Department of Internal Medicine, Division of Hospital Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA.
Department of Biostatistics, University of Nebraska Medical Center, Omaha, Nebraska, USA.
J Med Virol. 2023 Oct;95(10):e29100. doi: 10.1002/jmv.29100.
Little data is available regarding the incidence of gastrointestinal bleeding in adults hospitalized with COVID-19 infection and the influence of patient comorbidities and demographics, COVID-19 therapies, and typical medications used. In this retrospective study, we utilized the National COVID Cohort Collaborative to investigate the primary outcome of the development of gastrointestinal bleeding in 512 467 hospitalized US adults (age >18 years) within 14 days of a COVID-19 infection and the influence of demographics, comorbidities, and selected medications. Gastrointestinal bleeding developed in 0.44% of patients hospitalized with COVID-19. Comorbidities associated with gastrointestinal bleeding include peptic ulcer disease (adjusted odds ratio [aOR] 10.2), obesity (aOR 1.27), chronic kidney disease (aOR 1.20), and tobacco use disorder (aOR 1.28). Lower risk of gastrointestinal bleeding was seen among women (aOR 0.76), Latinx (aOR 0.85), and vaccinated patients (aOR 0.74). Dexamethasone alone or with remdesivir was associated with lower risk of gastrointestinal bleeding (aOR 0.69 and aOR 0.83, respectively). Remdesivir monotherapy was associated with upper gastrointestinal bleeding (aOR 1.25). Proton pump inhibitors were more often prescribed in patients with gastrointestinal bleeding, likely representing treatment for gastrointestinal bleeding rather than a risk factor for its development. In adult patients hospitalized with COVID-19, the use of dexamethasone alone or in combination with remdesivir is negatively associated with gastrointestinal bleeding. Remdesivir monotherapy is associated with increased risk of upper gastrointestinal bleeding.
关于 COVID-19 感染住院成人胃肠道出血的发生率以及患者合并症和人口统计学、COVID-19 治疗和常用药物的影响，相关数据较少。在这项回顾性研究中，我们利用国家 COVID 队列协作研究，调查了 512467 名美国 COVID-19 感染住院成人（年龄＞18 岁）在 COVID-19 感染后 14 天内发生胃肠道出血的主要结局，以及人口统计学、合并症和选定药物的影响。COVID-19 住院患者中有 0.44%发生胃肠道出血。与胃肠道出血相关的合并症包括消化性溃疡病（校正比值比[aOR]10.2）、肥胖症（aOR 1.27）、慢性肾脏病（aOR 1.20）和烟草使用障碍（aOR 1.28）。女性（aOR 0.76）、拉丁裔（aOR 0.85）和接种疫苗的患者胃肠道出血风险较低。地塞米松单独或与瑞德西韦联合使用与胃肠道出血风险降低相关（aOR 分别为 0.69 和 0.83）。瑞德西韦单药治疗与上消化道出血相关（aOR 1.25）。胃肠道出血患者更常开具质子泵抑制剂，可能代表对胃肠道出血的治疗而非其发生的危险因素。在 COVID-19 住院成人患者中，地塞米松单独或与瑞德西韦联合使用与胃肠道出血负相关。瑞德西韦单药治疗与上消化道出血风险增加相关。
