COVID-19 Patients’ Symptoms: Gastrointestinal Presentations, Comorbidities and Outcomes in a Canadian Hospital Setting
Authors: Brim Hassan , Moshkovich Michal , Figueiredo Melanie , Hartung Emily , Pizuorno Antonio , Hill Lee , Popov Jelena , Awoyemi Eyitope Olaide , Khan Waliul I , Oskrochi Gholamreza , Ashktorab Hassan , Pai Nikhil 
Published: October 2021

Background

The Coronavirus disease 2019 (COVID-19) pandemic has had significant global impact. While public health interventions and universal health insurance has been credited with minimizing transmission rates in Canada relative to neighboring countries, significant morbidity and mortality have occurred nationwide. We sought to determine factors associated with differences in gastrointestinal outcomes in COVID-19 patients at a Canadian hospital.

Methods

We collected data from 192 hospital records of COVID-19 patients across seven Hamilton Health Sciences hospitals, a network of academic health centres serving one of the largest metropolitan areas in Canada. Statistical and correlative analysis of symptoms, comorbidities, and mortality were performed.

Results

There were 192 patients. The mean age was 57.6 years (SD=21.0). For patients who died (n=27, 14%), mean age was 79.2 years old (SD=10.6) versus 54 years for survivors (SD=20.1). There was a higher mortality among patients with older age (p=0.000), long hospital stay (p=0.004), male patients (p=0.032), and patients in nursing homes (p=0.000). Patients with dyspnea (p=0.028) and hypertension (p=0.004) were more likely to have a poor outcome. Laboratory test values that were significant in determining outcomes were an elevated INR (p=0.007) and elevated creatinine (p=0.000). Cough and hypertension were the most common symptom and comorbidity, respectively. Diarrhea was the most prevalent (14.5%) gastrointestinal symptom. Impaired liver function was related to negative outcome (LR 5.6; p=0.018).

Conclusions

In a Canadian cohort, elevated liver enzymes, prolonged INR and elevated creatinine were associated with poor prognosis. Hypertension was also linked to a higher likelihood of negative outcome.

SUMMARY BOX

What is already known about this subject?

The prevalence of gastrointestinal symptoms in COVID-19 patients across Canada is lacking

Gastrointestinal manifestations of COVID-19 are well described, and longterm sequelae of gastrointestinal tract involvement are an ongoing concern

What are the new findings?

There was a significant prevalence of gastrointestinal symptoms in patients with a confirmed diagnosis of COVID-19 at one of the largest metropolitan regions across Canada

Liver enzyme abnormalities were common in patients at diagnosis

This report, over an 8-month period, represents the largest cohort of COVID-19 patients reported in Canada

How might these results impact on clinical practice in the foreseeable future?

Baseline gastrointestinal symptoms and laboratory abnormalities correlate with patient outcome in Canadian COVID-19 patients

These results enhance our knowledge of the prevalence of gastrointestinal symptoms and laboratory abnormalities in Canadian patients and offer important baseline data for longitudinal studies in these patients

Our findings increase our knowledge of the epidemiology of COVID-19 in Canada and allow future comparison with international data