Attaching clinical significance to COVID-19-associated diarrhea

Wang, Fantao; Zheng, Shiliang; Zheng, Chengbin; Sun, Xiaodong

doi:10.1016/j.lfs.2020.118312

Cited by 25 publications

(27 citation statements)

References 38 publications

(53 reference statements)

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“…Our population rarely suffered from gastrointestinal symptoms and this data contrast with an initial case report of Wang et al in which 80% of the patient presented with diarrhea. The reported incidence of diarrhea in patients with COVID-19 ranged from 2% to 49.5% in the literature [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

COVID-19 in hemodialysis patients: a single-center experience in Istanbul

et al. 2021

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Objective Coronavirus disease 2019 (COVID-19) causes a wide spectrum of symptoms, from asymptomatic conditions to severe inflammatory response. Hemodialysis (HD) patients have a higher risk for developing severe COVID-19 because of older age, multiple co-morbid conditions, and impaired immune system compared to the general population. As little is known about these special groups, we evaluated the clinical characteristics and outcomes of HD patients with COVID-19. Methods All hospitalized HD patients with COVID 19 between March 11, 2020 and May 31, 2020 were included in the study. The composite end-points consisted of admission to the intensive care unit (ICU), discharging or death were analysed. Demographic, clinical, laboratory, and treatment data were retrieved and compared between survivors and nonsurvivors. Results A total of 45 patients (median age 65.33 ± 12.22, 24 female, 53.96 ± 40.68) were enrolled and of whom 14 were admitted to ICU and overall 14 (31.1%) have died. Hypertension was the most common comorbidity and fever (60%), dyspnea (55.6%) and cough (53.3%) were predominant symptoms at admission. 8.8% of patients developed severe complications (acute respiratory distress syndrome, macrophage activation syndrome) and secondary infection was observed in 51.1% of the patients. Elevation in the level of inflammatory markers, lactate dehydrogenase, liver enzymes, troponin, creatine kinase, and decrease in lymphocyte count and serum albumin level were observed in non-survivors compared with survivors throughout the clinical course. No significant difference was observed in the score of chest CT performed on the day of hospitalization for the survivors and non-survivors. Conclusion Mortality of COVID-19 in HD patients is high and follow up of certain laboratory parameters can help to predict the prognosis of the patients.

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Section: Discussionmentioning

confidence: 99%

COVID-19 in hemodialysis patients: a single-center experience in Istanbul

et al. 2021

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“…The link between diarrhea and abdominal pain and the antibody response is intriguing. SARS-CoV-2-induced diarrhea may directly exacerbate inflammation and disease severity (32). Thus, diarrhea simply may be a marker of severe disease, which is associated with higher antibody titers.…”

Section: Discussionmentioning

confidence: 99%

“…However, we did not see increased diarrhea in our hospitalized patients (Table 1). Another possibility is that diarrhea, which is typically caused by enteric viral infection and damage (32), may directly enhance the antibody response, perhaps by activating inflammatory cells throughout the gut. However, at this time, the mechanism by which diarrhea might enhance antibody titers is unknown and requires further investigation.…”

Section: Discussionmentioning

confidence: 99%

Fever, Diarrhea, and Severe Disease Correlate with High Persistent Antibody Levels against SARS-CoV-2

Amjadi

Armbrust

Mergaert

et al. 2021

Preprint

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Lasting immunity will be critical for overcoming the coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, factors that drive the development of high titers of anti-SARS-CoV-2 antibodies and how long those antibodies persist remain unclear. Our objective was to comprehensively evaluate anti-SARS-CoV-2 antibodies in a clinically diverse COVID-19 convalescent cohort at defined time points to determine if anti-SARS-CoV-2 antibodies persist and to identify clinical and demographic factors that correlate with high titers. Using a novel multiplex assay to quantify IgG against four SARS-CoV-2 antigens, a receptor binding domain-angiotensin converting enzyme 2 inhibition assay, and a SARS-CoV-2 neutralization assay, we found that 98% of COVID-19 convalescent subjects had anti-SARS-CoV-2 antibodies five weeks after symptom resolution (n=113). Further, antibody levels did not decline three months after symptom resolution (n=79). As expected, greater disease severity, older age, male sex, obesity, and higher Charlson Comorbidity Index score correlated with increased anti-SARS-CoV-2 antibody levels. We demonstrated for the first time that COVID-19 symptoms, namely fever, abdominal pain, diarrhea and low appetite, correlated consistently with higher anti-SARS-CoV-2 antibody levels. Our results provide new insights into the development and persistence of anti-SARS-CoV-2 antibodies.

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“…A clinical study from COVID-19–positive patients in Hubei, China, revealed that 46% presented with gastrointestinal (GI) problems, such as vomiting, diarrhea, or abdominal pain early in the disease [ 23 , 24 ]. The most common digestive tract symptom in adults and children is diarrhea, with the reported incidence of diarrhea in patients with COVID-19 ranging from 2% to 49.5% [ 25 ]. The ACE2 receptor is highly expressed in the gastrointestinal tract and plays an important role in the control of intestinal inflammation and intestinal microbial ecology; when the ACE2 receptor is activated by SARS-CoV-2, it can cause inflammation (enteritis) and eventually diarrhea [ 23 , 25 , 26 ].…”

Section: The Gut Microbiome and Covid-19mentioning

confidence: 99%

“…The most common digestive tract symptom in adults and children is diarrhea, with the reported incidence of diarrhea in patients with COVID-19 ranging from 2% to 49.5% [ 25 ]. The ACE2 receptor is highly expressed in the gastrointestinal tract and plays an important role in the control of intestinal inflammation and intestinal microbial ecology; when the ACE2 receptor is activated by SARS-CoV-2, it can cause inflammation (enteritis) and eventually diarrhea [ 23 , 25 , 26 ]. Seventeen studies in China, the United States, and Singapore showed SAR-CoV-2 viral RNA has been detected in the stools of an average of 43% of COVID-19 patients [ 23 ].…”

Section: The Gut Microbiome and Covid-19mentioning

confidence: 99%

A Review of the Current Status of Clinical Management of COVID-19 in the Elderly

Zhao

2021

Med Sci Monit

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The high infectivity and severity of SARS-CoV-2 infection (COVID-19), and our limited understanding of the biology of the novel coronavirus, as well as the lack of an effective treatment for COVID-19, have created a global pandemic. Those most likely to become seriously ill with COVID-19 are adults, especially the elderly and those who are already weak or sick. At present, a specific drug for treatment of COVID-19 has not been developed. This, combined with the typical coexistence of a variety of chronic diseases in elderly patients, makes treatment challenging at present. In addition, for elderly patients, COVID-19 isolation measures during the epidemic can easily lead to psychological problems. Thus, how to manage elderly patients has become a focus of social attention in the current circumstances. This article reviews the effects of COVID-19 and makes management suggestions for elderly patients during this epidemic period. In addition to the elderly, critically ill people are also highly susceptible to this novel coronavirus. For elderly COVID-19 patients, antiviral therapy, immune regulation, and even auxiliary respiratory therapy can be given after a comprehensive evaluation of the disease. With the approval and use of COVID-19 vaccines, it is reasonable to expect that we can conquer SARS-CoV-2.

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Attaching clinical significance to COVID-19-associated diarrhea

Cited by 25 publications

References 38 publications

COVID-19 in hemodialysis patients: a single-center experience in Istanbul

COVID-19 in hemodialysis patients: a single-center experience in Istanbul

Fever, Diarrhea, and Severe Disease Correlate with High Persistent Antibody Levels against SARS-CoV-2

A Review of the Current Status of Clinical Management of COVID-19 in the Elderly

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