COVID-19 Enfeksiyonunda Gastrointestinal Kanama: Vaka- Kontrol Çalışması

Yıl 2022, Cilt: 4 Sayı: 3, 487 - 492, 22.09.2022

Esra Polat , Fatma Yekta Urkmez , Ahmet Hamdi Aktan , İbrahim Halil İnanç

https://doi.org/10.37990/medr.1112986

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

Öz

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.

Anahtar Kelimeler

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

Kaynakça

• 1. World Heart Organization Coronavirus (COVID-19) Dashboard, January 23, 2022, https://covid19.who.int/
• 2. Villapol, S. (2020). Gastrointestinal symptoms associated with COVID-19: impact on the gut microbiome. Translational Research. 2020; 226: 57-69.
• 3. Tuttolomondo, D., Frizzelli, A., Aiello, M., Bertorelli, G., Majori, M., & Chetta, A. Beyond the lung involvement in COVID-19 patients. A review. Minerva Medica. 2020 Jun 19
• 4. Fatma Yekta Ürkmez, Ayşe Kaya Kalem. Solunum Dışı Sistem Etkilenmeleri. In: Prof.Dr. Turan BUZGAN, Prof.Dr. Rahmet Güner editors. Ankara Yıldırım Beyazıt Üniversitesi Tıp Fakültesi COVID-19 Pandemisi,. ISBN: 978-605-4929-15-3. P 103-113.
• 5. Wang, J., Zhao, S., Liu, M., Zhao, Z., Xu, Y., Wang, P, et al. ACE2 expression by colonic epithelial cells is associated with viral infection, immunity and energy metabolism. MedRxiv. 2020, February 7]
• 6. Martin, T. A., Wan, D. W., Hajifathalian, K., Tewani, S., Shah, S. L., Mehta, A, et al. Gastrointestinal bleeding in patients with coronavirus disease 2019: a matched case-control study. The American Journal of Gastroenterology. 2020. 115; 1609-1616.
• 7. Hunt RH., East JE., Lanas A., Malfertheiner P., Satsangi J., Scarpignato C., Webb, G. J. COVID-19 and Gastrointestinal Disease: Implications for the Gastroenterologist. Digestive Diseases, 2021, 39(2), 119-139.
• 8. Narum, S., Westergren, T., Klemp, M. . Corticosteroids and risk of gastrointestinal bleeding: a systematic review and meta-analysis. BMJ Open, 2014. 4(5), e004587.
• 9. Carfora, V., Spiniello, G., Ricciolino, R., Di Mauro, M., Migliaccio, M. G., Mottola, F. F., et al. Anticoagulant treatment in COVID-19: a narrative review. Journal of thrombosis and thrombolysis, 2021, 51(3), 642-648.
• 10. Lanas-Gimeno, A., Lanas, A. Risk of gastrointestinal bleeding during anticoagulant treatment. Expert opinion on drug safety, 2017. 16(6), 673-685.
• 11. TC Sağlık Bakanlığı Erişkin Hasta Yönetimi ve Tedavi Rehberi , https://covid19.saglik.gov.tr/Eklenti/40719/0/covid-19rehberieriskinhastayonetimivetedavipdf.pdf
• 12. Gündogan, K., Akbudak, I. H., Hanci, P., Halacli, B., Temel, S., Güllü, Z., et al .Clinical Outcomes and Independent Risk Factors for 90-Day Mortality in Critically Ill Patients with Respiratory Failure Infected with SARS-CoV-2: A Multicenter Study in Turkish Intensive Care Units. Balkan Med J, 2021. 296-303.
• 13. Grasselli, G., Greco, M., Zanella, A., Albano, G., Antonelli, M., Bellani, G, et al. Risk factors associated with mortality among patients with COVID-19 in intensive care units in Lombardy, Italy. JAMA internal medicine, 2020, 180(10), 1345-1355.
• 14. Medetalibeyoğlu, A., Ezirmik, E., Şenkal, N., Bayrakdar, S., Aktar, İ., Reyhan, A. K. A. S., et al. Patıent Characterıstıcs And Rısk Factors For Mortalıty In 504 Hospıtalızed Patıents Due To Covıd-19. Journal Of Istanbul Faculty Of Medicine, 2021, 85(1), 3-4.
• 15. Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med 2020 May; 8(5):475-481.
• 16. Akbudak İsmail Hakkı, Retrospective evaluation of critical patients followed in intensive with the diagnosis of COVID-19 infection: single center experience. Pamukkale Medical Journal.2021;14(2):438-442.
• 17. Lin L., Jiang X., Zhang Z., et al. Gastrointestinal symptoms of 95 cases with SARS-CoV-2 Infection. Gut. 2020;69(6):997–1001.
• 18. Yang F., Shi S., Zhu J., Shi J., Dai K., Chen X. Analysis of 92 deceased patients with COVID‐19. Journal of Medical Virology. 2020;92(11):2511–2515.
• 19. Xiao F., Tang M., Zheng X., Liu Y., Li X., Shan H. Evidence for gastrointestinal infection of SARS-CoV-2. Gastroenterology. 2020;158(6):1831–1833.
• 20. Marasco G., Lenti M. V., Cremon C., et al. Implications of SARS-CoV-2 infection for neurogastroenterology. Neuro-Gastroenterology and Motility: The Official Journal of the European Gastrointestinal Motility Society. 2021;33(3).
• 21. Cook, D. J., Fuller, H. D., Guyatt, G. H., Marshall, J. C., Leasa, D., Hall, R., et al. (1994). Risk factors for gastrointestinal bleeding in critically ill patients. New England journal of medicine, 330(6), 377-381.
• 22. Kupfer, Y., Cappell, M. S., & Tessler, S. (2000). Acute gastrointestinal bleeding in the intensive care unit: the intensivist's perspective. Gastroenterology Clinics of North America, 29(2), 275-307.
• 23. Musoke, N., Lo, K. B., Albano, J., Peterson, E., Bhargav, R., Gul, F., et al. (2020). Anticoagulation and bleeding risk in patients with COVID-19. Thrombosis research, 196, 227-230.
• 24. Parisi, R., Costanzo, S., Di Castelnuovo, A., De Gaetano, G., Donati, M. B., et al. (2021, April). Different anticoagulant regimens, mortality, and bleeding in hospitalized patients with COVID-19: a systematic review and an updated meta-analysis. In Seminars in thrombosis and hemostasis. Thieme Medical Publishers, Inc. 2021; 47: 372-391.
• 25. Marasco, G., Maida, M., Morreale, G. C., Licata, M., Renzulli, M., Cremon, C., et al. (2021). Gastrointestinal Bleeding in COVID-19 Patients: A Systematic Review with Meta-Analysis. Canadian Journal of Gastroenterology and Hepatology, 2021.