Nonvariceal upper gastrointestinal bleeding in COVID-19 patients: insights from the National Inpatient Sample

Abstract

Background

This retrospective study, conducted using the U.S. National Inpatient Sample (NIS), examines the outcomes and management of nonvariceal upper gastrointestinal bleeding (NVUGIB) in COVID-19 patients and identifies predictive factors to enhance patient prognosis.

Methods

We analyzed the 2020 U.S. NIS data involving adult patients (≥18 years) admitted with NVUGIB and categorized them based on the presence of COVID-19. Primary and secondary outcomes, NVUGIB-related procedures, and predictive factors were evaluated.

Results

Of 184,885 adult patients admitted with NVUGIB, 1.6% (2990) had COVID-19. Patients with NVUGIB and COVID-19 showed higher inpatient mortality, acute kidney injury, need for intensive care, and resource utilization metrics. Notably, there was a lower rate of early esophagogastroduodenoscopy (EGD). Multivariate logistic regression revealed conditions like peptic ulcer disease, mechanical ventilation, and alcohol abuse as significant positive predictors for NVUGIB in COVID-19 patients, whereas female gender and smoking were negative predictors.

Conclusion

Our findings suggest that COVID-19 significantly increases the risk of mortality and complications in NVUGIB patients. The observed decrease in early EGD interventions, potentially contributing to higher mortality rates, calls for a review of treatment strategies. Further multicenter, prospective studies are needed to validate these results and improve patient care strategies.

Keywords:

• Nonvariceal upper gastrointestinal bleeding
• covid-19
• mortality
• acute kidney injury
• esophagogastroduodenoscopy
• inpatient care
• risk factors

Acknowledgment

The preliminary version of these data has been accepted for presentation as an abstract at the Annual Scientific Meeting of the American College of Gastroenterology, October 21-26, 2023, in Vancouver, BC, West Canada.

Ethical approval

The study was deemed exempt from full review by the institutional review board.lthough our study utilized the NIS database, which contains de-identified data, approval was nevertheless sought from the institutional review board. Given the nature of the data, this study was deemed exempt from full review.

Authors’ contributions

AJ, ZS, UF: Conceptualization, methodology, software, data curation, validation, writing, and original draft preparation. JG, JEM, SM, KD: Analysis and interpretation of results, reviewing, and editing of the manuscript. BC, PO: project administration, supervision, and critical revision of the manuscript. All authors had access to the study data and reviewed and approved the final manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.