GASTROINTESTINAL BLEEDING DURING THE COVID-19 PANDEMIC: IMPACT ON PATIENT PRESENTATION AND OUTCOMES

ABSTRACT

Background/Aim Since the beginning of the COVID-19 pandemic, gastroenterology divisions have reorganized their operations and modified their protocols to limit high-risk procedures and direct patient contact. In parallel, concerns about contracting COVID-19 have led patients to avoid medical care. This study aims to assess the impact of the COVID-19 pandemic on the presentation and outcomes of GIB in a tertiary care center in Lebanon. Methods We conducted a prospective cohort study of all patients admitted with overt GIB during two periods, the first prior to the COVID-19 pandemic (April 1, 2018, to April 1, 2019), and the second during the COVID-19 pandemic (April 1, 2020 to April 1, 2021), to the American University of Beirut Medical center. Severe GIB was defined as the presence of the following SBP <100mmHg, >2 units of blood transfused, or ≥2 units drop in hemoglobin (Hb). In-hospital mortality and end of follow-up rebleeding rates were compared between the two periods. Bivariate analysis was done to identify the factors associated with severe hemorrhage. Multivariate analysis was used to determine independent predictors of severe hemorrhage, using variables that were found to be significant on bivariate analysis. Results A total of 171 patients were admitted during both periods, with 67 (39.1%) admitted during the pandemic. Patients admitted during the pandemic were more likely to present with severe hemorrhage and to have a drop of Hb of ≥ 2 g/dL (Table 1). During the pandemic, the origin of GIB was more likely to remain unknown. Outcomes including length of hospital stay, in-hospital mortality and end of follow-up rebleeding did not differ significantly between the two periods (Table 1). Compared to patients who presented with non-severe hemorrhage, those with severe hemorrhage had a higher initial BUN level and were more likely to be admitted during the pandemic (Table 2). In the multivariate analysis admission during the pandemic was associated with an increased risk of severe hemorrhage (HR 2.08, [1.07-4.05]). Conclusion During the COVID-19 pandemic, patients with GIB were more likely to present with more severe hemorrhage. This could be related to delays in access to healthcare due to patient or healthcare system issues. These indirect effects of the pandemic must be addressed, and efforts should be directed to minimize their impact. (Table Presented) (Table Presented)