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©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
Clinical characteristics, gastrointestinal manifestations and outcomes of COVID-19 patients in Iran; does the location matters?
Pooneh Mokarram, Maryam Mehdipour Dalivand, Antonio Pizuorno, Farnaz Aligolighasemabadi, Mohammadamin Sadeghdoust, Ebtesam Sadeghdoust, Farshad Aduli, Gholamreza Oskrochi, Hassan Brim, Hassan Ashktorab
Pooneh Mokarram, Autophagy Research Center, Department of Biochemistry, Shiraz University of Medical Sciences, Shiraz 71348, Iran
Maryam Mehdipour Dalivand, Farshad Aduli, Hassan Brim, Hassan Ashktorab, Department of Medicine, Howard University, Washington, DC 20060, United States
Antonio Pizuorno, Department of Medicine, La Universidad del Zulia, Faculty of Medicine, Maracaibo 4002, Venezuela
Farnaz Aligolighasemabadi, Mohammadamin Sadeghdoust, Department of Internal Medicine, Mashhad Medical Sciences Branch, Islamic Azad University, Mashhad 13131, Iran
Ebtesam Sadeghdoust, Department of Internal Medicine, School of Medicine, Dezful University of Medical Sciences, Dezful 64616, Iran
Gholamreza Oskrochi, Collage of Engineering and Technology, American University of the Middle East, Egaila 54200, Kuwait
Author contributions: Ashktorab H designed the report and wrote the paper; Mokarram P, Dalivand MM, Pizuorno A, Aligolighasemabadi F, Sadeghdous M, Sadeghdoust E, Aduli F and Brim H collected and analyzed the clinical data; Oskrochi G performed statistical analysis.
Institutional review board statement: Local IRB approval obtained from the Health authority in each hospital for the chart review.
Informed consent statement: Written informed consent was waived.
Conflict-of-interest statement: The authors declare no conflicts of interest
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 which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: Hassan Ashktorab, PhD, Professor, Department of Medicine, Howard University, 2041 Georgia Ave, Washington, DC 20060, United States. hashktorab@howard.edu
Received: January 5, 2021
Peer-review started: January 5, 2021
First decision: January 27, 2021
Revised: February 4, 2021
Accepted: March 29, 2021
Article in press: March 29, 2021
Published online: June 26, 2021
ARTICLE HIGHLIGHTS
Research background
Coronavirus disease 2019 (COVID-19) and associated gastrointestinal symptoms (GI) in patients from different regions of Iran have not been reported, and this has major implications for GI related health and comorbidities.
Research motivation
The key issues are whether the outcome of COVID-19 and GI manifestations is different across regions of Iran.
Research objectives
To obtain a full understanding of GI manifestations in COVID-19 patients.
Research methods
We analyzed data from severe acute respiratory syndrome coronavirus 2 positive patients admitted at four hospitals in Iran (n = 91), including South, Southeast, North, and Northwest, between April and September 2020. Demographics, comorbidities, and clinical findings including GI symptoms were collected.
Research results
The average age of COVID-19 patients was 51.1 years, and 56% were male. Mortality rate was 17%. Cough with 84.6%, shortness of breath with 71.4%, fever with 52.7%, and loss of appetite with 43.9% were the main symptoms. Overall, cardiac disease was the most common comorbidity with an average of 28.5%, followed by hypertension (28.5%) and diabetes (25.2%). The highest comorbidity in North (Rasht) was diabetes (30%) and in South was (Dezful) hypertension (37%). Shiraz leads cardiac disease with 43.4%. The most reported GI symptoms included nausea, diarrhea, vomiting, and abdominal pain, with 42.8%, 31.8%, 26.8%, and 12% prevalence, respectively. In addition, albumin, alkaline phosphatase, aspartate aminotransferase, and alanine aminotransferase were elevated in 26.3%.
Research conclusions
Our results show hypertension and diabetes as the most common comorbidities, but their distribution was different in COVID-19 patients in the four studied regions of Iran. Nausea, diarrhea, and elevated liver enzymes were the most common GI findings. There was also a high mortality rate that was associated with high infection rates in Iran at the beginning of the pandemic. GI manifestations and liver function markers should be monitored in COVID-19 patients.
Research perspectives
Larger long-term prospective studies and predictive factors for duration and follow-up of GI symptoms in COVID-19 should be performed in future studies.
