Abstract
OBJECTIVES:Brazil has rapidly developed the second-highest number of COVID-19 cases in the world. As such, proper symptom identification, including gastrointestinal manifestations, and relationship to health outcomes remains key. We aimed to assess the prevalence and impact of gastrointestinal symptoms associated with COVID-19 in a large quaternary referral center in South America.METHODS:This was a single-center cohort study in a COVID-19 specific hospital in São Paulo, Brazil. Consecutive adult patients with laboratory confirmed SARS-CoV-2 were included. Baseline patient history, presenting symptoms, laboratory results, and clinically relevant outcomes were recorded. Regression analyses were performed to determine significant predictors of the gastrointestinal manifestations of COVID-19 and hospitalization outcomes.RESULTS:Four-hundred patients with COVID-19 were included. Of these, 33.25% of patients reported ≥1 gastrointestinal symptom. Diarrhea was the most common gastrointestinal symptom (17.25%). Patients with gastrointestinal symptoms had higher rates of concomitant constitutional symptoms, notably fatigue and myalgia (p<0.05). Gastrointestinal symptoms were also more prevalent among patients on chronic immunosuppressants, ACE/ARB medications, and patient with chronic kidney disease (p<0.05). Laboratory results, length of hospitalization, ICU admission, ICU length of stay, need for mechanical ventilation, vasopressor support, and in-hospital mortality did not differ based upon gastrointestinal symptoms (p>0.05). Regression analyses showed older age [OR 1.04 (95% CI, 1.02-1.06)], male gender [OR 1.94 (95% CI, 1.12-3.36)], and immunosuppression [OR 2.60 (95% CI, 1.20-5.63)], were associated with increased mortality.CONCLUSION:Based upon this Brazilian study, gastrointestinal manifestations of COVID-19 are common but do not appear to impact clinically relevant hospitalization outcomes including the need for ICU admission, mechanical ventilation, or mortality.
Highlights
The new coronavirus infection, as known as Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), was first reported in Wuhan, China in late 2019 [1]
Patients with suspicion for COVID-19 based upon symptoms alone or imaging with computed tomography (CT) without polymerase-chain reaction (PCR) confirmation were excluded from this analysis
There was a negative correlation between mechanical ventilation and use of angiotensin converting enzymeinhibitor (ACE-I) or angiotension receptor blocker (ARB) medications [odds ratio (OR) 0.58; p=0.033], the presence of myalgia [OR 0.56; p=0.027] and ageusia or anosmia [OR 0.27; p=0.001]
Summary
The new coronavirus infection, as known as Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), was first reported in Wuhan, China in late 2019 [1]. The virus has quickly spread across the world, becoming a pandemic as declared by the World Health Organization in March 2020. Received for publication on July 28, 2020. Accepted for publication on August 26, 2020. As of July 2020, more than 10 million confirmed cases of Coronavirus Disease (COVID-19) across five continents and over 500 thousand deaths have been reported [3]. While respiratory symptoms are the main presentation of COVID-19, such as dry cough and dyspnea gastrointestinal manifestations have been reported [4,5]. As the number of cases has increased, so too has our knowledge grown about various symptoms associated with the SARS-CoV-2 infection
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