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Impact of first wave of COVID-19 on outcomes of hospitalization for upper gastrointestinal bleeding in Hong Kong: a population-based study.

ABSTRACT: Background and study aims ?The COVID-19 pandemic has caused a major disruption in the healthcare system. This study determined the impact of the first wave of COVID-19 on the number and outcome of patients hospitalized for upper gastrointestinal bleeding (UGIB) in Hong Kong. Patients and methods ?Records of all patients hospitalized for UGIB in Hong Kong public hospitals between October 2018 and June 2020 were retrieved. The number and characteristics of patients hospitalized for UGIB after COVID-19 was compared by autoregressive integrated moving average (ARIMA) model prediction and historical cohort. Results? Since the first local case of COVID-19, there was an initial drop in UGIB hospitalizations (observed 29.8 vs predicted 35.5 per week; P ?=?0.05) followed by a rebound (39.8 vs 26.7 per week; P ?P ?P ?P ?P ?P ?=?0.82) and rebleeding (6.7?% vs 5.1?%; P ?=?0.11). There was also a higher proportion of patients with variceal bleeding (10.5?% vs baseline 5.3?%; P ?Conclusions? There was a dynamic change in the number of patients hospitalized for UGIB in Hong Kong during the first wave of the COVID-19 outbreak, with more obvious impact during the initial phase only.

SUBMITTER: Lui TKL

PROVIDER: S-EPMC7892267 | biostudies-literature | 2021 Mar

REPOSITORIES: biostudies-literature

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Impact of first wave of COVID-19 on outcomes of hospitalization for upper gastrointestinal bleeding in Hong Kong: a population-based study.

Lui Thomas K L TKL Lui Thomas K L TKL Tsui Vivien W M VWM Leung Wai K WK

Endoscopy international open 20210218 3

<b>Background and study aims</b> The COVID-19 pandemic has caused a major disruption in the healthcare system. This study determined the impact of the first wave of COVID-19 on the number and outcome of patients hospitalized for upper gastrointestinal bleeding (UGIB) in Hong Kong. <b>Patients and methods</b> Records of all patients hospitalized for UGIB in Hong Kong public hospitals between October 2018 and June 2020 were retrieved. The number and characteristics of patients hospitalized for U ...[more]

PMID: 33655022

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Project description:BackgroundUpper gastrointestinal (GI) bleeding is one of the most common, high risk emergency disorders in the western world. Almost nothing has been reported on longer term prognosis following upper GI bleeding. The aim of this study was to establish mortality up to three years following hospital admission with upper GI bleeding and its relationship with aetiology, co-morbidities and socio-demographic factors.MethodsSystematic record linkage of hospital inpatient and mortality data for 14 212 people in Wales, UK, hospitalised with upper GI bleeding between 1999 and 2004 with three year follow-up to 2007. The main outcome measures were mortality rates, standardised mortality ratios (SMRs) and relative survival.ResultsMortality at three years was 36.7% overall, based on 5215 fatalities. It was highest for upper GI malignancy (95% died within three years) and varices (52%). Compared with the general population, mortality was increased 27-fold during the first month after admission. It fell to 4.3 by month four, but remained significantly elevated during every month throughout the three years following admission. The most important independent prognostic predictors of mortality at three years were older age (mortality increased 53 fold for people aged 85 years and over compared with those under 40 years); oesophageal and gastric/duodenal malignancy (48 and 32 respectively) and gastric varices aetiologies (2.8) when compared with other bleeds; non-upper GI malignancy, liver disease and renal failure co-morbidities (15, 7.9 and 3.9); social deprivation (29% increase for quintile V vs I); incident bleeds as an inpatient (31% vs admitted with bleeding) and male patients (25% vs female).ConclusionOur study shows a high late as well as early mortality for upper GI bleeding, with very poor longer term prognosis following bleeding due to malignancies and varices. Aetiologies with the worst prognosis were often associated with high levels of social deprivation.

Project description:Importance:Anticoagulant choice and proton pump inhibitor (PPI) cotherapy could affect the risk of upper gastrointestinal tract bleeding, a frequent and potentially serious complication of oral anticoagulant treatment. Objectives:To compare the incidence of hospitalization for upper gastrointestinal tract bleeding in patients using individual anticoagulants with and without PPI cotherapy, and to determine variation according to underlying gastrointestinal bleeding risk. Design, Setting, and Participants:Retrospective cohort study in Medicare beneficiaries between January 1, 2011, and September 30, 2015. Exposures:Apixaban, dabigatran, rivaroxaban, or warfarin with or without PPI cotherapy. Main Outcomes and Measures:Hospitalizations for upper gastrointestinal tract bleeding: adjusted incidence and risk difference (RD) per 10?000 person-years of anticoagulant treatment, incidence rate ratios (IRRs). Results:There were 1?643?123 patients with 1?713?183 new episodes of oral anticoagulant treatment included in the cohort (mean [SD] age, 76.4 [2.4] years, 651?427 person-years of follow-up [56.1%] were for women, and the indication was atrial fibrillation for 870?330 person-years [74.9%]). During 754?389 treatment person-years without PPI cotherapy, the adjusted incidence of hospitalization for upper gastrointestinal tract bleeding (n?=?7119) was 115 per 10?000 person-years (95% CI, 112-118). The incidence for rivaroxaban (n?=?1278) was 144 per 10?000 person-years (95% CI, 136-152), which was significantly greater than the incidence of hospitalizations for apixaban (n?=?279; 73 per 10?000 person-years; IRR, 1.97 [95% CI, 1.73-2.25]; RD, 70.9 [95% CI, 59.1-82.7]), dabigatran (n?=?629; 120 per 10?000 person-years; IRR, 1.19 [95% CI, 1.08-1.32]; RD, 23.4 [95% CI, 10.6-36.2]), and warfarin (n?=?4933; 113 per 10?000 person-years; IRR, 1.27 [95% CI, 1.19-1.35]; RD, 30.4 [95% CI, 20.3-40.6]). The incidence for apixaban was significantly lower than that for dabigatran (IRR, 0.61 [95% CI, 0.52-0.70]; RD, -47.5 [95% CI,-60.6 to -34.3]) and warfarin (IRR, 0.64 [95% CI, 0.57-0.73]; RD, -40.5 [95% CI, -50.0 to -31.0]). When anticoagulant treatment with PPI cotherapy (264?447 person-years; 76 per 10?000 person-years) was compared with treatment without PPI cotherapy, risk of upper gastrointestinal tract bleeding hospitalizations (n?=?2245) was lower overall (IRR, 0.66 [95% CI, 0.62-0.69]) and for apixaban (IRR, 0.66 [95% CI, 0.52-0.85]; RD, -24 [95% CI, -38 to -11]), dabigatran (IRR, 0.49 [95% CI, 0.41-0.59]; RD, -61.1 [95% CI, -74.8 to -47.4]), rivaroxaban (IRR, 0.75 [95% CI, 0.68-0.84]; RD, -35.5 [95% CI, -48.6 to -22.4]), and warfarin (IRR, 0.65 [95% CI, 0.62-0.69]; RD, -39.3 [95% CI, -44.5 to -34.2]). Conclusions and Relevance:Among patients initiating oral anticoagulant treatment, incidence of hospitalization for upper gastrointestinal tract bleeding was the highest in patients prescribed rivaroxaban, and the lowest for patients prescribed apixaban. For each anticoagulant, the incidence of hospitalization for upper gastrointestinal tract bleeding was lower among patients who were receiving PPI cotherapy. These findings may inform assessment of risks and benefits when choosing anticoagulant agents.

Project description:BACKGROUND:The benefits of transfusion for acute upper gastrointestinal bleeding (UGIB) have not been well established; however, previous studies suggest that transfusion is associated with adverse outcomes. We performed an observational study using a 10-year database to analyze the association between red blood cell (RBC) transfusion and outcomes in patients with UGIB in the emergency department (ED). METHOD AND FINDINGS:All adult patients with UGIB were identified through diagnostic codes. Hospital mortality was the primary outcome; further bleeding was the secondary outcome. Logistic regression, propensity analyses, and conditional logistic regression were performed to determine factors associated with outcomes. Of 59,188 enrolled patients, 31.6% (n?=?18,705) received RBC transfusions within 24?h following presentation to the ED. Hospital mortality was noted in 3.9 and 10.6% of the patients in the non-RBC transfusion and RBC transfusion groups, respectively (P?<?0.001). RBC transfusion was associated with increased mortality risk (unadjusted odds ratio (OR) 2.95, 95% confidence interval (CI) 2.75-3.16; P?<?0.001) among all patients and in the propensity-matched cohort (unadjusted OR 1.55, 95% CI 1.39-1.72; P?<?0.001). Further bleeding was noted in 5.6 and 33.8% of the patients in the non-RBC transfusion and RBC transfusion groups, respectively (P?<?0.001). RBC transfusion was associated with increased risk of further bleeding (unadjusted OR 8.60, 95% CI 8.16-9.06; P?<?0.001) among all patients and in the propensity-matched cohort (unadjusted OR 2.58, 95% CI 2.37-2.79; P?<?0.001). CONCLUSION:RBC transfusion was significantly associated with increased rates of hospital mortality and further bleeding in patients with UGIB. Although our findings have strengths, these results are not generalizable to all patients presenting with UGIB, especially patients presenting with exsanguinating bleeding. Additional prospective trials to guide optimal transfusion strategies in UGIB patients are needed.

Project description:IntroductionWith increasing advances in minimally invasive endoscopic therapies and endoscopic resection techniques for luminal disease, there is an increased risk of post-procedure bleeding. This can contribute to significant burden on patient's quality of life and health resources when reintervention is required. Hemospray (Cook Medical, North Carolina, USA) is a novel haemostatic powder licensed for gastrointestinal bleeding. The aim of this single-arm, prospective, non-randomised multicentre international study is to look at outcomes in patients with upper gastrointestinal bleeds following elective endoscopic therapy treated with Hemospray to achieve haemostasis.MethodsData was prospectively collected on the use of Hemospray from 16 centres (January 2016-November 2019). Hemospray was used during the presence of progressive intraprocedural bleeding post-endoscopic therapy as a monotherapy, dual therapy with standard haemostatic techniques or rescue therapy once standard methods had failed. Haemostasis was defined as the cessation of bleeding within 5 min of the application of Hemospray. Re-bleeding was defined as a sustained drop in haemoglobin (>2 g/l), haematemesis or melaena with haemodynamic instability after the index endoscopy.ResultsA total of 73 patients were analysed with bleeding post-endoscopic therapy. The median Blatchford score at baseline was five (interquartile range 0-9). The median Rockall score was six (interquartile range 5-7). Immediate haemostasis following the application of Hemospray was achieved in 73/73 (100%) of patients. Two out of 57 (4%) had a re-bleed post-Hemospray, one was following oesophageal endoscopic mucosal resection and the other post-duodenal endoscopic mucosal resection. Both patients had a repeat endoscopy and therapy within 24 h. Re-bleeding data was missing for 16 patients, and mortality data was missing for 14 patients. There were no adverse events recorded in association with the use of Hemospray.ConclusionHemospray is safe and effective in achieving immediate haemostasis following uncontrolled and progressive intraprocedural blood loss post-endoscopic therapy, with a low re-bleed rate.

Dataset Information

Impact of first wave of COVID-19 on outcomes of hospitalization for upper gastrointestinal bleeding in Hong Kong: a population-based study.

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Impact of first wave of COVID-19 on outcomes of hospitalization for upper gastrointestinal bleeding in Hong Kong: a population-based study.

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