SARS-CoV-2 Gastrointestinal Infection Prolongs the Time to Recover From COVID-19

Objectives: We previously reported that SARS-CoV-2 infects the gastrointestinal (GI) epithelium. In this study, we aimed to explore the impact of SARS-CoV-2 GI infection on clinical outcomes of COVID-19. Materials and Methods: For this retrospective cohort study, 104 patients with COVID-19 were classified into a SARS-CoV-2 GI infection group and a non-infection group. The primary endpoint was the time of negative conversion of SARS-CoV-2 RNA in respiratory tract samples. The secondary outcome was the time of hospitalization for COVID-19. Results: Patients with SARS-CoV-2 GI infection had a longer duration of positive SARS-CoV-2 RNA in respiratory tract samples (median 12.0 days [95% CI: 10.0-13.2] vs. 9.0 days [95% CI: 7.5-10.5]; HR 0.575 [95% CI: 0.386-0.857]; P = 0.003) and hospitalization (median 28.0 days [95% CI: 23.2-32.8] vs. 15.0 days [95% CI: 13.6-16.4]; HR 0.149 [95% CI: 0.087-0.252]; P < 0.001) than patients without SARS-CoV-2 GI infection. Subgroup analyses for sex, age, epidemiological history, clinical classification and antiviral treatment showed consistent results. Conclusion: Our study indicates that SARS-CoV-2 GI infection prolongs the duration of SARS-CoV-2 shedding and hospitalization in the patients with COVID-19. More attention should be paid to SARS-CoV-2 GI infection of COVID-19 and fecal SARS-CoV-2 RNA test should be completed in time.