Zhao Xi, Tao Meihui, Chen Chaoyue, Zhang Ying, Fu Yu
Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
Infect Drug Resist. 2021 Oct 14;14:4217-4226. doi: 10.2147/IDR.S335868. eCollection 2021.
There has been an increasing number of COVID-19 patients around the world. Since some patients developed with gastrointestinal bleeding, our study focused on the clinical features and gastroscopic findings of these patients, and factors associated with occult gastrointestinal bleeding.
In this retrospective, observational study, we collected 368 COVID-19 patients who performed fecal or gastric occult blood from Wuhan Tongji Hospital, Jin Yin-tan Hospital, and Wuhan Union Hospital between February 1, 2020 and March 6, 2020. Clinical features were compared between patients with or without occult gastrointestinal bleeding, and gastroscopic findings of seven patients were described. Logistic regression analyses were performed to explore the factors associated with occult gastrointestinal bleeding.
In total, 43 (11.7%) patients presented occult gastrointestinal bleeding, whereas 35 (81.4%) of severe cases. CRP level, prothrombin time and D-dimer were higher, while lymphocyte count and albumin levels were decreased in patients with occult gastrointestinal bleeding. Gastroscopy in seven COVID-19 patients showed mucosal congestion, erosion or scattered bleeding at different sites. Albumin levels (OR, 0.856 [95% CI 0.793-0.924]; p < 0.001), prothrombin time (OR, 1.267 [1.089-1.475]; p = 0.002) on admission and severe disease (OR, 4.157 [1.765-9.791]; p = 0.001) were independent factors associated with GIB in COVID-19 patients, while antiviral drugs and glucocorticoid therapy were not associated with it.
COVID-19 patients with occult gastrointestinal bleeding suffered from worse prognosis. Patients with decreased serum albumin levels or prolonged prothrombin time, and severe cases were at higher risk of occult gastrointestinal bleeding.
全球新型冠状病毒肺炎（COVID-19）患者数量不断增加。由于部分患者出现了胃肠道出血，我们的研究聚焦于这些患者的临床特征、胃镜检查结果以及与隐匿性胃肠道出血相关的因素。
在这项回顾性观察研究中，我们收集了2020年2月1日至2020年3月6日期间在武汉同济医院、金银潭医院和武汉协和医院进行粪便或胃潜血检查的368例COVID-19患者。比较了有或无隐匿性胃肠道出血患者的临床特征，并描述了7例患者的胃镜检查结果。进行逻辑回归分析以探讨与隐匿性胃肠道出血相关的因素。
共有43例（11.7%）患者出现隐匿性胃肠道出血，其中35例（81.4%）为重症病例。隐匿性胃肠道出血患者的C反应蛋白水平、凝血酶原时间和D-二聚体较高，而淋巴细胞计数和白蛋白水平降低。7例COVID-19患者的胃镜检查显示不同部位黏膜充血、糜烂或散在出血。入院时白蛋白水平（比值比[OR]，0.856[95%置信区间0.793 - 0.924]；p < 0.001）、凝血酶原时间（OR，1.267[1.089 - 1.475]；p = 0.002）和重症疾病（OR，4.157[1.765 - 9.791]；p = 0.001）是COVID-19患者发生胃肠道出血的独立相关因素，而抗病毒药物和糖皮质激素治疗与之无关。
出现隐匿性胃肠道出血的COVID-19患者预后较差。血清白蛋白水平降低或凝血酶原时间延长的患者以及重症患者发生隐匿性胃肠道出血的风险较高。
