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Rathore SS, Wint ZS, Goyal A, Jeswani BM, Farrukh AM, Nieto-Salazar MA, Thugu TR, Erva S, Mehmood R, Toro-Velandia AC, Aneis H, Ratnani S, Al Shyyab IMY. Prevalence and outcomes of upper gastrointestinal bleeding in COVID-19: A systematic review and meta-analysis. Rev Med Virol 2024; 34:e2509. [PMID: 38282392 DOI: 10.1002/rmv.2509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/02/2023] [Accepted: 12/17/2023] [Indexed: 01/30/2024]
Abstract
Upper gastrointestinal bleeding (UGIB) in COVID-19 presents challenges in patient management. Existing studies lack comprehensive review due to varied designs, samples, and demographics. A meta-analysis can provide valuable insights into the incidence, features, and outcomes of UGIB in COVID-19. A comprehensive literature search was carried out using several databases. We considered all appropriate observational studies from all over the world. Mantel-Haenszel odds ratios and associated 95% confidence intervals (CIs) were produced to report the overall effect size using random effect models. Besides, Random effects models were used to calculate the overall pooled prevalence. Funnel plots, Egger regression tests, and Begg-Mazumdar's rank correlation test were used to appraise publication bias. Data from 21 articles consisting of 26,933 COVID-19 patients were considered. The pooled estimate of UGIB prevalence in patients admitted with COVID-19 across studies was 2.10% (95% CI, 1.23-3.13). Similarly, the overall pooled estimate for severity, mortality, and rebleeding in COVID-19 patients with UGIB was 55% (95% CI, 37.01-72.68), 29% (95% CI, 19.26-40.20) and 12.7% (95% CI, 7.88-18.42) respectively. Further, UGIB in COVID-19 patients was associated with increased odds of severity (OR = 3.52, 95% CI 1.80-6.88, P = 0.001) and mortality (OR = 2.16, 95% CI 1.33-3.51, P = 0.002) compared with patients without UGIB. No significant publication bias was evident in the meta-analysis. The results of our study indicate that UGIB in individuals with COVID-19 is linked to negative outcomes such as severe illness, higher mortality rates, and an increased risk of re-bleeding. These findings highlight the significance of identifying UGIB as a significant complication in COVID-19 cases and emphasise the importance of timely clinical assessment and proper treatment.
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Affiliation(s)
| | - Zario Shai Wint
- All American Institute of Medical Sciences, Black River, Jamaica
| | - Aman Goyal
- Department of Internal Medicine, Seth GS Medical College and KEM Hospital, Mumbai, India
| | | | | | | | | | - Snigdha Erva
- MNR Medical College and Hospital, Sangareddy, India
| | - Raafay Mehmood
- First Faculty of Medicine, Charles University, Prague, Czech Republic
| | | | - Hamam Aneis
- Department of Internal Medicine, UPMC, Mckeesport, Pennsylvania, USA
| | - Sunny Ratnani
- Saint James School of Medicine, The Quarter, Anguilla
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2
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Howard E. Nonvariceal upper gastrointestinal bleeding, COVID and mortality: confounders or true correlation? Proc AMIA Symp 2023; 37:42. [PMID: 38174005 PMCID: PMC10761007 DOI: 10.1080/08998280.2023.2279880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 11/01/2023] [Indexed: 01/05/2024] Open
Affiliation(s)
- Ericka Howard
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
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3
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Briciu V, Leucuta DC, Muntean M, Radulescu A, Cismaru C, Topan A, Herbel L, Horvat M, Calin M, Dobrota R, Lupse M. Evolving Clinical Manifestations and Outcomes in COVID-19 Patients: A Comparative Analysis of SARS-CoV-2 Variant Waves in a Romanian Hospital Setting. Pathogens 2023; 12:1453. [PMID: 38133336 PMCID: PMC10871103 DOI: 10.3390/pathogens12121453] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/11/2023] [Accepted: 12/13/2023] [Indexed: 12/23/2023] Open
Abstract
The aim of this study was to evaluate differences in the clinical manifestations and outcomes in hospitalized patients with COVID-19 in a single Romanian center during four pandemic waves determined by different SARS-CoV-2 variants of concern (VOCs). A retrospective study on 9049 consecutive hospitalized adult patients was performed between 27 February 2020 and 31 March 2023. The study interval was divided into waves based on national data on SARS-CoV-2 VOCs' circulation. Multivariate logistic regression models were built, predicting death and complications as functions of comorbidities, therapy, wave, severity form, and vaccination status, and adjusted for ages ≥65 years. Pulmonary (pneumothorax/pneumomediastinum, pulmonary embolism) and extrapulmonary complications (liver injury, acute kidney injury, ischemic/hemorrhagic stroke, myocardial infarction, and gastrointestinal bleeding) were present, more frequently in ICU hospitalized patients and with differences between waves. The highest in-hospital mortality was found in patients presenting pneumothorax/pneumomediastinum. All of the evaluated risk factors were significantly associated with death, except for obesity and the Omicron wave. Our study highlights the changing nature of COVID-19 and acknowledges the impacts of viral mutations on disease outcomes. For all four waves, COVID-19 was a severe disease with a high risk of poor outcomes.
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Affiliation(s)
- Violeta Briciu
- Department of Infectious Diseases and Epidemiology, Iuliu Hatieganu University of Medicine and Pharmacy, 400348 Cluj-Napoca, Romania; (V.B.); (M.M.); (A.R.); (C.C.); (A.T.); (M.H.); (M.L.)
- The Clinical Hospital of Infectious Diseases, 400348 Cluj-Napoca, Romania; (L.H.); (M.C.); (R.D.)
| | - Daniel-Corneliu Leucuta
- Department of Medical Informatics and Biostatistics, Iuliu Hatieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania
| | - Monica Muntean
- Department of Infectious Diseases and Epidemiology, Iuliu Hatieganu University of Medicine and Pharmacy, 400348 Cluj-Napoca, Romania; (V.B.); (M.M.); (A.R.); (C.C.); (A.T.); (M.H.); (M.L.)
- The Clinical Hospital of Infectious Diseases, 400348 Cluj-Napoca, Romania; (L.H.); (M.C.); (R.D.)
| | - Amanda Radulescu
- Department of Infectious Diseases and Epidemiology, Iuliu Hatieganu University of Medicine and Pharmacy, 400348 Cluj-Napoca, Romania; (V.B.); (M.M.); (A.R.); (C.C.); (A.T.); (M.H.); (M.L.)
- The Clinical Hospital of Infectious Diseases, 400348 Cluj-Napoca, Romania; (L.H.); (M.C.); (R.D.)
| | - Cristina Cismaru
- Department of Infectious Diseases and Epidemiology, Iuliu Hatieganu University of Medicine and Pharmacy, 400348 Cluj-Napoca, Romania; (V.B.); (M.M.); (A.R.); (C.C.); (A.T.); (M.H.); (M.L.)
- The Clinical Hospital of Infectious Diseases, 400348 Cluj-Napoca, Romania; (L.H.); (M.C.); (R.D.)
| | - Adriana Topan
- Department of Infectious Diseases and Epidemiology, Iuliu Hatieganu University of Medicine and Pharmacy, 400348 Cluj-Napoca, Romania; (V.B.); (M.M.); (A.R.); (C.C.); (A.T.); (M.H.); (M.L.)
- The Clinical Hospital of Infectious Diseases, 400348 Cluj-Napoca, Romania; (L.H.); (M.C.); (R.D.)
| | - Lucia Herbel
- The Clinical Hospital of Infectious Diseases, 400348 Cluj-Napoca, Romania; (L.H.); (M.C.); (R.D.)
| | - Melinda Horvat
- Department of Infectious Diseases and Epidemiology, Iuliu Hatieganu University of Medicine and Pharmacy, 400348 Cluj-Napoca, Romania; (V.B.); (M.M.); (A.R.); (C.C.); (A.T.); (M.H.); (M.L.)
- The Clinical Hospital of Infectious Diseases, 400348 Cluj-Napoca, Romania; (L.H.); (M.C.); (R.D.)
| | - Mihai Calin
- The Clinical Hospital of Infectious Diseases, 400348 Cluj-Napoca, Romania; (L.H.); (M.C.); (R.D.)
| | - Roxana Dobrota
- The Clinical Hospital of Infectious Diseases, 400348 Cluj-Napoca, Romania; (L.H.); (M.C.); (R.D.)
| | - Mihaela Lupse
- Department of Infectious Diseases and Epidemiology, Iuliu Hatieganu University of Medicine and Pharmacy, 400348 Cluj-Napoca, Romania; (V.B.); (M.M.); (A.R.); (C.C.); (A.T.); (M.H.); (M.L.)
- The Clinical Hospital of Infectious Diseases, 400348 Cluj-Napoca, Romania; (L.H.); (M.C.); (R.D.)
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Hibiya S, Fujii T, Fujii T, Suzuki S, Kondo M, Ooka S, Furumoto Y, Azuma S, Tanaka K, Kurata H, Tanaka S, Kurosaki M, Nagayama K, Kusano F, Iizuka Y, Kawamura T, Ikemiyagi H, Sakita S, Yauchi T, Watanabe H, Kawamoto A, Matsuyama Y, Ohtsuka K, Okamoto R. COVID-19 severity is associated with the risk of gastrointestinal bleeding. BMJ Open Gastroenterol 2023; 10:e001199. [PMID: 37963649 PMCID: PMC10649400 DOI: 10.1136/bmjgast-2023-001199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 10/12/2023] [Indexed: 11/16/2023] Open
Abstract
OBJECTIVE The association between the severity of COVID-19 and gastrointestinal (GI) bleeding is unknown. This study aimed to determine whether the severity of COVID-19 is a risk factor for GI bleeding. DESIGN A multicentre, retrospective cohort study was conducted on hospitalised patients with COVID-19 between January 2020 and December 2021. The severity of COVID-19 was classified according to the National Institute of Health severity classification. The primary outcome was the occurrence of GI bleeding during hospitalisation. The main analysis compared the relationship between the severity of COVID-19 and the occurrence of GI bleeding. Multivariable logistic regression analysis was performed to evaluate the association between the severity of COVID-19 and the occurrence of GI bleeding. RESULTS 12 044 patients were included. 4165 (34.6%) and 1257 (10.4%) patients had severe and critical COVID-19, respectively, and 55 (0.5%) experienced GI bleeding. Multivariable analysis showed that patients with severe COVID-19 had a significantly higher risk of GI bleeding than patients with non-severe COVID-19 (OR: 3.013, 95% CI: 1.222 to 7.427). Patients with critical COVID-19 also had a significantly higher risk of GI bleeding (OR: 15.632, 95% CI: 6.581 to 37.130). Patients with severe COVID-19 had a significantly increased risk of lower GI bleeding (OR: 10.349, 95% CI: 1.253 to 85.463), but the risk of upper GI bleeding was unchanged (OR: 1.875, 95% CI: 0.658 to 5.342). CONCLUSION The severity of COVID-19 is associated with GI bleeding, and especially lower GI bleeding was associated with the severity of COVID-19. Patients with severe or critical COVID-19 should be treated with caution as they are at higher risk for GI bleeding.
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Affiliation(s)
- Shuji Hibiya
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takashi Fujii
- Department of Gastroenterology, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
| | - Toshimitsu Fujii
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shinji Suzuki
- Department of Gastroenterology, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
| | - Mayumi Kondo
- Department of Gastroenterology, Tokyo Metropolitan Toshima Hospital, Tokyo, Japan
| | - Shinya Ooka
- Department of Gastroenterology, Tokyo Metropolitan Toshima Hospital, Tokyo, Japan
| | - Yohei Furumoto
- Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Seishin Azuma
- Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Kei Tanaka
- Department of Gastroenterology, Tokyo Metropolitan Otsuka Hospital, Tokyo, Japan
| | - Hitoshi Kurata
- Department of Gastroenterology, Tokyo Metropolitan Otsuka Hospital, Tokyo, Japan
| | - Shohei Tanaka
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Masayuki Kurosaki
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
| | | | - Fumihiko Kusano
- Department of Gastroenterology, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Yasuhiro Iizuka
- Department of Gastroenterology, Kashiwa Municipal Hospital, Chiba, Japan
| | - Takahiro Kawamura
- Department of Gastroenterology, JA Toride Medical Center, Ibaraki, Japan
| | - Hidekazu Ikemiyagi
- Department of Gastroenterology, Yokohama City Minato Red Cross Hospital, Kanagawa, Japan
| | - Shinya Sakita
- Department of Gastroenterology, Yokohama City Minato Red Cross Hospital, Kanagawa, Japan
| | - Tsunehito Yauchi
- Department of Gastroenterology, Soka Municipal Hospital, Saitama, Japan
| | - Hideki Watanabe
- Department of Gastroenterology, Yokosuka Kyosai Hospital, Kanagawa, Japan
| | - Ami Kawamoto
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yusuke Matsuyama
- Department of Oral Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kazuo Ohtsuka
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ryuichi Okamoto
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
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Karlafti E, Tsavdaris D, Kotzakioulafi E, Protopapas AA, Kaiafa G, Netta S, Savopoulos C, Michalopoulos A, Paramythiotis D. The Prevalence of Gastrointestinal Bleeding in COVID-19 Patients: A Systematic Review and Meta-Analysis. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1500. [PMID: 37629790 PMCID: PMC10456782 DOI: 10.3390/medicina59081500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 07/26/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023]
Abstract
Introduction: Severe acute respiratory syndrome coronavirus 2 caused the coronavirus disease of 2019 (COVID-19), which rapidly became a pandemic, claiming millions of lives. Apart from the main manifestations of this infection concerning the respiratory tract, such as pneumonia, there are also many manifestations from the gastrointestinal tract. Of these, bleeding from the gastrointestinal tract is a significant complication quite dangerous for life. This bleeding is divided into upper and lower, and the primary pathophysiological mechanism is the entering of the virus into the host cells through the Angiotensin-converting enzyme 2 receptors. Also, other comorbidities and the medication of corticosteroids and anticoagulants are considered to favor the occurrence of gastrointestinal bleeding (GIB). Methods: This systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and the studies were searched in two different databases (Scopus and PubMed) from November 2019 until February 2023. All studies that reported GIB events among COVID-19 patients were included. Results: 33 studies were selected and reviewed to estimate the prevalence of GIB. A total of 134,905 patients with COVID-19 were included in these studies, and there were 1458 episodes of GIB. The prevalence of GIB, in these 33 studies, ranges from 0.47% to 19%. This range of prevalence is justified by the characteristics of the COVID-19 patients. These characteristics are the severity of COVID-19, anticoagulant and other drug treatments, the selection of only patients with gastrointestinal manifestations, etc. The pooled prevalence of gastrointestinal bleeding was estimated to be 3.05%, rising to 6.2% when only anticoagulant patients were included. Conclusions: GIB in COVID-19 patients is not a rare finding, and its appropriate and immediate treatment is necessary as it can be life-threatening. The most common clinical findings are melena and hematemesis, which characterize upper GIB. Treatment can be conservative; however, endoscopic management of bleeding with embolization is deemed necessary in some cases.
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Affiliation(s)
- Eleni Karlafti
- Emergency Department, University General Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
- 1st Propaedeutic Department of Internal Medicine, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (E.K.); (A.A.P.); (G.K.); (C.S.)
| | - Dimitrios Tsavdaris
- 1st Propaedeutic Surgery Department, University General Hospital of Thessaloniki AHEPA, 54636 Thessaloniki, Greece; (D.T.); (S.N.); (A.M.); (D.P.)
| | - Evangelia Kotzakioulafi
- 1st Propaedeutic Department of Internal Medicine, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (E.K.); (A.A.P.); (G.K.); (C.S.)
| | - Adonis A. Protopapas
- 1st Propaedeutic Department of Internal Medicine, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (E.K.); (A.A.P.); (G.K.); (C.S.)
| | - Georgia Kaiafa
- 1st Propaedeutic Department of Internal Medicine, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (E.K.); (A.A.P.); (G.K.); (C.S.)
| | - Smaro Netta
- 1st Propaedeutic Surgery Department, University General Hospital of Thessaloniki AHEPA, 54636 Thessaloniki, Greece; (D.T.); (S.N.); (A.M.); (D.P.)
| | - Christos Savopoulos
- 1st Propaedeutic Department of Internal Medicine, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (E.K.); (A.A.P.); (G.K.); (C.S.)
| | - Antonios Michalopoulos
- 1st Propaedeutic Surgery Department, University General Hospital of Thessaloniki AHEPA, 54636 Thessaloniki, Greece; (D.T.); (S.N.); (A.M.); (D.P.)
| | - Daniel Paramythiotis
- 1st Propaedeutic Surgery Department, University General Hospital of Thessaloniki AHEPA, 54636 Thessaloniki, Greece; (D.T.); (S.N.); (A.M.); (D.P.)
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Steinberg HL, Auer TA, Gebauer B, Kloeckner R, Sieren M, Minko P, Jannusch K, Wildgruber M, Schmidt VF, Pinto Dos Santos D, Dratsch T, Hinrichs JB, Torsello G, Stoehr F, Müller L, Herbstreit F, Forsting M, Schaarschmidt BM. Embolization of active arterial bleeding in COVID-19 patients: A multicenter study. Eur J Radiol 2023; 165:110892. [PMID: 37269571 PMCID: PMC10212795 DOI: 10.1016/j.ejrad.2023.110892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/06/2023] [Accepted: 05/23/2023] [Indexed: 06/05/2023]
Abstract
PURPOSE The purpose of this study was to assess the efficacy of transarterial embolization in COVID-19 patients with an arterial bleeding and to investigate differences between various patient groups concerning survival. METHOD We retrospectively reviewed COVID-19 patients undergoing transarterial embolization due to an arterial bleeding in a multicenter study from April 2020 to July 2022 and analyzed the technical success of embolization and survival rate. 30-day survival between various patient groups was analyzed. The Chi- square test and Fisher's exact test were used for testing association between the categorical variables. RESULTS 53 COVID-19 patients (age: 57.3 ± 14.3 years, 37 male) received 66 angiographies due to an arterial bleeding. The initial embolization was technically successful in 98.1% (52/53). In 20.8% (11/53) of patients, additional embolization was necessary due to a new arterial bleeding. A majority of 58.5% (31/53) had a severe course of COVID-19 infection necessitating ECMO-therapy and 86.8% (46/53) of patients received anticoagulation. 30-day survival rate in patients with ECMO-therapy was significantly lower than without ECMO-therapy (45.2% vs. 86.4%, p = 0.004). Patients with anticoagulation did not have a lower 30-day survival rate than without anticoagulation (58.7% vs. 85.7%, p = 0.23). COVID-19 patients with ECMO-therapy developed more frequently a re-bleeding after embolization than non-ECMO-patients (32.3% vs. 4.5%, p = 0.02). CONCLUSIONS Transarterial embolization is a feasible, safe, and effective procedure in COVID-19 patients with arterial bleeding. ECMO-patients have a lower 30-day survival rate than non-ECMO-patients and have an increased risk for re-bleeding. Treatment with anticoagulation could not be identified as a risk factor for higher mortality.
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Affiliation(s)
- Hannah L Steinberg
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsmedizin Essen, Germany.
| | - Timo A Auer
- Klinik für Radiologie, Charité Universitätsmedizin Berlin, Germany; Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Straße 2, 10178 Berlin, Germany
| | - Bernhard Gebauer
- Klinik für Radiologie, Charité Universitätsmedizin Berlin, Germany
| | - Roman Kloeckner
- Institut für Interventionelle Radiologie, Universitätsklinikum Schleswig-Holstein, Germany
| | - Malte Sieren
- Institut für Interventionelle Radiologie, Universitätsklinikum Schleswig-Holstein, Germany
| | - Peter Minko
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Düsseldorf, Germany
| | - Kai Jannusch
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Düsseldorf, Germany
| | | | | | - Daniel Pinto Dos Santos
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Köln, Germany; Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Frankfurt, Germany
| | - Thomas Dratsch
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Köln, Germany
| | - Jan B Hinrichs
- Institut für Diagnostische und Interventionelle Radiologie, Medizinische Hochschule Hannover, Germany
| | - Giovanni Torsello
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsmedizin Göttingen, Germany
| | - Fabian Stoehr
- Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsmedizin Mainz, Germany
| | - Lukas Müller
- Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsmedizin Mainz, Germany
| | - Frank Herbstreit
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsmedizin Essen, Germany
| | - Michael Forsting
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsmedizin Essen, Germany
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Abstract
COVID-19 infection is an ongoing catastrophic global pandemic with significant morbidity and mortality that affects most of the world population. Respiratory manifestations predominate and largely determine patient prognosis, but gastrointestinal (GI) manifestations also frequently contribute to patient morbidity and occasionally affect mortality. GI bleeding is usually noted after hospital admission and is often one aspect of this multisystem infectious disease. Although the theoretical risk of contracting COVID-19 from GI endoscopy performed on COVID-19-infected patients remains, the actual risk does not seem to be high. The introduction of PPE and widespread vaccination gradually increased the safety and frequency of performing GI endoscopy in COVID-19-infected patients. Three important aspects of GI bleeding in COVID-19-infected patients are (1) GI bleeding is often from mucosal erosions from mucosal infalammation that causes mild GI bleeding; (2) severe upper GI bleeding is often from PUD or stress gastritis from COVID-19 pneumonia; and (3) lower GI bleeding frequently arises from ischemic colitis associated with thromboses and hypercoagulopathy from COVID-19 infection. The literature concerning GI bleeding in COVID-19 patients is presently reviewed.
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8
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Incidence, risk factors, and clinical impact of major bleeding in hospitalized patients with COVID-19: a sub-analysis of the CLOT-COVID Study. Thromb J 2022; 20:53. [PMID: 36127738 PMCID: PMC9485792 DOI: 10.1186/s12959-022-00414-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 08/07/2022] [Indexed: 11/10/2022] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) causes extensive coagulopathy and a potential benefit of anticoagulation therapy has been documented for prevention of thromboembolic events. Bleeding events has also been reported as a notable complication; whereas, the incidence, risks, and clinical impact of bleeding remain unclear. Method The CLOT-COVID Study was a nationwide, retrospective, multicenter cohort study on consecutive hospitalized patients with COVID-19 in Japan between April 2021 and September 2021. In this sub-analysis, we compared the characteristics of patients with and without major bleeding; moreover, we examined the risk factors for and clinical impact of bleeding events. Results Among 2882 patients with COVID-19, 57 (2.0%) had major bleeding. The incidence of major bleeding increased with COVID-19 severity as follows: 0.5%, 2.3%, and 12.3% in patients with mild, moderate, and severe COVID-19, respectively. COVID-19 severity, history of major bleeding, and anticoagulant type/dose were independently and additively associated with the bleeding incidence. Compared with patients without major bleeding, those with major bleeding exhibited a longer duration of hospitalization (9 [6–14] vs 28 [19–43] days, P < 0.001) and higher mortality during hospitalization (4.9% vs. 35.1%, P < 0.001). Conclusions In the real-world clinical practice, the incidence of major bleeding was not uncommon, especially in patients with severe COVID-19. Independent risk factors for major bleeding included history of major bleeding, COVID-19 severity, and anticoagulant use, which could be associated with poor clinical outcomes including higher mortality. Precise recognition of the risks for bleeding may be helpful for an optimal use of anticoagulants and for better outcomes in patients with COVID-19.
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9
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Mauro A, De Grazia F, Anderloni A, Di Sabatino A. Upper gastrointestinal bleeding in coronavirus disease 2019 patients. Curr Opin Gastroenterol 2022; 38:443-449. [PMID: 35916320 DOI: 10.1097/mog.0000000000000859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW Upper gastrointestinal bleeding (UGIB) has significant morbidity and UGIB cases have been described in coronavirus disease 2019 (COVID-19) patients. Management of this condition can be challenging considering both the possible severe COVID-19-related pneumonia as well as the risk of the virus spreading from patients to health operators. The aim of this paper is to review the most recent studies available in the literature in order to evaluate the actual incidence of UGIB, its clinical and endoscopic manifestations and its optimal management. RECENT FINDINGS UGIB has an incidence between 0.5% and 1.9% among COVID-19 patients, and it typically presents with melena or hematemesis. Peptic ulcers are the most common endoscopic findings. High Charlson Comorbidity Index (CCI), dialysis, acute kidney injury and advanced oncological disease increase the risk for UGIB. Although anticoagulants are commonly used in COVID-19 patients they are not associated with an increased incidence of UGIB. Conservative management is a common approach that results in similar outcomes compared to upper GI endoscopic treatment. Apparently, UGIB in COVID-19 seems not have a detrimental effect and only one study showed an increased mortality in those who developed UGIB during hospitalization. SUMMARY Incidence of UGIB in COVID-19 patients is similar to that of the general population. Despite the widespread use of anticoagulants in these patients, they are not associated with an increased risk of UGIB. Conservative management could be an effective option, especially for patients that are at risk of intubation.
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Affiliation(s)
- Aurelio Mauro
- First Department of Internal Medicine.,Gastroenterology and Endoscopic Unit, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Federico De Grazia
- Gastroenterology and Endoscopic Unit, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Andrea Anderloni
- Gastroenterology and Endoscopic Unit, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
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Increased Susceptibility for Thromboembolic Events versus High Bleeding Risk Associated with COVID-19. Microorganisms 2022; 10:microorganisms10091738. [PMID: 36144340 PMCID: PMC9505654 DOI: 10.3390/microorganisms10091738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 08/19/2022] [Accepted: 08/25/2022] [Indexed: 11/16/2022] Open
Abstract
The infection with the SARS-CoV-2 virus is associated with numerous systemic involvements. Besides the severe respiratory injuries and cardiovascular complications, it became obvious early on that this disease carries an increased risk of thromboembolic events, but a higher propensity for bleedings as well. We researched the medical literature over significant PubMed published articles debating on the prevalence, category of patients, the moment of occurrence, and evolution of venous thromboembolism (VTE), but also of venous and arterial “in situ” thrombosis (AT), and hemorrhagic events as well. Most researchers agree on an increased prevalence of thromboembolic events, ranging between 25 and 31% for VTE, depending on the analyzed population. For AT and hemorrhagic complications lower rates were reported, namely, about 2–3%, respectively, between 4.8 and 8%, occurring mostly in older patients, suffering from moderate/severe forms of COVID-19, with associated comorbidities. It is important to mention that patients suffering from hemorrhages frequently received thromboprophylaxis with anticoagulant drugs. As a consequence of thromboembolic and hemorrhagic complications which are both important negative prognostic factors, the evolution of patients infected with the SARS-CoV-2 virus is aggravated, determining an augmented morbidity and mortality of this population.
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Russo V, Caputo A, Imbalzano E, Di Micco P, Frontera A, Uccello A, Orlando L, Galimberti P, Golino P, D'Andrea A. The pharmacology of anticoagulant drug treatment options in COVID-19 patients: reviewing real-world evidence in clinical practice. Expert Rev Clin Pharmacol 2022; 15:1095-1105. [PMID: 36017645 DOI: 10.1080/17512433.2022.2117154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The optimal anticoagulation strategy for venous thromboembolism (VTE) prevention among COVID-19 patients, hospitalized or in the community setting, is still challenging and largely based on real-world evidence. AREAS COVERED We analyzed real-world data regarding the safety and effectiveness of anticoagulant treatment, both parenteral and oral, for VTE prevention or atrial fibrillation (AF)/VTE treatment among COVID-19 patients. EXPERT OPINION The efficacy of low-molecular-weight heparin (LMWH) doses for VTE prevention correlates with COVID-19 disease status. LMWH prophylactic dose may be useful in COVID-19 patients at the early stage of the disease. LMWH intermediate or therapeutic dose is recommended in COVID-19 patients with an advanced stage of the disease. COVID-19 patients on VKAs therapy for atrial fibrillation (AF) and VTE should switch to NOACs in the community setting or LMWH in the hospital setting. No definitive data on de-novo starting of NOACs or VKAs therapy for VTE prevention in COVID-19 outpatients are available. In patients at high risk discharged after hospitalization due to COVID-19, thromboprophylaxis with NOACs may be considered.
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Affiliation(s)
- Vincenzo Russo
- Department of Medical Translational Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples, Italy
| | - Adriano Caputo
- Department of Medical Translational Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples, Italy
| | - Egidio Imbalzano
- Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy
| | - Pierpaolo Di Micco
- Department of Internal Medicine and Cardiology, Fatebenefratelli Hospital, Naples, Italy
| | - Antonio Frontera
- Arrhythmology Department, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
| | - Ambra Uccello
- Department of Internal Medicine and Cardiology, Fatebenefratelli Hospital, Naples, Italy
| | - Luana Orlando
- Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy
| | - Paola Galimberti
- Arrhythmology Department, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
| | - Paolo Golino
- Department of Medical Translational Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples, Italy
| | - Antonello D'Andrea
- Department of Cardiology, Umberto I Hospital, 84014 Nocera Inferiore, Italy
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Mitrovic M, Tadic B, Jankovic A, Rankovic I, Kovac JD. Fatal gastrointestinal bleeding associated with acute pancreatitis as a complication of Covid-19: a case report. J Int Med Res 2022; 50:3000605221098179. [PMID: 35538708 PMCID: PMC9102154 DOI: 10.1177/03000605221098179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Clinical manifestations of Covid-19 vary widely among patients. Recent studies suggest that up to 15% of patients with severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infections develop gastrointestinal symptoms. The location of virus-host cell receptors angiotensin-converting enzyme 2 and transmembrane serine protease 2 has an important role in the pathophysiology and presentation of disease. They are expressed in the respiratory tract, as well as other organs and tissues including exocrine and endocrine pancreatic cells. These cells are therefore a possible target for the virus, which could explain the relationship between SARS-CoV-2 infection and pancreatic injury. We report a disastrous collateral effect of the Covid-19 pandemic on a 33-year-old man with chronic renal insufficiency and asymptomatic SARS-CoV-2 infection, who developed acute pancreatitis. Inflammation progressed rapidly toward necrosis and the development of a peripancreatic pseudoaneurysm which subsequently ruptured, causing death.
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Affiliation(s)
- Milica Mitrovic
- Center for Radiology and Magnetic Resonance Imaging, University Clinical Center of Serbia, Belgrade, Serbia
| | - Boris Tadic
- Clinic for Digestive Surgery, Department of HBP Surgery, University Clinical Center of Serbia, Belgrade, Serbia.,Department of Surgery with Anesthesiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Aleksandra Jankovic
- Center for Radiology and Magnetic Resonance Imaging, University Clinical Center of Serbia, Belgrade, Serbia
| | - Ivan Rankovic
- Clinic for Gastroenterology and Hepatology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Jelena Djokic Kovac
- Center for Radiology and Magnetic Resonance Imaging, University Clinical Center of Serbia, Belgrade, Serbia.,Department of Radiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Wichmann D, Schempf U, Göpel S, Stüker D, Fusco S, Königsrainer A, Malek NP, Werner CR. Analysis of the effects of the first and second/third waves of the COVID-19 pandemic on an Interdisciplinary Endoscopy Unit in a German 'hotspot' area: a single-center experience. Therap Adv Gastroenterol 2022; 15:17562848221086753. [PMID: 35340756 PMCID: PMC8949732 DOI: 10.1177/17562848221086753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 02/23/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Since December 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has posed a pandemic threat to global health. We are now in the fourth wave of this pandemic. As the pandemic developed, the requirements and therapeutic endoscopic procedures for SARS-CoV-2-positive patients underwent changes. METHODS Analysis of implications for an endoscopy unit during the first and second/third waves of the COVID-19 pandemic with a focus on COVID-19-related process changing. Addressed are number of SARS-CoV-2-positive patients and endoscopic examinations performed in patients who tested positive for SARS-CoV-2 during the various waves, adherence to scheduled examinations, rotation of staff to COVID-dedicated structures and, finally, impact of vaccination on infection rate among endoscopic staff. RESULTS During the first wave, 10 SARS-CoV-2-positive in-house patients underwent a total of 22 gastrointestinal (GI) endoscopic procedures. During the second and third waves, 59 GI endoscopies were performed in 38 patients. While in the first wave, GI bleeding was the main indication for endoscopy (82%), in the second and third waves the main indication for endoscopy was endoscopic insertion of deep feeding tubes (78%; p < 0.001). During the first wave, 5 (17%) of 29 Interdisciplinary Endoscopy Unit (IEU) staff members were moved to designated COVID wards, which was not necessary during the following waves. Lack of protective clothing was critical during the first wave, but not in the later waves. Screening tests for patients and staff were widely available after the first wave, and IEU staff was vaccinated during the second wave. CONCLUSION Strategies to ensure safe endoscopies with respect to preventing transmission of SARS-CoV-2 from patients to staff were effective. Organizational adjustments allowed the routine program to continue unaffected. Indications for GI endoscopies changed over time: during the first wave, GI endoscopies were performed for life-threatening indications, whereas later supportive procedures were the main indication.
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Affiliation(s)
- Dörte Wichmann
- Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany
| | - Ulrike Schempf
- Department of Gastroenterology, Hepatology, Gastrointestinal Oncology, Geriatrics and Infectious diseases, University Hospital Tübingen, Tübingen, Germany
| | - Siri Göpel
- Department of Gastroenterology, Hepatology, Gastrointestinal Oncology, Geriatrics and Infectious diseases, University Hospital Tübingen, Tübingen, Germany
| | - Dietmar Stüker
- Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany
| | - Stefano Fusco
- Department of Gastroenterology, Hepatology, Gastrointestinal Oncology, Geriatrics and Infectious diseases, University Hospital Tübingen, Tübingen, Germany
| | - Alfred Königsrainer
- Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany
| | - Nisar P. Malek
- Department of Gastroenterology, Hepatology, Gastrointestinal Oncology, Geriatrics and Infectious diseases, University Hospital Tübingen, Tübingen, Germany
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