A case series on upper GI bleeding among patients admitted with COVID-19 infection

Background: Patients with COVID-19 infection are liable to develop coagulopathies and bleeding. An increase in the use of anticoagulants among this group of patients may be associated with an increase in the risk of developing GI bleeding. We aimed to evaluate the endoscopic characteristics of patients with COVID-19 that developed a GI bleed. Methods: A retrospective analysis of patients admitted to Rashid hospital with Upper GI bleeding, and COVID was done. We collected details on patient demographics, comorbid conditions, the severity of COVID infection, use of antiplatelet/anticoagulants, and their endoscopic findings. Results: 14 cases of Upper GI bleeding were included, half of which were on antiplatelet/anticoagulant. Endoscopic findings included peptic ulcer disease, Mallory Weis, gastritis, dieulafouy lesion, esophageal varices, and small gastric erosions. Peptic ulcer disease was the most common finding on endoscopy. Conclusion: Coagulopathy and bleeding risk remains a challenge in patients with COVID-19. Although peptic ulcer disease was the commonest etiology, it is still unclear whether the risk of bleeding was secondary to COVID-19 infection itself or the use of anticoagulants. We recommend physicians to be cognizant of the possible endoscopic features that may be encountered in COVID-19 infected patients presenting with GI bleeding so as to provide optimal management.

Prediction of Cytokine Storm and Mortality in Patients with COVID-19 Admitted to ICU: Do Markers Tell the Story?

Introduction: COVID-19 has caused approximately one million deaths worldwide as of November 24, 2020. Markers of disease activity like ferritin, C-reactive protein (CRP), and D-dimers are frequently monitored to detect the best opportunity for intensive treatment. Methods: All patients of >18 years of age were included. The primary variables of interest, ferritin, CRP, and D-dimers, for each patient throughout hospitalization were recorded. Primary clinical outcomes of length of stay in ICU and survival were recorded. Demographics: age, gender, BMI, and nationality. Ferritin, CRP, and D-dimers were recorded daily if available for the whole ICU stay, and all other variables were recorded on admission day to ICU. Results: The sample includes 235 records. More than 95% of patients have all markers on the day of admission to ICU were ferritin (median 1,278;IQR 1,424), D-dimer 1.21 (3.4), and CRP 129.5 (121). Daily average levels of markers were different from their admission day level: ferritin 1,395 (1,331), D-dimer 3.11 (5.52), and CRP 107 (75.8). Multiple logistic regression analysis determined that average CRP during the stay was the only predictor of survival. Discussion: Data on markers utilization to detect the acute phase of inflammation help clinicians focus on the opportunity window for intensive treatment. Conclusion: Average CRP during the stay in ICU is higher than CRP on admission. Average CRP is the only factor that predicts survival.