S1435 Outcomes in Patients With COVID-19 Presenting With Gastrointestinal Symptoms

Abstract

Introduction: Coronavirus Disease 2019 (COVID-19) can present with a variety of symptoms. We investigated outcomes in patients with COVID-19 presenting with gastrointestinal (GI) symptoms. Methods: We retrospectively analyzed inpatients age >18 years with COVID-19 from March 2020 to June 2020 in our urban, academic, safety-net hospital. Patients were stratified based on whether they presented with only GI (Only-GI), only non-GI (Non-GI), or a combination (Mixed-Sxs) of symptoms. GI symptoms included abdominal pain, diarrhea, nausea, and vomiting. Non-GI symptoms included generalized (anorexia, fatigue, fever), pulmonary (cough, dyspnea), and head & neck (anosmia, dysgeusia) symptoms. Results: Of 750 patients admitted during the study period, 373 (49.7%) had GI symptoms: 106 patients with abdominal pain, 219 with diarrhea, 196 with nausea, and 123 with vomiting. 21 (2.8%), 377 (50.3%), and 352 (46.9%) patients were in the Only-GI, Non-GI, and Mixed-Sxs cohorts, respectively, with mortality rates of 19.0%, 9.8%, and 5.7% (P = 0.006). Comparing patients with GI symptoms, the Only-GI cohort had higher intensive care unit (ICU) requirements (23.8% vs 17.0%), lower rates of discharges to home (52.4% vs 78.7%), higher rates of discharges to other facilities (28.6% vs 15.6%), and higher mortality (19.0% vs 5.7%) compared to the Mixed-Sxs cohort (P = 0.02, Table 1). Univariate logistic regression analysis found higher mortality rates in the Only-GI group compared to the Mixed-Sxs group (OR: 3.9, 95% CI: 1.1-11.8, P = 0.02). Comparing patients with any GI symptoms (Only-GI and Mixed-Sxs cohorts) and no GI symptoms (Non-GI), those with GI symptoms had lower ICU requirements (17.4% vs 20.2%), higher rates of discharges to home (77.2% vs 67.4%), lower rates of discharges to other facilities (16.4% vs 22.8%), and lower mortality rates (6.4% vs 9.8%) [P = 0.02, Table 1]. Mortality associated with multi-organ dysfunction was higher in patients with GI symptoms (41.7% vs 5.4%) and respiratory failure was higher in patients without GI symptoms (70.3% vs 45.8%) [P = 0.02]. Conclusion: Half of our patients hospitalized for COVID-19 presented with GI symptoms. Patients who presented with only GI symptoms comprised a small minority (2.8%); however, these patients had worse outcomes compared to those who presented with concomitant GI and non-GI symptoms. These patients also had the higher ICU requirements (23.8%) and mortality rates (19.0%) than those with mixed symptoms (17.0%, 5.7%) and Non-GI symptoms (20.2%, 9.8%).Table 1.: Patient outcomes comparing those with GI symptoms and mixed symptoms as well as those with any GI symptoms and no GI symptoms.