Gastrointestinal Complications in Critically Ill Patients With and Without COVID-19

Abstract

Coronavirus disease 2019 (COVID-19) appears to have significant extrapulmonary complications affecting multiple organ systems. 1-3 Critically ill patients with COVID-19 often develop gastrointestinal complications during their hospital stay, including bowel ischemia, transaminitis, gastrointestinal bleeding, pancreatitis, Ogilvie syndrome, and severe ileus. 3 Whether the high incidence of gastrointestinal complications is a manifestation of critical illness in general or is specific to COVID-19 remains unclear. We compared the incidence of gastrointestinal complications of critically ill patients with COVID-19-induced acute respiratory distress syndrome (ARDS) vs comparably ill patients with non-COVID-19 ARDS using propensity score analysis. Methods | All patients with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on reverse transcriptase-polymerase chain reaction who were intubated and admitted to 1 of 13 (preexistent and surge) intensive care units (ICUs) of the Massachusetts General Hospital between March 13, 2020, and May 7, 2020, were included, then matched to a cohort of patients admitted between 2018 and 2019 and meeting the Berlin criteria for ARDS. 4 No changes

Are asymptomatic gastrointestinal findings on imaging more common in COVID-19 infection? Study to determine frequency of abdominal findings of COVID-19 infection in patients with and without abdominal symptoms and in patients with chest-only CT scans

“…Patients with ICU admission are in general at risk of coagulopathy and the bowel findings could potentially be related to the systemic status rather than direct COVID-19 associated coagulopathy. Though in a recent study published form the same hospital, a higher rate of gastrointestinal complications were found in critically ill COVID-19 patients compared with propensity score-matched patients without COVID-19 [ 23 ], the results of this need validation in multi-institutional studies. In the study by Goldberg-Stein et al, the incidence of bowel wall thickening was lower than the study by Bhayana et al and comparable to our study [ 12 , 13 ].…”

COVID-19 vasculitis and novel vasculitis mimics

“…With respect to gut involvement, critical gut ischaemia was reported in 2·5% of patients with COVID-19, compared with no cases in individuals with influenza. 85 , 86 Studies have also reported liver and adrenal infarction in a few cases, indicating compromised arterial blood supply. 87 The source of embolisation in the pulmonary venular territory leading to a vasculitis mimic would be expected to involve arterial tree divisions only and is distinct from systemic venous thrombosis as a cause of tissue damage, which has been reported in organs such as the heart ( table 2 ).…”

Cec and You Shall Find: Cecal Perforation in a Patient with COVID-19

“…Furthermore, SARS-CoV-2 infection has been associated with a state of hypercoagulability presumed to be caused by endothelial injury, immobilization, and activation of prothrombotic factors [ 6 , 7 ]. When 92 critically ill patients with acute respiratory distress syndrome (ARDS) were compared with 92 propensity matched ARDS patients with COVID-19, the latter group had significantly more abnormal aminotransferases (55% vs 27%, p < 0.001), severe ileus (48% vs 22%, p < 0.001), and bowel ischemia (4% vs 0%, p = 0.04) [ 8 ]. Three of the patients who had bowel ischemia required bowel resection; pathology demonstrated fibrin thrombi in the affected vasculature.…”