Rebeca González González1, Javier Jacob2, Òscar Miró3, Pere Llorens4, Sònia Jiménez3, Juan González Del Castillo5, Guillermo Burillo-Putze6, Alfonso Martín1, Francisco J Martín-Sánchez5, Jorge G Lamberechts5, Aitor Alquézar-Arbé7, Leopoldo Higa-Sansone7, Sara Gayoso Martín8, Virginia Carbajosa9, Fahd Beddar Chaib10, Manuel Salido11, María J Marchena González12, Ricardo Calvo López13, Félix González Martínez14, José Pavón Monzo15, Desiré M Velarde Herrera16, Ana P Niembro Valdés17, Eva Quero Motto18, José M Ferreras Amez19, Pascual Piñera-Salmerón20. 1. Emergency Department, Severo Ochoa University Hospital in Leganés. 2. Emergency Department, Bellvitge University Hospital, L'Hospitalet de Llobregat. 3. Emergency Department, Clínic Hospital Clínic, IDIBAPS, University of Barcelona. 4. Emergency Department, General Hospital of Alicante, University Miguel Hernández, Elche, Alicante. 5. Emergency Department, Hospital Clínico San Carlos, IDISSC, Complutense University. 6. Emergency Department, Canary Islands University Hospital, Tenerife. 7. Emergency Department, Santa Creu I Sant Pau Hospital, Barcelona, Catalonia. 8. Emergency Department, El Escorial Regional Hospital, Madrid. 9. Emergency Department, Rio Hortega University Hospital, Valladolid. 10. Emergency Department, Soria Assistance Complex. 11. Emergency Department, Regional University Hospital of Malaga. 12. Emergency Department, Juan Ramón Jiménez University Hospital, Huelva. 13. Emergency Department, University Hospital Complex of A Coruña. 14. Emergency Department, Virgen de la Luz Hospital, Cuenca. 15. Emergency Department, University Hospital of Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria. 16. Emergency Department, Central University Hospital Asturias, Oviedo. 17. Emergency Department, University Hospital of Cabueñes, Gijón. 18. Emergency Department, University Clinical Hospital Virgin of the Arrixaca. 19. Emergency Department, Lozano Blesa University Clinical Hospital, Zaragoza, Spain. 20. Emergency Department, Reina Sofia University General Hospital, Murcia.
Abstract
OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
Authors: Hassan Ashktorab; Tiziano Russo; Gholamreza Oskrochi; Giovanni Latella; Sara Massironi; Martina Luca; Lakshmi G Chirumamilla; Adeyinka O Laiyemo; Hassan Brim Journal: Gastro Hep Adv Date: 2022-03-10