S3283 Prevalence and Duration of Hospitalization of COVID-19 Patients Presenting With GI Symptoms

Abstract

Introduction: SARS-CoV-2 (COVID-19) patients most commonly present with fever and respiratory symptoms, such as cough and shortness of breath. However, increasing evidence suggests that the illness can initially present with non-respiratory symptoms without fever, particularly gastrointestinal (GI) symptoms such as diarrhea, nausea, vomiting and decreased appetite. The etiology of GI symptoms associated with COVID-19 infection is not well understood, however it is suspected that the angiotensin-converting enzyme (ACE2) cellular receptor may play a critical role in the pathogenesis of the disease. The ACE2 receptor is widely expressed in the GI tract. Prior studies suggest patients with GI symptoms had greater severity of disease with a longer duration of symptomatic infection from onset to hospital admission than those without GI symptoms. This study investigated the prevalence and length of hospitalization of COVID-19 patients with GI symptoms of diarrhea and vomiting. It was expected that patients that present with GI symptoms experience greater length of hospitalization. The length of stay (LOS) of COVID-19 patients with GI symptoms versus patients with pulmonary symptoms was compared. Methods: A descriptive, cross-sectional study was conducted at Franciscan Health in Olympia Fields, Illinois from 3/2020 to 5/2020. All inpatient admissions, greater than the age of 18, who tested positive for COVID-19 via PCR were included. Patients were categorized by presenting symptoms, including GI (vomiting and diarrhea), pulmonary (cough and shortness of breath), and other (all other presenting symptoms). Patient data, including LOS, was extracted from EPIC EMR software and an ANOVA test was utilized for statistical comparison. Results: A total of 354 patients were identified; 23 (6.5%) presented with GI symptoms, 179 (50.6%) presented with pulmonary symptoms and 152 (42.9%) presented with other symptoms. There was no significant difference in the mean LOS for patients with GI symptoms compared to those with pulmonary symptoms, 7.0 and 9.71 days, respectively (p = 0.294). Conclusion: Patients presenting with GI symptoms had shorter LOS compared to those with pulmonary symptoms. The shorter LOS may be attributed to the smaller number of patients presenting with GI symptoms compared to those with pulmonary symptoms. It may also be attributed to a less severe COVID-19 infection in those GI symptom patients. This outcome is contrary to what was initially expected.