S3158 A Descriptive Analysis of Patients Presenting Solely With Gastrointestinal (GI) Manifestations Secondary to SAR-CoV-2 Identified Through the Advocate Lutheran Coronavirus (ALCO) Database

Abstract

INTRODUCTION: SAR-CoV-2 is a new coronavirus first identified in Wuhan, China that has led to a global pandemic with an associated high morality. Literature from Wuhan, China has shown that digestive symptoms and elevation in liver enzymes are very common in patients acutely infected with COVID19. The ALCO database is being created at Advocate Lutheran General Hospital, Park Ridge, Illinois to evaluate the prevalence, incidence and outcomes of those affected by COVID19 with only GI manifestations. METHODS: Retrospective analysis was performed in all patients presenting to ALGH Emergency Department (ED) between March 1, 2020 to April 30, 2020 due to an active COVID19 infection identified by ICD Code U07.1COVID19. After comprehensive chart review, descriptive analysis of patients presenting with GI manifestations without respiratory symptoms was completed. RESULTS: Of 144 patients, 14 (7 female, 7 male) presented with GI symptoms and no respiratory symptoms as their chief complaint. 50% of patients had diarrhea, 21% had abdominal pain, 28% had nausea, 28% were vomiting and 71% had anorexia. None of these patients presented initially to the hospital with upper respiratory symptoms (Figure 2). These patients had no underlying chronic digestive diseases.Admission laboratory tests of interests include AST, ALT, Ferritin, Procalcitonin, LDH and CRP. The mean AST level was 73.08 IU/L in these patients in comparison to 56.2 IU/L (P = 0.15). The mean ALT level was 64.08 IU/L versus 44.60 IU/L (P = 0.06). The mean Ferritin level was elevated at 1054 ng/ml versus 675.44 ng/ml (P = 0.056). (Figure 2).85% required hospitalization (n = 12). Average length of stay was longer compared to those without GI symptoms or those who also had respiratory symptoms (n = 7.42 days versus n = 4.8 days), (P = 0.089, Mann-Whitney test). 3 deaths occurred in patients with GI symptoms (21%) versus 13 deaths in the other 130 patients (10%). CONCLUSION: Preliminary data supports studies from China that GI symptoms are rather common secondary to COVID19 and that patients who initially present with extra-pulmonary symptoms are at risk for severe disease. The initial trends from the ALCO database support that GI symptoms without concomitant respiratory symptoms can be indicative of severe disease characterized by increased inflammation, elevated transaminases and longer hospitalizations. Our hope is continued investigation will lead to more information to clarify the role of GI manifestations in COVID19.Table 1.: Demographics, clinical characteristics, clinical outcomes, and laboratory values of patients presenting to Lutheran General Hospital Emergency Department with Gastrointestinal symptoms secondary to COVID19 without upper respiratory symptomsFigure 1.: Symptoms identified by patients with COVID19 at the time of presentation to the Emergency Department.Figure 2.: Average laboratory values of interests in those patient with only GI symptoms at the time of presentation in comparison to those with respiratory symptoms.