Antecedentes: No se ha determinado si la hemorragia digestiva aumenta la mortalidad en pacientes con COVID-19, pero se teme que el uso de anticoagulantes profilácticos afecte negativamente a estos sangrados y haya una mayor exposición al contagio al realizar endoscopías. Objetivo: Determinar la mortalidad de los pacientes con COVID-19 y hemorragia digestiva y comparar el efecto del manejo endoscópico con el del tratamiento conservador. Métodos y Materiales: Se realizó una revisión sistemática según PRISMA de las bases de datos de PubMed, Ovid, Clinical Key y Cochrane. Se incluyeron pacientes hospitalizados con COVID-19, no gestantes, mayores de 18 años con y sin hemorragia digestiva, de estudios publicados entre el 01 de enero de 2020 y el 30 de abril de 2021. La calidad de los artículos fue evaluada con las escalas de Newcastle-Ottawa y de National Institutes of Health. Se usó Review Manager 5.4.1 de Cochrane para el metaanálisis. Resultados: Se encontró un OR 2,7 significativo para la mortalidad de pacientes COVID-19 expuestos a hemorragia digestiva (IC 95% [1,77-4,13], I2 = 20%, y p < 0,00001) y un OR 2,04 significativo en el subanálisis de casos y controles (IC 95% [1,23-3,38], p = 0,006 e I2 = 0%). Los resultados son cuestionables debido a los valores y pesos de cada estudio. Conclusión: No hay evidencia suficiente para asegurar que los pacientes con COVID-19 y hemorragia digestiva tengan una mortalidad mayor que aquellos sin sangrado. Parece haber una buena respuesta al manejo conservador.
Background: It hasn’t been determined whether gastrointestinal hemorrhage increases mortality in COVID-19 patients, however the use of prophylactic anticoagulation for the infection is feared as it might negatively affect them due to increased bleeding and increase risk of infection due to performing endoscopies. Objective: To determine the mortality in COVID-19 patients with digestive bleeding and to compare the effect on mortality of the endoscopic versus the conservative treatment. Methods and Materials: A systematic review of the PubMed, Ovid, Clinical Key and Cochrane databases was made, according to PRISMA. Studies involving hospitalized patients older than 18 years old with COVID-19, not pregnant, with and without gastrointestinal hemorrhage, ranging from January 1st 2020 to April 30th 2021 were included. Their quality was assessed with the Newcastle-Ottawa and the National Institutes of Health scales. Cochrane’s Review Manager 5.4.1 was used for the meta-analysis. Results: A significative OR of 2,7 was found concerning mortality of COVID-19 patients with digestive bleeding (CI 95% [1,77-4,13], p < 0,00001 and I2 = 20%). Another significative OR of 2,04 was found when doing a sub-analysis of the case-control studies (CI 95% [1,23-3,38], p = 0,006 and I2 = 0%). These results are questionable due to the values and weight of each study. Conclusion: There isn’t enough evidence to confirm that COVID-19 patients with gastrointestinal hemorrhage have a higher mortality than those without it. There seems to be a good response to conservative therapy.
