RISK SCORING SYSTEMS TO PREDICT NEED FOR ENDOSCOPIC TREATMENT IN HOSPITALIZED PATIENTS WITH COVID-19 PNEUMONIA AND UPPER GASTROINTESTINAL BLEEDING

Aims Given the risks of endoscopy and transmitting the virus, the management of patients with COVID-19 pneumonia and upper gastrointestinal bleeding (UGB) is challenging. We evaluated 3 risk scoring systems for assessing the need for endoscopic treatment in patients with COVID-19 pneumonia and UGB.

Methods Dual-centre, retrospective, study involving hospitalized patients with COVID-19 pneumonia and UGB (3/2020-11/2021). The performance of Glascow-Blatchford score (GBS), pre-endoscopy Rockall and AIMS65 for predicting the need for endoscopic treatment was assessed using the area-under-receiver-operating-characteristic-curve (AUROC).

Results 24 patients were included (14 males, mean 71.4±19.2 years). At the onset of UGB, 18 were on supplemental oxygen, 6 had an endotracheal tube, 22 were under enoxaparine, 8 were taking antiplatelets and 2 were taking direct oral anticoagulants. All 24 patients were treated with proton pump inhibitors, whereas all intubated patients were treated with vasoactive drugs. Upper endoscopy was performed after a median of 1 days (range 0-3). Peptic ulcer was the most common finding (10/24), followed by erosive gastritis (5/24) and oesophagitis (4/24). Endoscopic treatment (endoclips±adrenaline injection) was required in 10/24 cases. For predicting the need for endoscopic treatment, GBS showed a good performance (AUROC=0.84, 95%CI:0.69-0.99) and pre-endoscopy Rockall performed fairly (AUROC=0.77, 95%CI:0.58-0.96), whereas the performance of AIMS65 was poor (AUROC=0.61, 95%CI:0.38-0.84). No endoscopic treatment was required at a GBS<12.5 (8/24 patients; sensitivity=100%, specificity=57.1%) and a pre-endoscopic Rockall<1.5 (4/24 patients; sensitivity=100%, specificity=28.6%).

Fig. 1

Conclusions Risk scoring systems appear to be useful for triaging the need for endoscopic intervention in patients with COVID-19 pneumonia who develop UGB.

Publication History

Article published online:
14 April 2022