Digestive Manifestations in Patients Hospitalized With Coronavirus Disease 2019
B Joseph Elmunzer1, Rebecca L Spitzer1, Lydia D Foster2
1Division of Gastroenterology and Hepatology, Department of Medicine, Charleston, South Carolina.
Insights
Digestive symptoms like diarrhea and nausea were common in hospitalized coronavirus disease 2019 (COVID-19) patients. However, these gastrointestinal issues were usually mild and did not predict a worse clinical outcome.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Internal Medicine
Background:
- Digestive manifestations in coronavirus disease 2019 (COVID-19) are not well understood.
- Assessing the prevalence and clinical significance of gastrointestinal symptoms in COVID-19 patients is crucial.
Purpose of the Study:
- To determine the prevalence, spectrum, severity, and significance of digestive manifestations in hospitalized COVID-19 patients.
- To evaluate the association between digestive symptoms and severe COVID-19 outcomes.
Main Methods:
- A retrospective analysis of 1992 hospitalized COVID-19 patients across 36 North American centers.
- Data on symptoms, laboratory tests, and clinical outcomes were extracted from electronic health records.
- Regression analyses were used to assess the link between digestive issues and severe outcomes like mechanical ventilation or death.
Main Results:
- Over half of patients (53%) reported gastrointestinal symptoms, most commonly diarrhea (34%), nausea (27%), and vomiting (16%).
- The majority of these symptoms (74%) were mild.
- Liver function test abnormalities were observed in 35% of patients, typically mild.
- Neither gastrointestinal symptoms nor liver test abnormalities were independently associated with mechanical ventilation or death.
Conclusions:
- Gastrointestinal symptoms and liver test abnormalities are frequent in hospitalized COVID-19 patients.
- These manifestations are generally mild and do not appear to be linked to a more severe disease course.
- The study clarifies the impact of digestive issues on COVID-19 severity.
Background & Aims:
The prevalence and significance of digestive manifestations in coronavirus disease 2019 (COVID-19) remain uncertain. We aimed to assess the prevalence, spectrum, severity, and significance of digestive manifestations in patients hospitalized with COVID-19.
Methods:
Consecutive patients hospitalized with COVID-19 were identified across a geographically diverse alliance of medical centers in North America. Data pertaining to baseline characteristics, symptomatology, laboratory assessment, imaging, and endoscopic findings from the time of symptom onset until discharge or death were abstracted manually from electronic health records to characterize the prevalence, spectrum, and severity of digestive manifestations. Regression analyses were performed to evaluate the association between digestive manifestations and severe outcomes related to COVID-19.
Results:
A total of 1992 patients across 36 centers met eligibility criteria and were included. Overall, 53% of patients experienced at least 1 gastrointestinal symptom at any time during their illness, most commonly diarrhea (34%), nausea (27%), vomiting (16%), and abdominal pain (11%). In 74% of cases, gastrointestinal symptoms were judged to be mild. In total, 35% of patients developed an abnormal alanine aminotransferase or total bilirubin level; these were increased to less than 5 times the upper limit of normal in 77% of cases. After adjusting for potential confounders, the presence of gastrointestinal symptoms at any time (odds ratio, 0.93; 95% CI, 0.76-1.15) or liver test abnormalities on admission (odds ratio, 1.31; 95% CI, 0.80-2.12) were not associated independently with mechanical ventilation or death.
Conclusions:
Among patients hospitalized with COVID-19, gastrointestinal symptoms and liver test abnormalities were common, but the majority were mild and their presence was not associated with a more severe clinical course.
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