IMPACT OF THE NOVEL COVID-19 VIRUS ON OUTCOMES OF GASTROINTESTINAL BLEEDING: A MULTICENTER STUDY

ABSTRACT

Background: COVID-19 has been shown to have profound effects on multiple organ systems including the gastrointestinal (GI) tract. Due to the novelty of the virus, it is unknown whether the presence of COVID-19 infection affects the recovery from acute GI bleeds or increases the risk of complications including rebleeding. We aimed to describe the epidemiology of GI bleeding in patients with COVID-19 and to determine if active infection affects GI bleeding outcomes. Methods: We utilized the TriNetX research network, a globally federated health research network (with waiver from Western IRB) which accumulates deidentified data from electronic health records of 41 participating health care organizations located within the United States. We identified initial GI bleeding events in 3 groups subjects with active COVID-19, recovered COVID-19, and no COVID-19. Primary outcome included rate of recurrent bleed within 30, 60, and 90 days of initial bleed. Secondary outcomes included mortality, ICU requirement, need for endoscopic therapy, and blood transfusion requirement within 30, 60, and 90 days of initial bleed. We also performed a multivariate logistic regression to examine predictors for primary and secondary outcomes. Results: We identified 119,549 patients (Recovered COVID-19 = 715, Active COVID-19 = 1853, No COVID-19 = 116,981), with a mean age of 57.7 years, and 50.04% of patients being female. Active COVID-19 patients were significantly older, predominately male, and predominately African American. Compared to patients without COVID or COVID recovered, patients with active COVID-19 had statistically significant higher rates of recurrent GI bleeding, overall mortality, blood transfusion requirements, and ICU stay within 30, 60, and 90 days of initial bleed (Table 1). Multivariate analyses revealed several risk factors that predicted higher rates of rebleeding, mortality, endoscopic therapy requirement, and ICU stay within 30 days of initial bleed (Table 2). Location of GI bleed (upper versus lower) did not significantly predict higher rebleeding or mortality rates. Conclusion: Based on our results, we determined that patients with active COVID-19 infection who have an initial GI bleed, either upper or lower bleed, are at increased risk for rebleeding and have higher overall mortality, transfusion requirements, and ICU needs compared to patients without infection or who have recovered. Although other factors including comorbidities and medications need to be accounted for, patients with COVID-19 should be monitored closely after an initial GI bleed given high likelihood of poor outcome. (Table Presented) Table 1. Univariate analysis of the outcomes of recurrent bleeding, mortality, blood transfusion requirement, and ICU requirement, within 30, 60 and 90 days of initial bleed event. (Table Presented) Table 2. Multivariate logistic regression analyses of predictors of outcomes of 30-day recurrent bleeding, mortality, endoscopic therapy requirement, and ICU requirement *OR= odds ratio, CI= confidence interval