Association of digestive symptoms with severity and mortality of COVID-19

Zhang, Yufang; Ma, P.; Zhang, Xiu; Pei, Zhuoxi; Wang, Haixia; Dou, Xin‐Man

doi:10.1097/md.0000000000022736

Cited by 8 publications

(9 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, any possible true difference in mortality may be worth further investigation among better defined patients with COVID-19 subgroups with GI symptoms/ elevated liver enzymes because one study showed that prevalence of severe disease was more common in patients who had GI symptoms than those who did not. 156 Our meta-analysis did not find a statistically significant association between patients with GI symptoms/elevated liver enzymes and ICU admission. However, to investigate such an association, it is important to consider other causes of elevated liver enzymes in patients admitted to ICU such as sepsis, hypoperfusion, hepatotoxic drugs, and parenteral nutrition.…”

Section: Discussioncontrasting

confidence: 59%

Gastroenterological and hepatic manifestations of patients with COVID-19, prevalence, mortality by country, and intensive care admission rate: systematic review and meta-analysis

Shehab

Alrashed

Shuaibi

et al. 2021

BMJ Open Gastroenterol

View full text Add to dashboard Cite

Background and aimsPatients infected with the SARS-CoV-2 usually report fever and respiratory symptoms. However, multiple gastrointestinal (GI) manifestations such as diarrhoea and abdominal pain have been described. The aim of this study was to evaluate the prevalence of GI symptoms, elevated liver enzymes and mortality of patients with COVID-19.MethodsA systematic review and meta-analysis of published studies that included a cohort of patients infected with SARS-CoV-2 were performed from 1 December 2019 to 15 December 2020. Data were collected by conducting a literature search using PubMed, Embase, Scopus, and Cochrane according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We analysed pooled data on the prevalence of individual GI symptoms and elevated liver enzymes and performed subanalyses to investigate the relationship between GI symptoms/elevated liver enzymes, geographical location, mortality, and intensive care unit (ICU) admission.ResultsThe available data of 78 798 patients positive for SARS-CoV-2 from 158 studies were included in our analysis. The most frequent manifestations were diarrhoea (16.5%, 95% CI 14.2% to 18.4%), nausea (9.7%, 95% CI 9.0% to 13.2%) and elevated liver enzymes (5.6%, 95% CI 4.2% to 9.1%). The overall mortality and GI mortality were 23.5% (95% CI 21.2% to 26.1%) and 3.5% (95% CI 3.1% to 6.2%), respectively. Subgroup analysis showed non-statistically significant associations between GI symptoms/elevated liver enzymes and ICU admissions (OR=1.01, 95% CI 0.55 to 1.83). The GI mortality was 0.9% (95% CI 0.5% to 2.2%) in China and 10.8% (95% CI 7.8% to 11.3%) in the USA.ConclusionGI symptoms/elevated liver enzymes are common in patients with COVID-19. Our subanalyses showed that the presence of GI symptoms/elevated liver enzymes does not appear to affect mortality or ICU admission rate. Furthermore, the proportion of GI mortality among patients infected with SARS-CoV-2 varied based on geographical location.

show abstract

Section: Discussioncontrasting

confidence: 59%

Gastroenterological and hepatic manifestations of patients with COVID-19, prevalence, mortality by country, and intensive care admission rate: systematic review and meta-analysis

Shehab

Alrashed

Shuaibi

et al. 2021

BMJ Open Gastroenterol

View full text Add to dashboard Cite

show abstract

“…COVID-19 patients who present with GI manifestations, have been found to be more likely to excrete viral RNA in stool [ [69] , [70] , [71] , [72] ], and sometimes have prolonged time to viral clearance [ 73 ], even long after respiratory viral RNA is cleared [ 74 , 75 ]. Since the initial cases reported in Wuhan China, which described low rates of GI symptoms in COVID-19 patients [ 1 , 76 ], the presence of marked digestive symptoms has been described at much higher rates (10% to over 50%) in other cohorts, some out of Wuhan itself [ 6 , 77 , 78 ]. One study investigating the clinical characteristics of COVID-19 in 204 patients, reported vomiting, diarrhea and abdominal pain in 50.5% of cases [ 68 ].…”

Section: Covid-19 the Gut And The Lung-gut Axismentioning

confidence: 99%

Autoimmunity and COVID-19 – The microbiotal connection

Katz-Agranov

Zandman‐Goddard

2021

Autoimmunity Reviews

View full text Add to dashboard Cite

Background and aims The novel SARS-CoV-2 has been rattling the world since its outbreak in December 2019, leading to the COVID-19 pandemic. The learning curve of this new virus has been steep, with a global scientific community desperate to learn how the virus is transmitted, how it replicates, what cause such a wide spectrum of disease manifestations, causing none or few symptoms in some. Others are burdened by an intense immune response that resembles the cytokine storm syndrome (CSS), which leads to severe disease manifestations, often complicated by fatal acute respiratory distress syndrome and death. Research efforts have been focusing on finding effective cures and vaccinations for this virus. The presence of SARS-CoV-2 in the gastrointestinal (GI) tract, represented by several GI manifestations, has led to its investigation as a target for the virus and as an indicator of disease severity. The response of the microbiome (which is heavily linked to immunity) to the novel SARS-CoV-2 virus, and its role in igniting the exaggerated immune response has therefore become a focus of interest. The objective of our study was to gather the data connecting between the microbiome, the GI tract and COVID-19 and to investigate whether these reported alterations in the gut microbiome bear any resemblance to those seen in lupus, the prototypical autoimmune disease. Confirming such changes may become the steppingstone to potential therapies that may prevent transmission, progression and immune related manifestations of COVID-19, via manipulation of the gut microbiota. Methods We performed an extensive literature review, utilizing the Pubmed search engine and Google Scholar for studies evaluating the microbiome in COVID-19 patients and compared results with studies evaluating the microbiome in lupus. We searched for the terms: microbiome, dysbiosis, COVID-19, SARS-CoV-2, gastrointestinal as well as lupus and autoimmune. While there were hundreds of articles which referred to gastrointestinal manifestations in COVID-19, to date only 4 studies investigated the gastrointestinal microbiome in this setting. We compared the similarities between microbiome of COVID-19 patients and lupus patients. Results We found that there are several similar processes of immune dysregulation in patients with COVID-19 and in those with lupus, with several other alterations seen in other pathological states. Some of these similarities include loss of microbiota biodiversity, increased representation of pathobionts, which are microbes associated with inflammation and disease (i.e Proteobacteria) and a relative decrease of symbionts, which are protective microbes, associated with anti-inflammatory properties (i.e Lactobacillus). Compromise to the intestinal barrier has also been reported in both. Conclusions We conclude that the gastrointestinal tract contributes to the disease manifestations in COVID-19. Whether gastrointestinal dysb...

show abstract

“…The patients who presented with atypical symptoms, as gastro-intestinal (GI) symptoms and reduced consciousness, had the highest mortality rate (100%). GI symptoms had an odds ratio of 1.833 (95% CI=0.590-5.697).While, in a published study [25], the odds ratios for nausea and vomiting were (0.63 [0.38-1.04] and 0.92 [0.59-1.44] respectively). Patients who were presented with typical symptoms had (25.6%) mortality rate.…”

Section: Discussionmentioning

confidence: 91%

Prediction of COVID-19 mortality among hospitalized patients in Sudan

El‐Raheem

Yousif²,

Mohamed³

2021

Preprint

View full text Add to dashboard Cite

Background: COVID-19 was primarily reported in China. The mortality rate across countries had ranged from 1% up to more than 10% and it is underestimated in some countries. Advanced age is the most frequently reported factor associated to mortality. Other factors were the presence of comorbidities such as diabetes mellitus, hypertension and obesity. Several models for mortality prediction had been developed to assist in improving the prognosis. The aim of our study was to assess the factors related to mortality among COVID-19 patients and develop a prediction model based on these factors. Methods: A retrospective cohort study assessed the factors related to the mortality among COVID-19 patients who attended Imperial Hospital isolation centre on November- December, 2020, Khartoum, Sudan. Statistical tests performed were chi-square test, odds ratio and regression to develop the prediction model. Tests were considered statistically significant when p < 0.05. Results: 105 patients were studied. 29% of the patients were deceased, while, 71% were discharged alive. A statistically significant association was found between the age and severity with regards to mortality rate (p=0.034, 0.018 respectively). The model equation for mortality prediction: Mortality = -14.724+ (1.387* Age) + (-0.323* Gender) + (1.814* Admission) + ( 0.193* Ischemic Heart Disease) + ( -0.369* Fever) + ( 1.595* Cough) + ( 1.953* Complications) + ( 0.149* Duration of hospitalization) + ( 0.999* Enoxaparin dose). Conclusions: Age, admission ward, cough and enoxaparin dose were statistically significant predictors for COVID-19 mortality ( p= 0.014, 0.011, 0.015, 0.006 respectively).

show abstract

Association of digestive symptoms with severity and mortality of COVID-19

Cited by 8 publications

References 29 publications

Gastroenterological and hepatic manifestations of patients with COVID-19, prevalence, mortality by country, and intensive care admission rate: systematic review and meta-analysis

Gastroenterological and hepatic manifestations of patients with COVID-19, prevalence, mortality by country, and intensive care admission rate: systematic review and meta-analysis

Autoimmunity and COVID-19 – The microbiotal connection

Prediction of COVID-19 mortality among hospitalized patients in Sudan

Contact Info

Product

Resources

About