Digestive Manifestations in Patients Hospitalized with COVID-19
Authors: Elmunzer B. Joseph , Spitzer Rebecca L. , Foster Lydia D. , Merchant Ambreen A. , Howard Eric F. , Patel Vaishali A. , West Mary K. , Qayed Emad , Nustas Rosemary , Zakaria Ali , Piper Marc S. , Taylor Jason R. , Jaza Lujain , Forbes Nauzer , Chau Millie , Lara Luis F. , Papachristou Georgios I. , Volk Michael L. , Hilson Liam G. , Zhou Selena , Kushnir Vladimir M. , Lenyo Alexandria M. , McLeod Caroline G. , Amin Sunil , Kuftinec Gabriela N. , Yadav Dhiraj , Fox Charlie , Kolb Jennifer M. , Pawa Swati , Pawa Rishi , Canakis Andrew , Huang Christopher , Jamil Laith H. , Aneese Andrew M. , Glamour Benita K. , Smith Zachary L , Hanley Katherine A. , Wood Jordan , Patel Harsh K. , Shah Janak N. , Agarunov Emil , Sethi Amrita , Fogel Evan L. , McNulty Gail , Haseeb Abdul , Trieu Judy A. , Dixon Rebekah E. , Yang Jeong Yun , Mendelsohn Robin B. , Calo Delia , Aroniadis Olga C. , LaComb Joseph F. , Scheiman James M. , Sauer Bryan G. , Dang Duyen T. , Piraka Cyrus R. , Shah Eric D. , Pohl Heiko , Tierney William M. , Mitchell Stephanie , Condon Ashwinee , Lenhart Adrienne , Dua Kulwinder S. , Kanagala Vikram S. , Kamal Ayesha , Singh Vikesh K. , Pinto-Sanchez Maria Ines , Hutchinson Joy M. , Kwon Richard S. , Korsnes Sheryl J. , Singh Harminder , Solati Zahra , Deshpande Amar R. , Rockey Don C. , Alford Teldon B. , Durkalski Valerie ,   the North American Alliance for the Study of Digestive Manifestations of COVID-19.
Published: July 2020

Background

The prevalence and significance of digestive manifestations in COVID-19 remain uncertain.

Methods

Consecutive patients hospitalized with COVID-19 were identified across a geographically diverse alliance of medical centers in North America. Data pertaining to baseline characteristics, symptomatology, laboratory assessment, imaging, and endoscopic findings from the time of symptom onset until discharge or death were manually abstracted from electronic health records to characterize the prevalence, spectrum, and severity of digestive manifestations. Regression analyses were performed to evaluate the association between digestive manifestations and severe outcomes related to COVID-19.

Results

A total of 1992 patients across 36 centers met eligibility criteria and were included. Overall, 53% of patients experienced at least one gastrointestinal symptom at any time during their illness, most commonly diarrhea (34%), nausea (27%), vomiting (16%), and abdominal pain (11%). In 74% of cases, gastrointestinal symptoms were judged to be mild. In total, 35% of patients developed an abnormal alanine aminotransferase or total bilirubin level; these were elevated to less than 5 times the upper limit of normal in 77% of cases. After adjusting for potential confounders, the presence of gastrointestinal symptoms at any time (odds ratio 0.93, 95% confidence interval 0.76-1.15) or liver test abnormalities on admission (odds ratio 1.31, 95% confidence interval 0.80-2.12) were not independently associated with mechanical ventilation or death.

Conclusions

Among patients hospitalized with COVID-19, gastrointestinal symptoms and liver test abnormalities were common but the majority were mild and their presence was not associated with a more severe clinical course