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=Volume 8 - 2021

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=Background: 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.

Methods: 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.

Results: Overall, 2552 COVID-19 patients were included. The prevalence of GI symptoms was 21.0% (537/2552). Diarrhea (8.9%, 226/2552) 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; P<0.001) and death (OR=2.137, 95%CI=1.209-3.778; P=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; P=0.002), but not death (OR=1.726, 95%CI=0.946-3.150; P=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, P<0.001) and death (OR=6.640, 95%CI=2.567-17.179, P<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).

Conclusion: 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.