COVID-19 inpatients with gastrointestinal onset: sex and care needs’ differences in the district of Ferrara, Italy

Abstract

Background COVID-19 is characterized by interstitial pneumonia, but a presentation of the disease with digestive symptoms only may occur. This work was aimed at evaluating: (1) the prevalence of presentation with digestive symptoms only in our cohort of COVID-19 inpatients; (2) differences between patients with and without gastrointestinal onset; (3) differences among males and females with gastrointestinal presentation; (4) outcomes of the groups of subjects with and without gastrointestinal onset. Method We retrospectively divided the patients hospitalized with COVID-19 into two groups: (1) the one with digestive symptoms (DSG) and (2) the other without digestive symptoms (NDSG). We compared the subjects of DSG with those of NDSG and males with females in the DSG group only, in terms of demographics (age, sex), inflammation and organ damage indexes, length of stay, in-hospital and 100-day mortality. Results The prevalence of gastrointestinal symptoms at presentation was 12.5%. The DSG group showed a prevalence of females, and these tended to a shorter hospital stay; DSG patients were younger and with a higher load of comorbidities, but no differences concerning inflammation and organ damage indexes, need for intensification of care, in-hospital and 100-day mortality were detected. Among DSG patients, males were younger than females, more comorbid, with higher serum CRP and showed a longer length of hospital stay. Survival functions of DSG patients, in general, are more favourable than those of NDSG if adjusted for sex, age and comorbidities. Conclusions (1) The prevalence of gastrointestinal presentation among hospitalized COVID-19 patients was 12.5%; (2) DSG patients were on average younger, more comorbid and with a prevalence of females, with a shorter hospital stay; (3) in the DSG group, males had a higher Charlson Comorbidity Score and needed a longer hospital stay; (4) DSG subjects seem to survive longer than those of the NDSG group.

Impact of COVID-19 on digestive system: prevalence, clinical characteristics, outcome, and relation to the severity of COVID-19

“…In consistent with the published literature [7,24], no significant difference was detected in the mean level of transaminases among patients with and without digestive symptoms. In contrast, a meta-analysis by Wijarnpreecha et al [33] and a cross-sectional study by Teima et al [25] showed a higher level of transaminases in patients with GI symptoms.…”

“…Within our cohort, 104 (34.7%) patients presented with GI symptoms which is lower than the results reported by other studies conducted in the USA and China which were in the range of 50.5-61.3% [10,12]. In contrast, this prevalence was higher than other studies conducted in China, Italy, and Egypt [7,22,24,25].…”

“…However, reports from both the source outbreak of COVID-19 in China and emerging data from other international sites have notified subgroups of COVID-19 patients with gastrointestinal (GI) symptoms [4] that can occur with and without pulmonary manifestations of COVID-19 [5]. The reported prevalence of GI symptoms has been highly variable ranging from 3.8 to 61.3% [6][7][8][9][10][11][12].…”

Paralytic Ileus as an Extra-Pulmonary Manifestation of COVID-19

“…Several studies have found that SARS-CoV-2 RNA can be found in stool in approximately 50% of patients with active infection [ 11 ], indicating the presence of viral infection along the GI tract. The local presence of SARS-CoV-2 along the GI tract is associated with greater intestinal inflammation and the release of cytokines such as interleukin-6 (IL-6) and Tumor Necrosis Factor-α [ 12 ]. These cytokines play an important role in causing the local and systemic inflammatory response and are released in response to tissue injury and pro-inflammatory stimulus from the innate and adaptive immune system.…”

SARS-CoV-2 in Environmental Samples of Quarantined Households

“…A study by Greco and colleagues looked at the distribution of symptoms depending on age, sex, and disease outcome, among other factors. In this study, gastrointestinal symptoms occurred in 12.5% of infected individuals [ 34 ].…”