Correlation of Gastrointestinal Symptoms at Initial Presentation with Clinical Outcomes in Hospitalized COVID-19 Patients: Results from a Large Health System in the Southern USA

Abstract

Background We aimed to understand the association of gastrointestinal (GI) symptoms at initial presentation with clinical outcomes during COVID-19 hospitalization. Methods This retrospective, multicenter cohort study included consecutive hospitalized COVID-19 patients from a single, large health system. The presence of GI symptoms was assessed at initial presentation and included one or more of the following: nausea, vomiting, diarrhea and abdominal pain. Patients were divided into three cohorts: Only GI symptoms, GI and non-GI symptoms and only non-GI symptoms. The primary outcome was association of GI symptoms with mortality. Secondary outcomes included prevalence of GI symptoms and survival analysis. Results A total of 1672 COVID-19 patients were hospitalized (mean age: 63 ± 15.8 years, females: 50.4%) in our system during the study period. 40.7% patients had at least one GI symptom (diarrhea in 28.3%, nausea/vomiting in 23%, and abdominal pain in 8.8% patients), and 2.6% patients had only GI symptoms at initial presentation. Patients presenting with GI symptoms (with or without non-GI symptoms) had a lower mortality rate compared to patients presenting with only non-GI symptoms (20% vs. 26%; p < 0.05). The time from hospitalization to being discharged was less for patients presenting with only GI symptoms (7.4 days vs. > 9 days, p < 0.0014). After adjusting for other factors, the presence of GI symptoms was not associated with mortality ( p > 0.05). Conclusion Among a hospitalized COVID-19 positive Southern US population, 41% patients presented with either diarrhea, nausea, vomiting or abdominal pain initially. The presence of GI symptoms has no association with in-hospital all-cause mortality.

Meta‐analysis of the demographic and prognostic significance of gastrointestinal symptoms in COVID‐19 patients

“…Further, 78 studies were excluded as 61 were single‐arm studies and 17 did not provide sufficient data. Therefore, 24 comparative observational studies 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 were deemed appropriate for inclusion (Fig. 1 ).…”

“…Of the 24 studies included in this review, 20 reported on hospitalized patients only. 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 34 , 36 The remainder 14 , 33 , 35 , 37 provided data on a mixed cohort of patients including those hospitalized (in‐patients) and those not admitted (outpatients/ambulatory).…”

Increase in Serum Calcitonin Gene-Related Peptide β (CGRPβ) Levels in COVID-19 Patients with Diarrhea: An Underlying Mechanism?

“…As recently reported in this journal by Patel et al, diarrhea is the most frequent gastrointestinal symptoms in COVID-19 hospitalized patients, but its pathophysiology is obscure [ 1 ]. Calcitonin gene-related peptide (CGRP) is a 37-amino acid neuropeptide member of the calcitonin family.…”

“…COVID-19 infection has a wide spectrum of clinical manifestations. Headache and diarrhea, two symptoms seen with CGRP infusion, are among the most common in COVID-19 patients and could perfectly be explained by a CGRP release [ 1 , 4 ]. Angiotensin-converting enzyme 2 (ACE2) and the serine protease TMPRSS2, the two proteins required for COVID-19 infection, are highly coexpressed in gastrointestinal cells.…”

“…Angiotensin-converting enzyme 2 (ACE2) and the serine protease TMPRSS2, the two proteins required for COVID-19 infection, are highly coexpressed in gastrointestinal cells. There is little doubt that direct viral infection is the likely cause of gastrointestinal manifestations, including diarrhea, in COVID-19, but the specific mechanisms involved in diarrhea pathogenesis remain unclear [ 1 ]. Our aim was to analyze the levels of CGRPβ in a series of COVID-19 patients with diarrhea.…”