In a poster presentation at the American College of Gastroenterology (ACG) 2020 clinical meeting, researchers from Rush University Medical Center and Midwestern University in Chicago, Illinois, reported that patients who were diagnosed with COVID-19 and who presented with gastrointestinal (GI) symptoms were more likely to require hospitalization, admission to the intensive care unit (ICU), and intubation than patients with COVID-19 without GI symptoms.

Presented by Darbaz Adnan, MBChB, the poster was named an ACG Award Winner, ACG Newsworthy Abstract, and ACG Outstanding Poster Presenter. The research project was designed to determine if in fact the presence of GI symptoms could help to predict outcomes among patients with COVID-19. The team examined electronic records of patients who tested positive for COVID-19 between March 12, 2020, and April 3, 2020. These patients were screened for symptoms that included fever, shortness of breath, cough, anosmia, and body aches, as well as for GI symptoms such as nausea, vomiting, diarrhea, and abdominal pain.

Of the 921 patients for whom data was accessible, the researchers found that 206 (22.4%) reported at least one GI symptom; 61.7% of these patients most commonly reported nausea and/vomiting as their GI issue. Just under half (49.5%) of all patients reported only one GI symptom; 33.4% reported having 2 symptoms, and 11.6% had diarrhea, nausea/vomiting, and abdominal pain.

The patients who presented with GI symptoms generally had a greater prevalence of diabetes and hypertension, higher BMI, and older age. Those with initial GI symptoms also had lower mean hemoglobin, calcium, and albumin, and higher creatinine and aspartate aminotransferase  values. Additionally, patients presenting with GI symptoms showed higher admission rates to the hospital, ICU, and higher intubation rates.

The predictive value of these GI symptoms were analyzed based on the number of such symptoms a patient had on presentation, with a score of 1 for a single GI symptom and a score of 2 for 2 or more symptoms. The scoring system demonstrated a stepwise increase in the likelihood of poor outcomes for patients with GI symptoms when compared with patients without GI symptoms. These worse outcomes were associated with GI symptoms after adjustments for demographics.

“The association of GI symptoms with age, higher [body mass index], and hypertension is noteworthy as these factors are shown to predict worse course of COVID-19 infections,” Dr Adnan stated. “However, our analysis, adjusted for all these factors, indicates that GI symptoms are independently linked to poor outcomes.”

—Rebecca Mashaw

Reference:

Adnan D, Deshmukh AA, Khan SR, et al. Gastrointestinal symptoms predict the outcomes of COVID-19 infection. Talk presented at: American College of Gastroenterology 2020 Clinical Meeting, October 24, 2020. Virtual