University therapeutic journal

Model for assessing the risk of gastroduodenal bleeding in Covid-19 patients with evaluation of morphometric factors

ORIGINAL PAPERS

Keywords:
COVID-19 SARS CoV-2 gastrointestinal bleeding endoscopic hemostasis risk factors endotheliopathy COVID-19 SARS CoV-2 желудочно кишечное кровотечение эндоскопический гемостаз факторы риска эндотелиопатия

Abstract

Introduction.In the pathogenesis of the hemorrhagic syndrome in COVID-19, the key points are the development of heparin-induced coagulopathy and the release of pro-inflammatory factors into the bloodstream. SARS-Co V-2-associated endotheliopathy is also considered an additional link. At the same time, the diagnostic process requires the identification of markers that contribute to the development of gastrointestinal bleeding. The aim is to determine the main risk factors for gastrointestinal bleeding in COVID-19 patients based on a comprehensive clinical, laboratory and instrumental examination and to analyze the effectiveness of hemostasis methods in patients with gastroduodenal bleeding. The study involved 332 patients with COVID-19 and developed gastrointestinal bleeding.Materials and methods.The study conducted at the S.P. Botkin Clinical Infectious Diseases Hospital and the Mariinsky City Hospital included cases of COVID-19 patients with upper gastrointestinal tract bleeding.Results.An immunohistochemical investigation using monoclonal antibodies to CD31, CD34, CD68 and v WF receptors revealed an alteration of the endothelial monolayer, contributing to the occurrence of a hemorrhagic event. When creating a prognostic model using logistic regression with the ROC-curve construction, a correlation was established between the development of gastrointestinal bleeding and coagulogram indicators, the degree of lung parenchymal involvement, history of cardiac rhythm disorders, and the method of providing respiratory support (р ˂0.05). Based on a model constructed by binary logistic regression, a prognostic risk scale for the development of gastroduodenal bleeding in patients with COVID-19 was created. The sensitivity of the method was 64.3%, specificity 72.1%, accuracy 68%.Conclusion.An increase in the frequency of gastrointestinal bleeding in COVID-19 patients is directly related to the direct cytopathic effect of the SARS-Co V-2 on endotheliocytes. The risk scale for the development of gastroduodenal bleeding from erosive and ulcerative mucosal defects in patients with COVID-19 is a highly informative method that allows to predict hemorrhagic events in a timely manner.

Author Biographies

Konstantin V. Medvedev, S.P. Botkin Clinical Infectious Diseases Hospital; Saint Petersburg State Pediatric Medical University

Cand. Sci. (Med), Associate Professor, Department of Faculty Surgery named after Professor A.A. Rusanov, Saint Petersburg State Pediatric Medical University; Chief Surgeon, Botkin Clinical Infectious Diseases Hospital

Denis A. Gusev, S.P. Botkin Clinical Infectious Diseases Hospital; Almazov National Medical Research Centre

Dr. Sci. (Med), Professor, Head of the Department of Infectious Diseases with a course in Epidemiology, Almazov National Medical Research Centre; Chief Physician, Botkin Clinical Infectious Diseases Hospital

Vsevolod A. Zinserling, S.P. Botkin Clinical Infectious Diseases Hospital; Almazov National Medical Research Centre

Dr. Sci. (Med), Professor, Head of the Pathomorphology Research Department, Institute of Experimental Medicine, Almazov National Medical Research Centre; advisor, Botkin Clinical Infectious Diseases Hospital

Mikhail A. Protchenkov, Hospital for War Veterans; Saint Petersburg State Pediatric Medical University

Dr. Sci. (Med), Professor, Department of Faculty Surgery named after Professor A.A. Rusanov, Saint Petersburg State Pediatric Medical University; Head of the Surgical Department, Hospital for War Veterans

Artyom L. Ivanov, S.P. Botkin Clinical Infectious Diseases Hospital; Saint Petersburg State Pediatric Medical University

Cand. Sci. (Med), Associate Professor, Department of Faculty Surgery named after Professor A.A. Rusanov, Saint Petersburg State Pediatric Medical University; Surgeon, Botkin Clinical Infectious Diseases Hospital

Ivan A. Solovyov, Saint Petersburg State Pediatric Medical University; City Mariinsky Hospital

Dr. Sci. (Med), Professor, Department of Hospital Surgery, Saint Petersburg State Pediatric Medical University; Deputy Chief Physician for Surgery, City Mariinsky Hospital

Nicolay Yu. Kohanenko, Saint Petersburg State Pediatric Medical University

Dr. Sci. (Med), Head of the Department of Faculty Surgery named after Professor A.A. Rusanov, Saint Petersburg State Pediatric Medical University

Ruben G. Avanesyan, Saint Petersburg State Pediatric Medical University; City Mariinsky Hospital

Dr. Sci. (Med), Head of the Department of General Surgery with a course in Endoscopy, Saint Petersburg State Pediatric Medical University; Surgeon, City Mariinsky Hospital

Karina E. Borta, S.P. Botkin Clinical Infectious Diseases Hospital; Saint Petersburg State Pediatric Medical University

Postgraduate Student, Senior Laboratory Assistant, Department of Faculty Surgery named after Professor A.A. Rusanov, Saint Petersburg State Pediatric Medical University; Surgeon, Botkin Clinical Infectious Diseases Hospital

Natalya Yu. Semenova, S.P. Botkin Clinical Infectious Diseases Hospital; Almazov National Medical Research Centre

Senior Researcher, Pathomorphology Research Department, Institute of Experimental Medicine, Almazov National Medical Research Centre

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How to Cite
Model for assessing the risk of gastroduodenal bleeding in Covid-19 patients with evaluation of morphometric factors: ORIGINAL PAPERS. (2026). University Therapeutic Journal, 8(2), 123-141. https://doi.org/10.56871/
Issue
Vol. 8 No. 2 (2026)
Section
Original papers
Published
2026-07-27

How to Cite

Model for assessing the risk of gastroduodenal bleeding in Covid-19 patients with evaluation of morphometric factors: ORIGINAL PAPERS. (2026). University Therapeutic Journal, 8(2), 123-141. https://doi.org/10.56871/