Predictors of Mortality in COVID‐19 Patients Presenting With Gastrointestinal Bleeding: A Retrospective Cross‐Sectional Study

ABSTRACT Background and Aims Coronavirus disease 2019 (COVID‐19), since its outbreak, has been a potentially fatal disorder. Gastrointestinal bleeding (GIB) with a notable prevalence of 1.5%–3% has been identified as a prominent cause of death in COVID‐19 patients. This study was conducted to evaluate GIB prevalence and mortality rate in COVID‐19 patients and to assess the role of potential risk factors on patient outcomes. Methods In this retrospective cross‐sectional study, the records of RT‐PCR confirmed COVID‐19 patients who presented with overt GIB symptoms (melena, hematochezia, and hematemesis) in their course of admission or hospitalization in Isfahan Shariati Hospital, between March 2020 and 2022, were enrolled. After exclusion, data on patients' demographics, comorbid conditions, manifestations of GIB, bleeding onset, and anticoagulant administration were extracted. Subjects were divided into two groups: alive and deceased 30 days after discharge to assess the role of variables on mortality. Results Among 7243 COVID‐19 patients, 107 (1.5%) individuals experienced GIB symptoms. After excluding patients with GIB not attributable to COVID‐19, 63 patients (0.86%) were included in the analysis, of whom 47.6% were reported deceased. The most common manifestations were hematemesis (42.9%) and melena (33.3%), indicating 76.2% of the upper GIB source. 61.9% of GIBs occurred during hospitalization, and the prevalence of hypertension, diabetes, and cardiovascular disease was 39.7%, 31.7%, and 19%, respectively. Endoscopic evaluation was performed in 12 patients, with gastric and duodenal ulcers being the most frequent findings (5 cases, 41.6%). Other than a significant association between the outcomes and the onset of bleeding ( p = 0.001, OR = 5.53), no statistically significant relationship was found among other variables. Conclusion GIB developing during hospitalization, as opposed to bleeding that occurred prior to admission, was suggested as a prognostic factor of mortality in COVID‐19 patients. Considering the fatal consequences of GIB in COVID‐19 patients, further studies are recommended to assess the roles of risk factors in preventing adverse outcomes.