ABSTRACT
Introduction: Since the advent of the COVID-19 pandemic, infected patients demonstrate severe coagulation disturbances leading to considerable mortality. COVID-19 vaccination has been shown to not only reduce infection risk but also to improve survival from breakthrough infections. It is not known if COVID vaccination improves outcomes from bleeding. Alabama has one of the lowest vaccination rates in the US. We, therefore, sought to examine the effect of vaccination on patient outcomes with GI bleeding in the setting of a COVID infection in this population. Methods: A retrospective review was conducted of adult patients admitted at a single institution with GI bleeding and COVID infection from May 2020 to October 2021. Inclusion Criteria included patients who had active COVID infection and evidence of GI bleeding (hematemesis, melena, hematochezia or anemia secondary to GI blood loss). Data collected included baseline demographics, vaccination status, mortality, and inpatient treatment including supplemental oxygen requirement, mechanical ventilation, and blood transfusions. The group was dichotomized by vaccination status and clinical outcomes were compared. Results: A total of 113 patients were included in the final analysis. The mean age was 57.3 years (range 19-93), 51.3% were female, and 68.1% identified as White. 44 patients (39.0%) and 63 (61.0%) were vaccinated and unvaccinated, respectively. Vaccinated patients were older than unvaccinated (mean age 63.3 vs. 53.1 years, p=0.003) and more likely to be White (72.7% vs. 50.7%, p=0.03) but had similar gender (%female, 45.5% vs. 54.4%, p=0.44). At presentation, the two groups had similar pulmonary status (vaccinated vs. unvaccinated, need for supplemental oxygen: 11.4% vs. 17.4%, p=0.43;need for mechanical ventilation, 0% vs. 5.8%, p=0.16). Vaccinated patients required significantly fewer blood transfusions (mean, 0.2 units vs. 1.4 units, p=0.03), and this translated to lower mortality (0% vs. 10.1%, p=0.04). In multivariable logistic analysis, the strongest predictor of mortality was lack of COVID-19 vaccination (OR=infinity, p=0.004). Conclusions: In this early analysis, COVID vaccination is associated with decreased mortality related to GI bleeding. This was true even when initial oxygen requirements were accounted for in either of the groups. Further work should be done to elucidate differences in the coagulation cascade in these patient cohorts.(Table Presented)
ABSTRACT
Introduction: Telemedicine (TM) usage has exponentially increased during the COVID-19 pandemic with an emphasis on video visits. This trend will likely persist after the pandemic ends. TM can increase access to specialized healthcare services like GI Medicine and cancer care, but successful TM use requires technological readiness for these platforms. We (and others) have shown that TM expansion further exacerbates existing disparities in cancer care with TM underutilized in Black, male, older, and lower income oncology patients during the pandemic. Advanced patient age is most predictive of TM unreadiness. This disparity is exacerbated when considering video visits only. We hypothesize that this inequality will be mitigated when younger patients are compared to an older cohort and sought to test this directly by comparing TM usage between Oncology (older) and GI Medicine (younger) patients during the pandemic. Methods: A retrospective review was conducted of patient visits to a large tertiary referral hospital for patients evaluated in Oncology and GI/Hepatology clinics from March-October 2020. Income was estimated by zip codes using US Census Data. A TM visit was defined as being either video visit or phone call. Logistic multivariable analyses were performed of the entire cohort to predict TM or Video. Results: There were 32,189 Oncology and 13,900 GI patients seen during the study period. In the unadjusted comparison, GI clinic patients were significantly younger, more likely to be male, and more likely to have private insurance. Oncology patients lived farther distances from the hospital and had greater estimated income. GI Clinic patients used both TM and video visits far more often than Oncology patients (Table 1). The two cohorts were propensity matched for age, race, and payer type. The differences in TM (43.6% vs. 3.1%, P<0.001) and video (21.2% vs. 1.6%, P<0.001) visits were even more pronounced for GI patients in adjusted analysis. In multivariable analysis, variables predicting TM usage included younger patient age, gender, race, estimated income, Medicare/Medicaid payer status, and a GI clinic visit predicted video visits usage. The strongest predictor of TM and video visit was a GI/ Hepatology clinic appointment (Table 2). Conclusions: GI patients were evaluated substantially more frequently via TM options than Oncology patients during the COVID-19 pandemic— a finding not driven by traditional predictors of disparities. The perceived mortal nature of cancer care probably pushes both patients and providers toward in-person encounters compared to treatment of chronic GI conditions. With TM effectiveness in expanding healthcare, future work should focus on educating providers and patients in TM use for high anxiety conditions. (Table presented) Comparison of GI Medicine and Oncology Patients During the COVID-19 Pandemic (Table presented) Multivariable Logistic Analysis Predicting Telemedicine and Video Use During the COVID-19 Pandemic