COVID-19 Disease Outcomes: Does Gastrointestinal Burden Play a Role?

Abstract

Background:The novel coronavirus disease 2019 presents an urgent threat to global health. As the epidemic grows, prognosis prediction is essential for monitoring risky patient. It is thus important to consider gastrointestinal manifestations and the duration of symptoms as predictors of prognosis. Our aim was to determine the correlation of gastrointestinal symptoms and laboratory markers with disease outcomes and whether symptom duration varies substantially between patients. We also undertook this study to determine the optimal time to predict COVID-19 outcome. Patients and Methods: A total of 190 patients with polymerase chain reaction-confirmed COVID-19 were followed up until recovery. We proposed a correlation between gastrointestinal symptoms and disease severity (based on clinical data, and diagnostic investigations) to estimate the duration of symptoms as a predictor of COVID-19 prognosis. Results: The prevalence of gastrointestinal symptoms was 49.5%, consisting mainly of diarrhea in 27.9% of patients. In addition, a longer disease duration and higher temperature were observed in patients with diarrhea. Symptom duration was variable, with a median of 12 days and a range of 1-55 days. Statistical analysis indicated that patients with a duration of symptoms ≥12 day had more severe symptoms and a worse prognosis. Patients who complained of diarrhea had 2.7 times the odds of a longer duration of symptoms, and those with a history of chronic lung disease have 7.2 times the odds of a longer duration of symptoms. Conclusion: GIT manifestations (mainly diarrhea) and the duration of symptoms of COVID-19 provide prognostic evidence of COVID-19 outcomes, irrespective of earlier categorization by the World Health Organization. Thus, patients with mild symptoms who present with diarrhea and a duration of symptoms longer than 12 days are expected to have a worse prognosis.

Diarrhea as a Prognostic Factor for Severe COVID-19

“…While three studies by Mao R et al, Wang H et al, and Deane K et al found no significance in the presence of diarrhea and prevalence of severe COVID-19 disease (OR = 1.22, 95% CI: 0.81-1.84; OR = 1.24, 95% CI: 0.90-1.72; OR = 0.82, 95% CI: 0.47-1.44). 1,[9][10][11][12]…”

“…A retrospective study by Hegazy MA et al (2021) found significant factors between the mild and severe cohorts. 10 Where age, sex, presence of chronic lung diseases and metabolic comorbidities were factors that have a significant impact on COVID-19 severity. 10 These factors were then used to adjust the analysis of diarrhea as an independent prognostic factor.…”

“…10 Where age, sex, presence of chronic lung diseases and metabolic comorbidities were factors that have a significant impact on COVID-19 severity. 10 These factors were then used to adjust the analysis of diarrhea as an independent prognostic factor. 10 Between the two cohort studies, one has clinical significance while the other does not.…”

“…10 These factors were then used to adjust the analysis of diarrhea as an independent prognostic factor. 10 Between the two cohort studies, one has clinical significance while the other does not.…”

“…8 There are growing evidence showing how gastrointestinal involvement is associated with severe cases. 6,7,9,10 Moreover, it is also stated early in the early phase of the pandemic that diarrhea is the most prevalent gastrointestinal involvement in COVID-19. 1 Therefore, this paper is interested in looking into diarrhea as an independent prognostic factor by investigating available studies on the association between the presence of diarrhea and severe cases of COVID-19.…”