Emergency Department, Severo Ochoa University Hospital in Leganés.
Emergency Department, Bellvitge University Hospital, L'Hospitalet de Llobregat.
J Clin Gastroenterol. 2022 Jan 1;56(1):e38-e46. doi: 10.1097/MCG.0000000000001465.
The authors investigated the incidence, risk factors, clinical characteristics, and outcomes of upper gastrointestinal bleeding (UGB) in patients with coronavirus disease 2019 (COVID-19), who were attending the emergency department (ED), before hospitalization.
We retrospectively reviewed all COVID-19 patients diagnosed with UGB in 62 Spanish EDs (20% of Spanish EDs, case group) during the first 2 months of the COVID-19 outbreak. We formed 2 control groups: COVID-19 patients without UGB (control group A) and non-COVID-19 patients with UGB (control group B). Fifty-three independent variables and 4 outcomes were compared between cases and controls.
We identified 83 UGB in 74,814 patients with COVID-19 who were attending EDs (1.11%, 95% CI=0.88-1.38). This incidence was lower compared with non-COVID-19 patients [2474/1,388,879, 1.78%, 95% confidence interval (CI)=1.71-1.85; odds ratio (OR)=0.62; 95% CI=0.50-0.77]. Clinical characteristics associated with a higher risk of COVID-19 patients presenting with UGB were abdominal pain, vomiting, hematemesis, dyspnea, expectoration, melena, fever, cough, chest pain, and dysgeusia. Compared with non-COVID-19 patients with UGB, COVID-19 patients with UGB more frequently had fever, cough, expectoration, dyspnea, abdominal pain, diarrhea, interstitial lung infiltrates, and ground-glass lung opacities. They underwent fewer endoscopies in the ED (although diagnoses did not differ between cases and control group B) and less endoscopic treatment. After adjustment for age and sex, cases showed a higher in-hospital all-cause mortality than control group B (OR=2.05, 95% CI=1.09-3.86) but not control group A (OR=1.14, 95% CI=0.59-2.19) patients.
The incidence of UGB in COVID-19 patients attending EDs was lower compared with non-COVID-19 patients. Digestive symptoms predominated over respiratory symptoms, and COVID-19 patients with UGB underwent fewer gastroscopies and endoscopic treatments than the general population with UGB. In-hospital mortality in COVID-19 patients with UGB was increased compared with non-COVID patients with UGB, but not compared with the remaining COVID-19 patients.
本研究旨在调查在因 2019 冠状病毒病（COVID-19）而到急诊就诊的患者中，上消化道出血（UGB）的发生率、风险因素、临床特征和结局，这些患者在住院前就已被确诊为 COVID-19。
我们回顾性分析了西班牙 62 家急诊室（占西班牙急诊室的 20%，病例组）在 COVID-19 爆发的头 2 个月期间确诊为 UGB 的所有 COVID-19 患者。我们形成了 2 个对照组：COVID-19 患者中无 UGB 者（对照组 A）和非 COVID-19 患者中有 UGB 者（对照组 B）。比较了病例与对照组之间的 53 个独立变量和 4 个结局。
我们在因 COVID-19 而到急诊就诊的 74814 例患者中发现了 83 例 UGB（1.11%，95%置信区间=0.88-1.38）。与非 COVID-19 患者相比，这一发生率较低[2474/1388879，1.78%，95%置信区间（CI）=1.71-1.85；比值比（OR）=0.62；95%CI=0.50-0.77]。与 COVID-19 患者发生 UGB 风险较高相关的临床特征为腹痛、呕吐、呕血、呼吸困难、咳痰、黑便、发热、咳嗽、胸痛和味觉障碍。与非 COVID-19 患者 UGB 相比，COVID-19 患者 UGB 更常出现发热、咳嗽、咳痰、呼吸困难、腹痛、腹泻、间质性肺浸润和磨玻璃样肺混浊。他们在急诊室接受的内镜检查较少（尽管病例组与对照组 B 的诊断无差异），内镜治疗也较少。在校正年龄和性别后，病例组的住院全因死亡率高于对照组 B（OR=2.05，95%CI=1.09-3.86），但低于对照组 A（OR=1.14，95%CI=0.59-2.19）。
与非 COVID-19 患者相比，COVID-19 患者在急诊就诊时发生 UGB 的发生率较低。消化系统症状较呼吸系统症状更为突出，COVID-19 患者 UGB 接受的胃镜检查和内镜治疗均少于普通 UGB 人群。COVID-19 患者 UGB 的住院死亡率高于非 COVID-19 患者 UGB，但与其余 COVID-19 患者相比则无差异。
