Pausawasdi Nonthalee, Manomaiwong Ekawat, Kaosombatwattana Uayporn, Karaketklang Khemajira, Charatcharoenwitthaya Phunchai
Siriraj GI Endoscopy Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
J Clin Med. 2022 Apr 27;11(9):2461. doi: 10.3390/jcm11092461.
This study aims to investigate the effects of COVID-19 on clinical outcomes of non-COVID-19 patients hospitalized for upper gastrointestinal bleeding (UGIB) during the pandemic. A retrospective review is conducted. We recruited patients with UGIB admitted during the pandemic’s first wave (April 2020 to June 2020), and the year before the pandemic. The outcomes between the two groups were compared using propensity score matching (PSM). In total, 60 patients (pandemic group) and 460 patients (prepandemic group) are included. Patients admitted during the pandemic (mean age of 67 ± 14 years) had a mean Glasgow−Blatchford score of 10.8 ± 3.9. They were older (p = 0.045) with more underlying malignancies (p = 0.028), had less history of NSAID use (p = 0.010), had a lower platelet count (p = 0.007), and had lower serum albumin levels (p = 0.047) compared to those admitted before the pandemic. Esophagogastroduodenoscopy (EGD) was performed less frequently during the pandemic (43.3% vs. 95.4%, p < 0.001). Furthermore, the procedure was less likely to be performed within 24 h after admission (p < 0.001). After PSM, admissions during the pandemic were significantly associated with decreased chances of receiving an endoscopy (adjusted odds Ratio (OR), 0.02; 95% CI, 0.003−0.06, p < 0.001) and longer hospital stay (adjusted OR, 2.17; 95% CI, 1.13−3.20, p < 0.001). Additionally, there was a slight increase in 30-day mortality without statistical significance (adjusted OR, 1.92; 95% CI, 0.71−5.19, p = 0.199) and a marginally higher rebleeding rate (adjusted OR, 1.34; 95% CI, 0.44−4.03, p = 0.605). During the pandemic, the number of EGDs performed in non-COVID-19 patients with UGIB decreased with a subsequent prolonged hospitalization and potentially increased 30-day mortality and rebleeding rate.
本研究旨在调查2019冠状病毒病（COVID-19）大流行期间，因上消化道出血（UGIB）住院的非COVID-19患者的临床结局受到的影响。进行了一项回顾性研究。我们招募了在大流行第一波期间（2020年4月至2020年6月）以及大流行前一年收治的UGIB患者。使用倾向得分匹配法（PSM）比较两组患者的结局。总共纳入了60例患者（大流行组）和460例患者（大流行前组）。大流行期间收治的患者（平均年龄67±14岁）格拉斯哥-布拉奇福德评分平均为10.8±3.9。与大流行前收治的患者相比，他们年龄更大（p = 0.045），潜在恶性肿瘤更多（p = 0.028），非甾体抗炎药使用史更少（p = 0.010），血小板计数更低（p = 0.007），血清白蛋白水平更低（p = 0.047）。大流行期间食管胃十二指肠镜检查（EGD）的实施频率较低（43.3%对95.4%，p < 0.001）。此外，该检查在入院后24小时内进行的可能性较小（p < 0.001）。PSM后，大流行期间的入院与接受内镜检查的机会减少（调整后的优势比（OR）为0.02；95%置信区间（CI）为0.003 - 0.06，p < 0.001）以及住院时间延长（调整后的OR为2.17；95%CI为1.13 - 3.20，p < 0.001）显著相关。此外，30天死亡率略有上升，但无统计学意义（调整后的OR为1.92；95%CI为0.71 - 5.19，p = 0.199），再出血率略高（调整后的OR为1.34；95%CI为0.44 - 4.03，p = 0.605）。在大流行期间，非COVID-19的UGIB患者接受EGD检查的次数减少，随后住院时间延长，30天死亡率和再出血率可能增加。
