Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 26, 2020; 8(14): 2950-2958
Published online Jul 26, 2020. doi: 10.12998/wjcc.v8.i14.2950
Clinical characteristics of patients with COVID-19 presenting with gastrointestinal symptoms as initial symptoms: Retrospective case series
Tuo-Yun Yang, Yuan-Chao Li, Si-Cong Wang, Qing-Qing Dai, Xue-Song Jiang, Shu Zuo, Liu Jia, Jun-Bo Zheng, Hong-Liang Wang
Tuo-Yun Yang, Yuan-Chao Li, Qing-Qing Dai, Xue-Song Jiang, Shu Zuo, Liu Jia, Jun-Bo Zheng, Hong-Liang Wang, Department of Critical Care Medicine, the Second Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
Si-Cong Wang, Department of Critical Care Medicine, the Cancer Hospital of Harbin Medical University, Harbin 150081, Heilongjiang Province, China
Author contributions: Yang TY and Wang HL designed this research study; Yang TY, Li YC, Dai QQ, Wang SC, and Jiang XS performed the research; Jia L, Zheng JB, and Zuo S analyzed the data; Yang TY, Dai QQ, and Zheng JB wrote the manuscript; all authors have read and approve the final manuscript.
Supported by China International Medical Foundation, No. Z-2018-35-1902.
Institutional review board statement: Due to the special circumstances, this study was authorized by the Ethics Commission of Second Affiliated Hospital of Harbin Medical University (KY2020-007) and orally authorized by the Wuhan Union Hospital.
Informed consent statement: Written informed consent was waived by the Ethics Commission for emerging infectious diseases.
Data sharing statement: The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
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: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Hong-Liang Wang, MD, Department of Critical Care Medicine, the Second Affiliated Hospital of Harbin Medical University, No. 246, Xuefu Road, Nangang District, Harbin 150086, Heilongjiang Province, China. icuwanghongliang@163.com
Received: May 21, 2020
Peer-review started: May 21, 2020
First decision: June 4, 2020
Revised: June 14, 2020
Accepted: July 1, 2020
Article in press: July 1, 2020
Published online: July 26, 2020
Processing time: 64 Days and 8.1 Hours
ARTICLE HIGHLIGHTS
Research background

A large number of pneumonia cases due to coronavirus disease 2019 (COVID-19) have been first reported in China. Meanwhile, the virus is sweeping all around the world and has infected millions of people. Fever and pulmonary symptoms have been noticed as major and early signs of infection, whereas gastrointestinal symptoms were also observed in a significant portion of patients. The clinical investigation of disease onset was underestimated, especially due to the neglection of cases presenting with gastrointestinal symptoms.

Research motivation

We aimed to address this issue and provide an insight into the different initial symptoms between the pulmonary symptoms and gastrointestinal symptoms.

Research objectives

The objective of this case series study was to characterize the clinical features of coronavirus-infected patients with gastrointestinal symptoms as initial symptoms.

Research methods

This is a retrospective, single-center case series of the general consecutive hospitalized patients with confirmed COVID-19 at Wuhan Union Hospital from February 2, 2020 to February 13, 2020. According to their initial symptoms, these patients were classified into two groups. Patients in group one presented with pulmonary symptoms (PS) as initial symptoms, and group two presented with gastrointestinal symptoms (GS). Epidemiological, demographic, clinical, laboratory, and treatment data were collected for analysis.

Research results

Among the 50 patients recruited, no patient has been admitted to intensive care units, and no patient died during the study. The duration of hospitalization was longer in the GS group than in the PS group (12.13 ± 2.44 vs 10.00 ± 2.13, P < 0.01). All of the 50 patients exhibited decreased lymphocytes. However, lymphocytes in the GS group were significantly lower compared to those in the PS group (0.94 ± 0.06 vs 1.04 ± 0.15, P < 0.01). Procalcitonin and hs-CRP were both significantly higher in the GS group than in the PS group. Accordingly, the duration of viral shedding was significantly longer in the GS group compared to the PS group (10.22 ± 1.93 vs 8.15 ± 1.87, P < 0.01).

Research conclusions

COVID-19 patients presenting with gastrointestinal symptoms as initial symptoms need more days of viral shedding and hospitalization than the patients presenting with pulmonary symptoms

Research perspectives

In this study, initial symptoms belonging to gastrointestinal type affect the time of general patients’ viral nucleic acids test turning negative. Currently, no effective drug treatment or vaccine exists. It is necessary to improve the treatment of patients whose initial symptoms belong to gastrointestinal type.