AUTHOR=Chen Hongxin , Tong Zhenhua , Ma Zhuang , Luo Li , Tang Yufu , Teng Yue , Yu Hao , Meng Hao , Peng Chengfei , Zhang Quanyu , Zhu Tianyi , Zhao Haitao , Chu Guiyang , Li Hongyu , Lu Hui , Qi Xingshun 

TITLE=Gastrointestinal Bleeding, but Not Other Gastrointestinal Symptoms, Is Associated With Worse Outcomes in COVID-19 Patients

JOURNAL=Frontiers in Medicine

VOLUME=8

YEAR=2021

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2021.759152

DOI=10.3389/fmed.2021.759152

ISSN=2296-858X

ABSTRACT=<p><bold>Background:</bold> Patients with coronavirus disease 2019 (COVID-19) can present with gastrointestinal (GI) symptoms. However, the prevalence of GI symptoms and their association with outcomes remain controversial in COVID-19 patients.</p><p><bold>Methods:</bold> All COVID-19 patients consecutively admitted to the Wuhan Huoshenshan hospital from February 2020 to April 2020 were collected. Disease severity and outcomes were compared between COVID-19 patients with and without GI symptoms. Logistic regression analyses were performed to evaluate the association of GI symptoms with the composite endpoint and death in COVID-19 patients. A composite endpoint was defined as transfer to intensive care unit, requirement of mechanical ventilation, and death. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated.</p><p><bold>Results:</bold> Overall, 2,552 COVID-19 patients were included. The prevalence of GI symptoms was 21.0% (537/2,552). Diarrhea (8.9%, 226/2,552) was the most common GI symptom. Patients with GI symptoms had significantly higher proportions of severe COVID-19 and worse outcomes than those without. Univariate logistic regression analyses demonstrated that GI symptoms were significantly associated with the composite endpoint (OR = 2.426, 95% CI = 1.608–3.661; <italic>P</italic> &lt; 0.001) and death (OR = 2.137, 95% CI = 1.209–3.778; <italic>P</italic> = 0.009). After adjusting for age, sex, and severe/critical COVID-19, GI symptoms were still independently associated with the composite endpoint (OR = 2.029, 95% CI = 1.294–3.182; <italic>P</italic> = 0.002), but not death (OR = 1.726, 95% CI = 0.946–3.150; <italic>P</italic> = 0.075). According to the type of GI symptoms, GI bleeding was an independent predictor of the composite endpoint (OR = 8.416, 95% CI = 3.465–20.438, <italic>P</italic> &lt; 0.001) and death (OR = 6.640, 95% CI = 2.567–17.179, <italic>P</italic> &lt; 0.001), but not other GI symptoms (i.e., diarrhea, abdominal discomfort, nausea and/or vomiting, constipation, acid reflux and/or heartburn, or abdominal pain).</p><p><bold>Conclusion:</bold> GI symptoms are common in COVID-19 patients and may be associated with their worse outcomes. Notably, such a negative impact of GI symptoms on the outcomes should be attributed to GI bleeding.</p>