointestinal illnesses who developed bleeding at least 24 hours after admission. Data was reviewed for clinical characteristics, cause of bleeding and clinical outcome. Data was analysed using SPSS 23. Among 47,337 hospitalised patients, upper gastrointestinal bleeding was identified in 147(0.3%); 98 (66.7%) males and 49 (33.3%) females. The overall mean age was 62.73±14.81 years (range 20-95 years). Of the total, 125(85%) presented with overt bleeding and 22(15%) with a drop in haemoglobin level. There were 34(23%) patients on aspirin, 36(24%) on dual anti-platelets, 41(28%) on therapeutic anticoagulation, and 81(55%) on prophylactic anticoagulation. There were 7(5%) patients having a history of non-steroidal anti-inflammatory drugs (NSAIDs), and 12(8%) were on steroids. In terms of associated medical conditions, pneumonia, stroke, and acute coronary syndrome were commonly seen with frequency of 29.9%, 8.1% and 7.4% respectively. Overall, 36(24.4%) patients underwent endoscopy, 8(5.4%) had therapeutic measures to control bleeding, 14(9.5%) had bleeding for >48 hours, 89(60.5%) were stepped up to special care. Mortality was seen in 36(24.5%) cases. Hospital acquired gastrointestinal bleeding was found to be uncommon, and there were several risk factors for such bleeding events.

Evaluating the Effectiveness of Modified Early Warning, Glasgow Blatchford, and Pre - Endoscopic Rockall Scoring Systems in Predicting Outcomes of Upper Gastrointestinal Bleeding in Emergency Care

Evaluating the Effectiveness of Modified Early Warning, Glasgow Blatchford, and Pre - Endoscopic Rockall Scoring Systems in Predicting Outcomes of Upper Gastrointestinal Bleeding in Emergency Care

Prevalence and outcomes of upper gastrointestinal bleeding in COVID-19: A systematic review and meta-analysis.

Upper gastrointestinal bleeding (UGIB) in COVID-19 presents challenges in patient management. Existing studies lack comprehensive review due to varied designs, samples, and demographics. A meta-analysis can provide valuable insights into the incidence, features, and outcomes of UGIB in COVID-19. A comprehensive literature search was carried out using several databases. We considered all appropriate observational studies from all over the world. Mantel-Haenszel odds ratios and associated 95% confidence intervals (CIs) were produced to report the overall effect size using random effect models. Besides, Random effects models were used to calculate the overall pooled prevalence. Funnel plots, Egger regression tests, and Begg-Mazumdar's rank correlation test were used to appraise publication bias. Data from 21 articles consisting of 26,933 COVID-19 patients were considered. The pooled estimate of UGIB prevalence in patients admitted with COVID-19 across studies was 2.10% (95% CI, 1.23-3.13). Similarly, the overall pooled estimate for severity, mortality, and rebleeding in COVID-19 patients with UGIB was 55% (95% CI, 37.01-72.68), 29% (95% CI, 19.26-40.20) and 12.7% (95% CI, 7.88-18.42) respectively. Further, UGIB in COVID-19 patients was associated with increased odds of severity (OR=3.52, 95% CI 1.80-6.88, P=0.001) and mortality (OR=2.16, 95% CI 1.33-3.51, P=0.002) compared with patients without UGIB. No significant publication bias was evident in the meta-analysis. The results of our study indicate that UGIB in individuals with COVID-19 is linked to negative outcomes such as severe illness, higher mortality rates, and an increased risk of re-bleeding. These findings highlight the significance of identifying UGIB as a significant complication in COVID-19 cases and emphasise the importance of timely clinical assessment and proper treatment.

Endoscopy Pre- and During Covid-19 Lockdown – Same Outcomes of Upper Gastrointestinal Bleeding Despite Its Severity and Comorbidity

Endoscopy Pre- and During Covid-19 Lockdown – Same Outcomes of Upper Gastrointestinal Bleeding Despite Its Severity and Comorbidity

Clinical outcome of early endoscopy in patients with acute upper gastrointestinal bleeding in Alexandria emergency department

ABSTRACT Background Upper gastrointestinal bleeding (UGIB) is a life-threatening emergency that causes considerable mortality and morbidity. The current study goal was to look at the endoscopic profile and clinical outcomes of patients with UGIB in Alexandria emergency department. Patients and methods 120 patients who had been admitted with acute UGIB were included in this study. All patients underwent upper gastrointestinal endoscopy. Outcomes that were determined included complications like re-bleeding, need for surgical intervention, mortality, hospital stay length, admission to intensive care units (ICUs), transfusion requirement, and re-admission. Results The majority of patients were males (69.2%) with a mean age of (45.47 ± 10.46). The most prevalent lesions causing UGIB were esophageal varices (65.8%) and (45.0%) presented with hematemesis. 51.7% were treated by band ligation. Death was reported in 5.00% and all patients who died had comorbidities, 6.7% re-bled and 50.0% of patients who re-bled were ≥ 60 years. 36.6% of patients had Rockall score (RS) ≥3. There was statistically significant relation between high RS and re-bleeding and mortality (p < 0.001). Conclusion We encountered that the timing of endoscopy was a good determinant of adverse outcomes in UGIB.

Factors Affecting Outcome of Patients with Upper Gastrointestinal Haemorrhage Presenting to Emergency Department: A Prospective observational cohort study

Background: Upper gastrointestinal bleeding (UGIB) is one of the most common presentations in an emergency department (ED). UGI endoscopy is the definitive diagnostic and therapeutic modality for UGIB. Aim of the study were look into the outcomes of UGIB and outcomes based on the timing of endoscopy (early endoscopy mean before 24 hours and late endoscopy mean after 24 hours). Methods: 180 patients presented in ED with UGIB and undergo Upper gastrointestinal (UGI) endoscopy. Socio-demographic profiles, with presenting signs and symptoms, co-morbidities, vitals, lab parameters, endoscopic diagnosis with the treatment of the patient were collected. They were followed up to day 7 of presentation to determine all-cause mortality, re-bleed, development of hemorrhagic shock, admission rate and length of ED stay, early endoscopy and late endoscopy. Result: The mortality difference in the early endoscopy (3.2%) and late endoscopy (16.1%) group was significant with a p-value of 0. 012. Late endoscopy (18.6%) was associated with a higher risk of development of hemorrhagic shock compared to the early group (4.8%) with a p-value of 0.011. The factors that had a significant association with mortality on univariate analysis were, late endoscopy, systolic blood pressure on presentation less than 90, variceal bleeding, blood transfusion requirement, AIMS 65 score greater than 0. Multivariate analysis showed that late endoscopy (OR 5.35(1.12-25.3)) and AIMS 65 score (OR 11.76(1.48-93.3)) were independent risk factors for mortality. Conclusion: We concluded that early endoscopy was associated with decreased mortality, decreased length of ED stay and decreased risk of development of hemorrhagic shock.

Performance of the New ABC and MAP(ASH) Scores in the Prediction of Relevant Outcomes in Upper Gastrointestinal Bleeding.

Background & Aims: Several risk scores have been proposed for risk-stratification of patients with upper gastrointestinal bleeding. ABC score was found more accurate predicting mortality than AIMS65. MAP(ASH) is a simple, pre-endoscopy score with a great ability to predict intervention and mortality. The aim of this study was to compare ABC and MAP(ASH) discriminative ability for the prediction of mortality and intervention in UGIB. As a secondary aim we compared both scores with Glasgow-Blatchford score and AIMS65. Methods: Our study included patients admitted to the emergency room of Virgen de las Nieves University Hospital with UGIB (2017-2020). Information regarding clinical, biochemical tests and procedures was collected. Main outcomes were in-hospital mortality and a composite endpoint for intervention. Results: MAP(ASH) and ABC had similar AUROCs for mortality (0.79 vs. 0.80). For intervention, MAP(ASH) (AUROC = 0.75) and ABC (AUROC = 0.72) were also similar. Regarding rebleeding, AUROCs of MAP(ASH) and ABC were 0.67 and 0.61 respectively. No statistically differences were found in these outcomes. With a low threshold for MAP(ASH) ≤ 2, ABC and MAP(ASH) classified a similar proportion of patients as being at low risk of death (42% vs. 45.2%), with virtually no mortality under these thresholds. Conclusions: MAP(ASH) and ABC were similar for the prediction of relevant outcomes for UGIB, such as intervention, rebleeding and in-hospital mortality, with an accurate selection of low-risk patients. MAP(ASH) has the advantage of being easier to calculate even without the aid of electronic tools.

Prognostic Scores for Predicting Clinical Outcomes in Upper Gastrointestinal Bleeding

Prognostic Scores for Predicting Clinical Outcomes in Upper Gastrointestinal Bleeding

CLINICAL CHARACTERISTICS, SEVERITY, AND OUTCOME OF ACUTE UPPER GASTROINTESTINAL BLEEDING IN ELDERLY AND NON-ELDERLY PATIENTS IN A TERTIARY CARE HOSPITAL- A PROSPECTIVE OBSERVATIONAL STUDY

Introduction: Upper gastrointestinal bleeding (UGIB) is a common emergency that requires hospitalization, and is more prevalent in men and older individuals. Age and co-morbidities are important factors for high mortality in UGIB patients, and elderly patients have an increased risk of mortality and morbidity compared to younger individuals. The type of UGIB experienced can also vary based on age. The Aim and objectives: aim of this study was to examine and compare the clinical characteristics, severity, and outcome of UGIB in elderly individuals (aged 60 or older) and non-elderly individuals (aged under 60) in Assam, India. Materials And Methods: This was a prospective observational study conducted at Assam Medical College and Hospital between April 2022 and September 2022. The study included adult patients presenting with UGIB. Patients below 18 years of age and in-patients who developed UGIB during hospitalization were excluded. A diagnosis of UGIB was based on the history of hematemesis and/or melena. Relevant blood and radiological investigations were conducted for all patients. All patients underwent upper GI endoscopy (UGIE). Data on clinical proles, laboratory reports, transfused blood/blood products, endoscopic ndings and interventions, and subsequent outcomes were collected prospectively for analysis. Results And Discussion: A total of 60 patients were included in the study, with a mean age of 42 years and 78.33% of patients being male. Of the 60 patients, 70% were non-elderly and 30% were elderly. The proportion of patients with co-morbidities and the use of non-steroidal anti-inammatory drugs or oral anti-coagulants was higher in the elderly group. The commonest mode of presentation among non-elderly patients was isolated melena (55%), while haematemesis in association with melaena was more common among elderly patients (50%). The proportion of patients with tachycardia and hypotension was signicantly higher among the elderly group. Variceal bleeding was signicantly higher among the elderly group (50% vs. 25%). The Rockall score, a measure of the severity of UGIB, was higher in 25% of elderly patients compared to 12

Effect of Direct-acting Oral Anticoagulants and Warfarin on Hospital Outcomes in Upper Gastrointestinal Bleeding.

To evaluate the comparison of direct-acting oral anticoagulants (DOACs) and warfarin for their effects on major bleeding and hospital outcomes in patients with acute nonvariceal upper gastrointestinal bleeding (NVUGIB). An observational study. Tekirdag Namik Kemal University Hospital, Hitit University Erol Olçok Education and Research Hospital, between January and December 2021. Adult patients prescribed warfarin and DOACs were followed up for one year. Their length of hospital stay, need for intensive care unit admission, need for red blood cell transfusion, and major bleeding rates were compared. Thirty-two patients (61.5%) were user of DOACs (DOAC group), and 20 patients (38.5%) were users of warfarin (warfarin group). No statistically significant difference was determined between patients in warfarin group and DOAC group for the number of packed red blood cells transfused [median 3 (0-6) units, 3 (0-10) units, p=0.229, respectively], length of hospital stay [median 5 days (3-10), and 4.5 days (2-20), p=0.739, respectively], rate of intensive care unit admission [(n=9, 45%; and n=10 (31%), p=0.623, respectively] and the occurrence of major bleeding events (warfarin-70%; DOACs-78%; p=0.529). Major bleeding episodes and hospital outcomes of acute NVUGIB were similar between patients receiving warfarin and DOACs. Direct-acting oral anticoagulants, Warfarin, Gastrointestinal bleeding, Outcome, Mortality.

The Etiology and Outcome of Upper Gastrointestinal Bleeding in Patients Presenting to Tertiary Care Hospital, Karachi

Objective: The aim of this study was to determine the causative factors that lead to bleeding in upper gastrointestinal tract and assess the outcomes after endoscopy. Methods: this study was conducted at the Department of Gastroenterology &amp; Hepatology, JPMC, Karachi using a non-probability sampling technique and cross-sectional study design for the period of one year from October 2020 to September, 2021. Adult patients of age between 18 years to 60 years of both genders, presented either with upper GI bleeding were enrolled in this study. Baseline and clinical characteristics were collected in a structured questionnaire. After enrollment of patients, lower upper gastrointestinal and upper gastrointestinal endoscopy were performed to establish the diagnosis and source of bleeding and final analysis was performed using SPSS v. 23. Results: Five thirty-six patients with UGIB were recruited for final analysis and among them most common were males and accounted for 58.0% (n = 311) Large esophageal varices were was observed more prevalent cause of UGIB (57.4%, n = 308). Recurrent bleeding in 17 (5.6%) patients were observed under ≤50 years of age while 20 (8.6%) were of &gt;50 years of age with a significant association between them (p= 0.028). Moreover, 02 (0.7%) died within 30 days under ≤50 years of age while 36 (15.5%) deaths were seen for those who were &gt;50 years of age with a significant association (p&lt; 0.001). Conclusion: In our study, we have observed that irrespective of age groups and gender, UGIB was most commonly caused by esophageal varices. Males were comparatively more prevalent. Our study also proves that risk of re-bleeding occurs as the age increasing along with higher short-term mortality. Keywords: Esophageal varices, UGIB, peptic ulcer, re-bleeding, mortality rate

Outcomes of Upper Gastrointestinal Bleeding in Hospitalized Patients With Generalized Anxiety Disorder.

BackgroundUpper gastrointestinal bleeding (UGIB) has a high morbidity and mortality. Social deprivation is a risk factor for UGIB and is associated with anxiety. The primary pharmaceutical therapeutic agents for anxiety are selective serotonin reuptake inhibitors. Anxiety is prevalent in the general population and generalized anxiety disorder (GAD) is a common form of anxiety. This study explores the impact of GAD on the outcomes of adult patients hospitalized with UGIB.MethodsAdult UGIB patients were selected utilizing the National (Nationwide) Inpatient Sample database from year 2014 and International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. The outcomes of UGIB patients with and without GAD were investigated. The outcomes explored include inpatient mortality, hypotension/shock, acute renal failure, acute hepatic failure, acute respiratory failure and acute myocardial infarction. A multivariate logistic regression analysis was used to determine if GAD is an independent predictor of the outcomes.ResultsAmong 19,850 UGIB patients studied, 2357 had comorbid GAD. GAD was identified as a risk factor for acute renal failure (adjusted odds ratio [aOR] 1.37, 95% confidence interval [CI] 1.30-1.57, p < 0.05) and inpatient mortality (aOR 1.50, 95% CI 1.01-2.06, p < 0.05). The aORs of hypotension/shock, acute hepatic failure, acute respiratory failure and acute myocardial infarction were not statistically significant.ConclusionUGIB patients with comorbid GAD are at elevated risk of inpatient mortality and acute renal failure. These results may gain increasing relevance as GAD prevalence has increased since the start of the coronavirus disease 2019 (COVID-19) pandemic.

Comparisons of six endoscopy independent scoring systems for the prediction of clinical outcomes for elderly and younger patients with upper gastrointestinal bleeding

ObjectivesTo compare the predictive ability of six pre-endoscopic scoring systems (ABC, AIMS65, GBS, MAP(ASH), pRS, and T-score) for outcomes of upper gastrointestinal bleeding (UGIB) in elderly and younger patients.MethodsA retrospective study of 1260 patients, including 530 elderly patients (age ge 65) and 730 younger patients (age < 65) presenting with UGIB, was performed at Zhongda Hospital Southeast University, from January 2015 to December 2020. Six scoring systems were used.ResultsABC had the largest areas under the curve (AUCs) of 0.827 (0.792–0.858), and 0.958 (0.929–0.987) for elderly and younger groups for predicting mortality respectively. The differences of the AUCs for predicting the outcome of mortality and rebleeding between the two groups were significant for ABC and pRS (p < 0.01). For intervention prediction, significant differences were observed only for pRS [AUC 0.623 (0.578–0.669) vs. 0.699 (0.646–0.752)] (p < 0.05) between the two groups. For intensive care unit (ICU) admission, the AUC for MAP (ASH) [0.791 (0.718–0.865) vs. 0.891 (0.831–0.950)] and pRS [0.610 (0.514–0.706) vs. 0.891 (0.699–0.865)] were more effective for the younger group (p < 0.05 and p < 0.01, respectively). For comparison of scoring systems in the same cohort, ABC was significantly higher than pRS: AUC 0.710 (0.699–0.853, p < 0.05) and T-score 0.670 (0.628–0.710, p < 0.01) for predicting mortality in the elderly group. In the younger group, ABC was significantly higher than GBS and T-score (p < 0.01). MAP(ASH) performs the best in predicting intervention in both groups.ConclusionsABC and pRS are more accurate for predicting mortality and rebleeding in the younger cohort, and pRS may not be suitable for elderly patients. There was no difference between the two study populations for GBS, AIMS65, and T-score. Except for ICU admission, MAP(ASH) showed fair accuracy for both cohorts.

Evaluation of Six Preendoscopy Scoring Systems to Predict Outcomes for Older Adults with Upper Gastrointestinal Bleeding.

Objectives To compare the ability of six preendoscopic scoring systems (ABC, AIMS65, Glasgow Blatchford score (GBS), MAP(ASH), pRS, and T-score) to predict outcomes of upper gastrointestinal bleeding (UGIB) in older adults. Methods This was a retrospective study of 602 older adults (age ≥ 65) presenting with UGIB at Zhongda Hospital Southeast University from January 2015 to June 2021. Six scoring systems were used to analyze all patients. Results ABC had the largest area under the curve (AUC) (0.833; 95% confidence interval (CI): 0.801–0.862) and was significantly higher than pRS 0.696 (95% CI: 0.658–0.733, p < 0.01) and T-score 0.667 (95% CI: 0.628–0.704, p < 0.01) in predicting mortality. MAP(ASH) (0.783; 95% CI: 0.748–0.815) performs the best in predicting intervention and was similar to GBS, T-score, ABC, and AIMS65. The AUCs for MAP(ASH) (0.732; 95% CI: 0.698–0.770), AIMS65 (0.711; 95% CI: 0.672–0.746), and ABC (0.718; 95% CI: 0.680–0.754) were fair for rebleeding, while those of GBS (0.662; 95% CI: 0.617–0.694), T-score (0.641; 95% CI: 0.606–0.684), and pRS (0.609; 95% CI: 0.569–0.648) were performed poorly. MAP(ASH) performs the best in predicting ICU admission (0.784; 95% CI: 0.749–0.816). All the five scores were significantly higher than pRS (p < 0.05 for ABC, AIMS65 and T-score, p < 0.01 for GBS and MAP). Conclusions Mortality, intervention, rebleeding, and ICU admission in UGIB for older adults can be predicted well using MAP(ASH). ABC is the most accurate for predicting mortality. Except for rebleeding, GBS has an acceptable performance in predicting ICU admission, mortality, and intervention. AIMS65 and T-score performed moderately, and pRS may not be suitable for the target cohort.

Short-term outcomes of upper gastrointestinal bleeding in emergency department Single-center study

Short-term outcomes of upper gastrointestinal bleeding in emergency department Single-center study

Outcomes of upper gastrointestinal bleeding are similar between direct oral anticoagulants and vitamin K antagonists.

The increased risk of upper gastrointestinal bleeding (UGIB) related to direct oral anticoagulants (DOACs) as compared to vitamin K antagonists (VKA) remains debated. To describe the epidemiology and outcomes of UGIB in patients treated with oral anticoagulants. A prospective, multicentre study in French general hospitals enrolled all consecutive patients with UGIB during one year. Patients treated with oral anticoagulants were retrieved from the cohort. Main outcomes were mortality and rebleeding during the first 6weeks and need for non-endoscopic treatment (surgery or interventional radiology). Among the 2498 patients included, 475 (19%) had an oral anticoagulant, mostly with VKA (267 patients [56.2%]). Baseline characteristics were similar between the groups except for renal failure and cirrhosis that were more prevalent in the VKA group. Gastroscopy was normal in 73 patients (15.3%); peptic lesions were the main cause of UGIB (n=233, 49%). Endoscopic treatment was performed in 128 patients (26.9%), leading to bleeding resolution in 74% (n=95). Mortality rate at 6weeks was 12.4% (59 patients), and was higher in the VKA group compared to DOACs (16.1% vs 7.8%, P<0.01). By multivariate analysis, only the Charlson index≥5 and UGIB occurrring in in-patients were independently associated with mortality. Rebleeding (56 patients [11.8%]) and need for non-endoscopic treatment (18 patients [3.8%]) were not associated with the type of anticoagulant. DOACs do not alter outcomes of UGIB as compared to VKA. Comorbidities and associated treatment are the most important factors worsening the prognosis of UGIB.

A prospective cohort study of patients presenting to the emergency department with upper gastrointestinal bleeding.

Background:Upper gastrointestinal (UGI) bleeding is a common presentation to the Emergency Department (ED), and is associated with re-bleeding and significant mortality. Although several studies have described etiology and outcome of UGI bleeding, few have been done in the EDs.Materials and Methods:This prospective observational cohort study included all patients presenting with hematemesis or melena, between June 2016 and January 2017 to the ED. Demographic data, risk factors, endoscopy findings and prognosticating scores were noted. Patients were followed up through telephonic communication after 3 months to assess re-bleeding rate and mortality.Results:The study cohort included 210 patients with a male predominance (76.2%). The mean (SD) age was 51 (16.8) years. They presented with either hematemesis (33.8%), melena (28.6%), or both (37.6%). One third (35.7%) had variceal bleed, 21% had peptic ulcer disease (PUD), and 43.3%bled due to other etiology. UGI scopy was performed in 85.2% of patients with banding (25.1%) and sclerotherapy (14%) being the most frequently performed procedures. Endoscopic intervention was not required in 58.6%of patients. Packed red cells were transfused in 46.7% patients. The 48-h re-bleed rate among variceal bleeders was 5.3% and 11.4% among peptic ulcer bleeders. The 3-month re-bleeding rate was 42.9% and the 3-month mortality rate was 17.5% among the variceal bleeders and the same was 5.6% and 2.8%, respectively, among the peptic ulcer bleeders. The overall mortality was 12.4%.Conclusions:Variceal bleeding and PUD were the predominant causes of UGI bleeding. Overall, a quarter of our patients had a re-bleed within 3 months, with majority being variceal bleeds.

Incidence, Clinical Characteristics, Risk Factors, and Outcomes of Upper Gastrointestinal Bleeding in Patients With COVID-19: Results of the UMC-19-S12.

The authors investigated the incidence, risk factors, clinical characteristics, and outcomes of upper gastrointestinal bleeding (UGB) in patients with coronavirus disease 2019 (COVID-19), who were attending the emergency department (ED), before hospitalization. We retrospectively reviewed all COVID-19 patients diagnosed with UGB in 62 Spanish EDs (20% of Spanish EDs, case group) during the first 2 months of the COVID-19 outbreak. We formed 2 control groups: COVID-19 patients without UGB (control group A) and non-COVID-19 patients with UGB (control group B). Fifty-three independent variables and 4 outcomes were compared between cases and controls. We identified 83 UGB in 74,814 patients with COVID-19 who were attending EDs (1.11%, 95% CI=0.88-1.38). This incidence was lower compared with non-COVID-19 patients [2474/1,388,879, 1.78%, 95% confidence interval (CI)=1.71-1.85; odds ratio (OR)=0.62; 95% CI=0.50-0.77]. Clinical characteristics associated with a higher risk of COVID-19 patients presenting with UGB were abdominal pain, vomiting, hematemesis, dyspnea, expectoration, melena, fever, cough, chest pain, and dysgeusia. Compared with non-COVID-19 patients with UGB, COVID-19 patients with UGB more frequently had fever, cough, expectoration, dyspnea, abdominal pain, diarrhea, interstitial lung infiltrates, and ground-glass lung opacities. They underwent fewer endoscopies in the ED (although diagnoses did not differ between cases and control group B) and less endoscopic treatment. After adjustment for age and sex, cases showed a higher in-hospital all-cause mortality than control group B (OR=2.05, 95% CI=1.09-3.86) but not control group A (OR=1.14, 95% CI=0.59-2.19) patients. The incidence of UGB in COVID-19 patients attending EDs was lower compared with non-COVID-19 patients. Digestive symptoms predominated over respiratory symptoms, and COVID-19 patients with UGB underwent fewer gastroscopies and endoscopic treatments than the general population with UGB. In-hospital mortality in COVID-19 patients with UGB was increased compared with non-COVID patients with UGB, but not compared with the remaining COVID-19 patients.

Clinical Outcomes of Upper Gastrointestinal Bleeding in Egyptian Patients with Decompensated Liver Cirrhosis, Does the Bleeding Source Matter?

Background: Upper gastrointestinal bleeding (UGIB) is a prevalent emergency and mortality cause in cirrhotic patients. It prolongs the hospital length of stay (LOS) and increases hospital readmission. Objectives: We investigated the clinical outcomes of acute variceal bleeding (AVB) and non-variceal bleeding (NVB) in patients with decompensated cirrhosis and the possible risk factors for prolonged hospital LOS. Patients and Methods: All patients with decompensated liver cirrhosis and UGIB (AVB & NVB) hospitalized from August 2018 to March 2019 were enrolled in this study. We assessed mortality rate, the hospital LOS and hospital readmission rate along with the probable risk factors associated with prolonged hospital LOS. Results: Our study included 582 patients with decompensated liver cirrhosis, 367 patients had AVB and 215 patients had NVB. There was no significant difference in mortality rate between both groups (11.4% vs. 9.3%, P= 0.43). The hospital LOS in AVB patients was longer than that in NVB group (5.8 ± 2.2 vs. 4.3 ± 1.8, p=0.001). Rate of hospital re-admission within 30 days was significantly higher in the AVB group (27%) compared to NVB group (18%). Inhospital re-bleeding and the need for repeated endoscopy were also higher in AVB patients (20%) than in NVB patients (12%). Risk factors for prolonged hospital LOS were development of hepatic encephalopathy, spontaneous bacterial peritonitis (SBP), in-hospital re-bleeding, Child C score and higher Model for end-stage liver disease (MELD) score. Conclusion: Patients with decompensated cirrhosis and AVB have longer hospital LOS and re-hospitalization rate than those with NVB with no significant difference in mortality rate between both groups.