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©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
Digestive system involvement and clinical outcomes among COVID-19 patients: A retrospective cohort study from Qatar
Muhammad Umair Khan, Kamran Mushtaq, Deema Hussam Alsoub, Phool Iqbal, Fateen Ata, Hammad Shabir Chaudhry, Fatima Iqbal, Girisha Balaraju, Muna A Al Maslamani, Betsy Varughese, Rajvir Singh, Khalid Al Ejji, Saad Al Kaabi, Yasser Medhat Kamel, Adeel Ajwad Butt
Muhammad Umair Khan, Kamran Mushtaq, Girisha Balaraju, Betsy Varughese, Khalid Al Ejji, Saad Al Kaabi, Yasser Medhat Kamel, Department of Gastroenterology and Hepatology, Hamad Medical Corporation, Doha 3050, Qatar
Muhammad Umair Khan, Kamran Mushtaq, Deema Hussam Alsoub, Fatima Iqbal, ECPE- Executive and Continuing Professional Education, Harvard T.H Chan School of Public Health, Boston, MA 02115-5810, United States
Deema Hussam Alsoub, Department of Palliative Care, National Center for Cancer Care & Research, Hamad Medical Corporation, Doha 3050, Qatar
Phool Iqbal, Fateen Ata, Hammad Shabir Chaudhry, Adeel Ajwad Butt, Department of Medicine, Hamad Medical Corporation, Doha 3050, Qatar
Fatima Iqbal, Muna A Al Maslamani, Department of Infectious Disease, Communicable Disease Center, Hamad Medical Corporation, Doha 3050, Qatar
Rajvir Singh, Department of Cardiology Research, Heart Hospital, Hamad Medical Corporation, Doha 3050, Qatar
Adeel Ajwad Butt, Department of Medicine, Division of Infectious Diseases, Weill Cornell Medical College, New York, NY 10075, United States
Adeel Ajwad Butt, Department of Medicine, Weill Cornell Medical College - Qatar, Doha 24144, Qatar
Author contributions: Khan MU and Mushtaq K conceived and designed the study and performed data analysis, literature review, and manuscript writing; Alsoub DH, Iqbal P, Ata F, Chaudhry HS, Iqbal F, Balaraju G, Maslamani MAA, Varughese B, Ejji KA, Kaabi SA, and Kamel YM performed data collection, data analysis, manuscript writing, and literature review; Singh R reviewed the statistical part of the manuscript; Butt AA performed the literature review and revised the final manuscript; all authors verified the final version of the study.
Supported by Hamad Medical Corporation, No. MRC-01-20-631.
Institutional review board statement: The study was approved by the Medical Research Center of Hamad Medical Corporation (MRC-01-20-631).
Informed consent statement: Due to the retrospective design of the study, the requirement of informed consent was waived by the Institutional Review Board.
Conflict-of-interest statement: All authors and study participants declare no potential conflicting interests related to this paper.
Data sharing statement: The authors confirm that the data supporting the findings of this study are available within the article.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Adeel Ajwad Butt, MBBS, MS, Doctor, Professor, Department of Medicine, Hamad Medical Corporation, PO Box 3050, Hamad Medical Corporation, Doha, Qatar, Doha 3050, Qatar. aabutt@hamad.qa
Received: April 28, 2021
Peer-review started: April 28, 2021
First decision: June 13, 2021
Revised: June 29, 2021
Accepted: November 28, 2021
Article in press: November 28, 2021
Published online: December 14, 2021
BACKGROUND
Coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 virus most commonly presents with respiratory symptoms. While gastrointestinal (GI) manifestations either at presentation or during hospitalization are also common, their impact on clinical outcomes is controversial. Some studies have described worse outcomes in COVID-19 patients with GI symptoms, while others have shown either no association or a protective effect. There is a need for consistent standards to describe GI symptoms in COVID-19 patients and to assess their effect on clinical outcomes, including mortality and disease severity.
AIM
To investigate the prevalence of GI symptoms in hospitalized COVID-19 patients and their correlation with disease severity and clinical outcomes.
METHODS
We retrospectively reviewed 601 consecutive adult COVID-19 patients requiring hospitalization between May 1-15, 2020. GI symptoms were recorded at admission and during hospitalization. Demographic, clinical, laboratory, and treatment data were retrieved. Clinical outcomes included all-cause mortality, disease severity at presentation, need for intensive care unit (ICU) admission, development of acute respiratory distress syndrome, and need for mechanical ventilation. Multivariate logistic regression model was used to identify independent predictors of the adverse outcomes.
RESULTS
The prevalence of any GI symptom at admission was 27.1% and during hospitalization was 19.8%. The most common symptoms were nausea (98 patients), diarrhea (76 patients), vomiting (73 patients), and epigastric pain or discomfort (69 patients). There was no difference in the mortality between the two groups (6.21% vs 5.5%, P = 0.7). Patients with GI symptoms were more likely to have severe disease at presentation (33.13% vs 22.5%, P < 0.001) and prolonged hospital stay (15 d vs 14 d, P = 0.04). There was no difference in other clinical outcomes, including ICU admission, development of acute respiratory distress syndrome, or need for mechanical ventilation. Drugs associated with the development of GI symptoms during hospitalization were ribavirin (diarrhea 26.37% P < 0.001, anorexia 17.58%, P = 0.02), hydroxychloroquine (vomiting 28.52%, P = 0.009) and lopinavir/ritonavir (nausea 32.65% P = 0.049, vomiting 31.47% P = 0.004, and epigastric pain 12.65% P = 0.048). In the multivariate regression analysis, age > 65 years was associated with increased mortality risk [odds ratio (OR) 7.53, confidence interval (CI): 3.09-18.29, P < 0.001], ICU admission (OR: 1.79, CI: 1.13-2.83, P = 0.012), and need for mechanical ventilation (OR: 1.89, CI:1.94-2.99, P = 0.007). Hypertension was an independent risk factor for ICU admission (OR: 1.82, CI:1.17-2.84, P = 0.008) and need for mechanical ventilation (OR: 1.66, CI: 1.05-2.62, P = 0.028).
CONCLUSION
Patients with GI symptoms are more likely to have severe disease at presentation; however, mortality and disease progression is not different between the two groups.
Core Tip: There is a high prevalence of gastrointestinal symptoms in coronavirus disease 2019 patients both at presentation and during hospitalization. Drugs are associated with the development of gastrointestinal symptoms during hospitalization. The presence of gastrointestinal symptoms in coronavirus disease 2019 patients is associated with disease severity at presentation but is not a predictor of mortality or disease progression.
