Disease Course and Outcomes of COVID-19 Among Hospitalized Patients With Gastrointestinal Manifestations

Abstract

Background & Aims Our understanding of outcomes and disease time course of COVID-19 in patients with gastrointestinal (GI) symptoms remains limited. In this study we characterize the disease course and severity of COVID-19 among hospitalized patients with gastrointestinal manifestations in a large, diverse cohort from the Unites States. Methods This retrospective study evaluated hospitalized individuals with COVID-19 between March 11 and April 28, 2020 at two affiliated hospitals in New York City. We evaluated the association between GI symptoms and death, and also explored disease duration, from symptom onset to death or discharge. Results Of 2,804 patients hospitalized with COVID-19, the 1,084 (38.7%) patients with GI symptoms were younger (aOR for age≥75 0.59, 95% CI 0.45-0.77) and had more co-morbidities (aOR for modified Charlson comorbidity score ≥2 1.22, 95% CI 1.01-1.48) compared to those without GI symptoms. Individuals with GI symptoms had better outcomes, with a lower likelihood of intubation (aHR 0.66, 95% CI 0.55-0.79) and death (aHR 0.71, 95% CI 0.59-0.87), after adjusting for clinical factors. These patients had a longer median disease course from symptom onset to discharge (13.8 vs. 10.8 days, log-rank p=0.048; among 769 survivors with available symptom onset time), which was driven by longer time from symptom onset to hospitalization (7.4 vs. 5.4 days, log-rank p<0.01). Conclusion Hospitalized patients with GI manifestations of COVID-19 have a reduced risk of intubation and death, but may have a longer overall disease course driven by duration of symptoms prior to hospitalization.

Clinical Outcome of COVID-19 Patients Presenting With Gastrointestinal Symptoms

“…Significant associations have been found in other studies [17,18]. This study's findings are consistent with those of Laszkowska et al, who found better outcomes in COVID-19 patients with GI symptoms, including lower rates of mortality and lower rates of requiring mechanical ventilation [7].…”

“…Here, we found no differences in mean age between the two groups. There was also no significant difference in comorbidities, which contradicts the findings of Laszkowska et al [7]. This study concluded that 24.1% of patients included here had GI symptoms.…”

“…One important strength of our study is the validation of our results from other studies by Laszkowska et al [ 7 ]. Additionally, to the best of our knowledge, this is the first study from Pakistan to evaluate outcomes of patients with GI symptoms on presentation.…”

“…This study reports that COVID-19 patients with GI symptoms had significantly lower D-dimer levels than those without such symptoms, while serum ferritin, lactate dehydrogenase, and C-reactive protein levels were not significantly different. In contrast, Laszkowska et al demonstrated lower C-reactive protein and other markers, including D-dimer and lactate dehydrogenase levels [ 7 ]. In one multicenter study, Zhou et al also found elevated C-reactive protein levels in COVID-19 patients with GI symptoms [ 19 ].…”

Coronavirus Disease-2019 (COVID-19) and the Liver

“…The prevalence of GI and hepatic manifestations of COVID-19 is variable across studies from different regions, as highlighted in the data from meta-analyses (Table 1) [7][8][9][10][11][12][13] and individual studies ( Table 2). [14][15][16][17][18][19] In addition, endemic areas are associated with co-infections, such as acute viral hepatitis, and tropical infections, such as malaria and dengue. [20][21][22]…”