Clinical characteristics of coronavirus disease 2019 patients with diarrhea in Daegu

Abstract

Background/Aims: Coronavirus disease 2019 (COVID-19) can reportedly cause gastrointestinal symptoms. Therefore, we investigated the clinical characteristics of COVID-19 patients with diarrhea. Methods: We included 118 COVID-19 patients admitted to a single hospital from February 20 to March 31, 2020. Medical records with clinical characteristics, laboratory data, treatment course, and clinical outcomes were compared based on the presence or absence of diarrhea. Prognostic factors for disease severity and mortality in COVID-19 were also assessed. Results: Among patients, 54 (45.8%) had diarrhea, whereas seven (5.9%) had only diarrhea. The median age of patients with diarrhea was 59 years (44 to 64), and 22 (40.7%) were male. Systemic steroid use, intensive care unit admission, septic shock, and acute respiratory distress syndrome were less frequent in the diarrhea group than in the non-diarrhea group. No significant differences were observed in total hospital stay and mortality between groups. On multivariate analysis, age (odds ratio [OR], 1.06; 95% confidence interval [CI], 1.01 to 1.12; p = 0.044), diabetes (OR, 3.00; 95% CI, 1.25 to 20.47; p = 0.042), and dyspnea (OR, 41.19; 95% CI, 6.60 to 823.16; p < 0.001) were independent risk factors for septic shock. On Cox regression analysis, diabetes (hazard ratio [HR], 4.82; 95% CI, 0.89 to 26.03; p = 0.043) and chronic obstructive pulmonary disease (HR, 16.58; 95% CI, 3.10 to 88.70; p = 0.044) were risk factors for mortality. Conclusions: Diarrhea was present in 45.8% of patients and was a common symptom of COVID-19. Although patients with diarrhea showed less severe clinical features, diarrhea was not associated with disease severity or mortality.

Evaluation of Mortality and Morbidity According to Initial Symptoms in COVID-19 Patients Using Clinical Epidemiologic Data from the Korea Centers for Disease Control & Prevention

“…Coronaviruses has been suggested to be transmitted enterically because of adhesion to angiotensin-converting enzyme 2 cell receptors [ 18 , 19 ]. A retrospective study reported that diarrhea was associated with a mild disease course of COVID-19 [ 11 ]. The authors found that patients with diarrhea had lower rates of systemic steroid use and ECMO therapy, milder clinical courses without intensive care unit admission, and lower rates of septic shock and acute respiratory distress syndrome than nondiarrhea patients [ 11 ].…”

“…A retrospective study reported that diarrhea was associated with a mild disease course of COVID-19 [ 11 ]. The authors found that patients with diarrhea had lower rates of systemic steroid use and ECMO therapy, milder clinical courses without intensive care unit admission, and lower rates of septic shock and acute respiratory distress syndrome than nondiarrhea patients [ 11 ]. Other coronavirus infections causing severe acute respiratory syndrome (SARS) were associated with gastrointestinal symptoms and watery diarrhea in approximately 38.4% of patients [ 20 ].…”

“…For COVID-19, some clinical symptoms have been reported to be associated with the severity of disease. For instance, diarrhea, an extrapulmonary symptom, was suggested to be related to mild disease [ 11 ]. In addition, the symptoms of dyspnea and anosmia were related to a relatively low viral load [ 7 ].…”

“…In addition, the symptoms of dyspnea and anosmia were related to a relatively low viral load [ 7 ]. On the other hand, dyspnea was also related to an increased risk of septic shock in COVID-19 patients [ 11 ]. These discrepancies could be partially explained by the variable study population and the disease stage at the time of symptom evaluation.…”

Importance of gut microbiome regulation for the prevention and recovery process after SARS‑CoV‑2 respiratory viral infection (Review)

“…A total of 3-6 days after infection, upper or lower respiratory tract symptoms, fever and diarrhea, or a combination of these, appear (1). Kang et al (2) reported that 45.8% of COVID-19 patients not only have respiratory symptoms, but also gastrointestinal (GI) symptoms, such as lack of appetite, diarrhea, vomiting and abdominal pain. OF 9,696 patients, 988 were reported to exhibit nausea and vomiting.…”