COVID-19 Enfeksiyonunda Gastrointestinal Kanama: Vaka- Kontrol Çalışması

Öz

Amaç: Gastrointestinal sistem, ACE-2 reseptörü içermesinden dolayı COVID-19 enfeksiyonu sırasında gastrointestinal kanama dahil olmak üzere gastrointestinal semptomlar sıklıkla görülür. Ayrıca sadece virüs nedeniyle değil enfeksiyonun tedavisinde kullanılan ilaçlar nedeniyle de gastrointestinal kanama riski artmaktadır. Bu çalışmada COVID-19 nedeni ile COVID-19 yoğun bakım ünitesinde tedavi edilen hastalarda gastrointestinal kanama sıklığının saptanması ve antikoagülan, antiagregan, kortikosteroid, antibiyotik ve antiviral tedavilerin kanama riski üzerine etkilerini incelemeyi amaçladık. Materyal ve Metot: Çalışma retrospektif bir çalışmadır. Çalışmaya COVID-19 yoğun bakım ünitesinde takip edilen 189 hasta dahil edilmiştir. Hastalar gastrointestinal kanama varlığına göre analiz edildi. Hastaların steroid, pulse steroid, antikoagülan, antiagregan ve proton pompa inhibitörü tedavisi alıp almaması, tedavi süresi ve tedavi dozları incelendi. Gastrointestinal kanama olan ve olmayan hastalarda entübasyon ihtiyacı ve mortalite oranları karşılaştırıldı. Bulgular: COVID-19 yoğun bakımda takip edilen hastaların 34 (%18)’ünde gastrointestinal kanama geliştiği gözlendi. Gastrointestinal kanaması olan hastaların, kanaması olmayanlara göre daha uzun süre steroid ve antikoagülan tedavi kullanımına sahip olduğu gözlendi ( p<0.001 ve p=0.005). Gastrointestinal kanama geçirenlerde mortalite oranı daha yüksek izlendi (%73.5 vs %51, p=0.027) Sonuç: COVID-19 yoğun bakım ünitesinde yatan hastalarda gastrointestinal kanama geçirme riskinin, antikoagülan ve steroid tedavisinin süresi ile ilişkili olduğu gösterilmiştir. Bu nedenle, bu tedavileri alan hastaların gastrointestinal kanama açısından takip edilmesi gerektiğini düşünmekteyiz.

Anahtar Kelimeler

• COVID-19
• gastrointestinal kanama
• yoğun bakım ünitesi
• antikoagülan
• proton pompa inhibitörü

Gastrointestinal Bleeding In COVID-19 Infection: A case-control study

Abstract

Aim: Since the gastrointestinal tract contains ACE-2 receptors, gastrointestinal symptoms, including gastrointestinal bleeding (GIB), are frequently seen during COVID-19 infection. In addition, the risk of GIB increases not only due to the virus but also to the drugs used during the treatment of infection. In this study, we aimed to determine the frequency of GIB in patients being treated due to COVID-19 infection in the intensive care unit (ICU), and to examine the effects of anticoagulant, antiaggregant, corticosteroid, antibiotic, and antiviral treatments on bleeding risk. Material and Methods: This retrospective study included a total of 189 patients hospitalized due to the COVID-19 infection in the intensive care unit. Patients were analyzed according to the presence of GIB. The duration and doses of treatment with steroid, pulse steroid, anticoagulant, antiaggregant, and proton pump inhibitors were also analyzed. Intubation need and mortality rates were compared between GIB and without GIB. Results: GIB developed in 34 (18%) patients followed in the COVID-19 -ICU. Patients with GIB had longer use of steroids and anticoagulants than those without GIB (p<0.001 and p=0.005). The mortality rate was higher in those with GIB (73.5% vs 51%, p=0.027) Conclusion: It has been shown that the risk of GIB in patients hospitalized in the COVID-19 ICU is associated with the duration of anticoagulant and steroid therapy. Therefore, we think that patients receiving these treatments should be followed up for the risk of GIB.

Keywords

• COVID-19
• gastrointestinal bleeding
• intensive care unit
• anticoagulant
• proton pump inhibitor

Kaynakça

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