P0594 - Unraveling the COVID Connection: Reduced Early Endoscopy and Increased Mortality in NVUGIB Patients-Insight from National Inpatient Sample

Sunday, October 22, 2023

3:30 PM – 7:00 PM PT

Location: Exhibit Hall

Has Audio

Presenting Author(s)

AJ

Ali Jaan, MD

Rochester General Hospital
Rochester, NY

Ali Jaan, MD¹, Umer Farooq, MD¹, Ahmed Shehadah, MD¹, Le Yu Naing, MD², Uzair Chatha, MD³, Syed Murtaza Haider Zaidi, MD⁴, Ahmad Khan, MD⁵, Byron Cryer, MD⁶, Sultan Mahmood, MD⁷
¹Rochester General Hospital, Rochester, NY; ²University of Louisville, Louisville, KY; ³Lahore Medical and Dental College, Overland Park, KS; ⁴King Edward Medical University, Lahore, Punjab, Pakistan; ⁵Case Western Reserve/UHCMC, Cleveland, OH; ⁶Baylor University Medical Center, Dallas, TX; ⁷Beth Israel Deaconess Medical Center, Boston, MA

Introduction: Since the outbreak of the COVID-19 pandemic, there has been limited data regarding the association between COVID-19 and Nonvariceal Upper Gastrointestinal Bleeding (NVUGIB). Some studies showed an association between COVID-19 and esophageal injury, while others speculated that NVUGIB may be in the setting of concomitant use of anticoagulants or severe infection. Our objective was to investigate the impact of COVID infection on mortality and other outcomes of NVUGIB.

Methods: Using the 2020 National Inpatient Sample (NIS) database and International Classification of Diseases, Tenth Revision, Clinical Modifications (ICD-10- CM) codes, we identified adult patients (aged ≥18 years) admitted with NVUGIB. The patients were further divided into two groups based on the presence or absence of COVID-19 on admission. Multivariate regression models were used to compare the outcomes between the two groups. Outcomes were adjusted for confounding variables and the severity of COVID-19 infection (i.e., sepsis and acute respiratory distress syndrome). STATA 14.2 was utilized for statistical analysis.

Results: A total of 36,977 adult patients with NVUGIB were admitted, of whom 598 (16.17%) were COVID-positive. Analysis showed that NVUGIB patients who were COVID-positive had increased odds of mortality compared to patients without COVID (adjusted odds ratio [aOR] 3.64, P< 0.01) (Table 1). NVUGIB patients with COVID-19 also had higher odds of developing acute kidney injury (AKI) (aOR 1.56, P< 0.01), requiring vasopressors (aOR 1.93, P< 0.01), and intensive care unit (ICU) admission (aOR 3.08, P< 0.01). Other interesting observations included significantly reduced diagnostic esophagogastroduodenoscopy (EGD) (aOR 0.28, P< 0.01) and repeat EGDs (aOR 0.67, P = 0.01) during the same hospitalization in the COVID arm. NVUGIB patients with COVID-19 also had a longer length of hospital stay and much higher total hospitalization cost.

Discussion: Our study identifies COVID-19 as an independent predictor of mortality and morbidity in patients with NVUGIB. It places the NVUGIB patient population at a higher risk of mortality, AKI, and ICU admission. Since EGD within 24 hours of admission in patients with NVUGIB is associated with lower in-hospital mortality as compared to delayed or no EGD, the significant reduction in early endoscopy in our COVID NVUGIB patient sample may be causally associated with their observed increased mortality. Prospective, multicenter studies are warranted to validate these findings.

NVUGIB + age >18 y = 36,977
Outcomes	With COVID (n=598)	Without COVID (n=36,379)	*Adjusted OR (95% CI)	P-value
Mortality, %	28.98	6.86	3.64 (2.81- 4.71)	< 0.01
Total parenteral nutrition, %	2.34	1.62	1.08 (0.58-1.99)	0.81
Acute kidney Injury, %	57.02	39.42	1.56 (1.26-1.91)	< 0.01
Blood transfusion, %	34.62	32.76	0.93 (0.76 - 1.14)	0.47
Vasopressor requirement, %	11.54	3.74	1.93 (1.33- 2.80)	< 0.01
Requiring ICU admission, %	43.14	14.85	3.08 (2.43- 3.90)	< 0.01
Diagnostic EGD without intervention, %	33.28	64.65	0.28 (0.23 - 0.33)	< 0.01
EGD with intervention, %	23.75	23.95	1.00 (0.82 - 1.23)	0.99
Any EGD, %	49.83	78.55	0.27 (0.23 - 0.33)	< 0.01
EGD within 24 hours of admission, %	8.19	34.26	0.18 (0.13 - 0.25)	< 0.01
Repeat EGD during the hospitalization, %	24.50	33.00	0.67 (0.51 - 0.89)	0.01
Radiography-guided embolization, %	0.84	0.84	0.89 (0.33 - 2.42)	0.82
Adjusted Mean Difference
Mean Length of hospital stay, days (95% CI)	20.53 (18.91- 22.15)	9.52 (9.32- 9.72)	6.50 (4.82- 8.19)	< 0.01
Total Hospitalization Charges, mean, USD	329,716 (278,991-380,442)	144,978 (138,792-151,164)	77,511 (28,651-126,371)	< 0.01

Table: Table 1: Unadjusted and adjusted outcomes of NVUGIB in patients with and without COVID-19.
*Adjusted for sex, age, hospital bed size, Charlson index, hospital location, hospital teaching status, hospital region, Median household
income in the patient’s zip code, race, SIRS or severe sepsis, ARDS, anticoagulation, use of antiplatelets, coronary artery disease, end-stage renal disease, cirrhosis, obesity, and congestive heart failure. CI means confidence interval. Abbreviations: NVUGIB: nonvariceal Upper GI Bleed, COVID: Coronavirus Disease, ICU: Intensive care unit; EGD: esophagogastroduodenoscopy; SIRS: Systemic inflammatory response syndrome, ARDS: Acute Respiratory Distress Syndrome.

Disclosures:

Ali Jaan indicated no relevant financial relationships.

Umer Farooq indicated no relevant financial relationships.

Ahmed Shehadah indicated no relevant financial relationships.

Le Yu Naing indicated no relevant financial relationships.

Uzair Chatha indicated no relevant financial relationships.

Syed Murtaza Haider Zaidi indicated no relevant financial relationships.

Ahmad Khan indicated no relevant financial relationships.

Byron Cryer indicated no relevant financial relationships.

Sultan Mahmood indicated no relevant financial relationships.

Ali Jaan, MD¹, Umer Farooq, MD¹, Ahmed Shehadah, MD¹, Le Yu Naing, MD², Uzair Chatha, MD³, Syed Murtaza Haider Zaidi, MD⁴, Ahmad Khan, MD⁵, Byron Cryer, MD⁶, Sultan Mahmood, MD⁷. P0594 - Unraveling the COVID Connection: Reduced Early Endoscopy and Increased Mortality in NVUGIB Patients-Insight from National Inpatient Sample, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.