Factors Associated With Poor Outcomes Among Patients With SARS-CoV-2 Coronavirus Infection and Gastrointestinal Symptoms
MD Nikita Patil, Pankush Kalgotra, Suneha Sundaram, Stephanie Melquist, Sravanthi Parasa, Madhav Desai, Prateek Sharma
Gastro Hep Advances, doi:10.1016/j.gastha.2022.08.004
BACKGROUND AND AIMS: Gastrointestinal (GI) symptoms are present in 20% of patients with SARS-CoV-2 coronavirus infection (COVID-19). We studied the association of GI symptoms (in patients with COVID-19) with adverse outcomes and factors associated with poor outcomes in these patients. METHODS: The study cohort included 100,902 patients from the Cerner Real-World Data COVID-19 Database of hospital encounters and emergency department visits with COVID-19 infection from December 1, 2019, to November 30, 2020. Multivariate analysis was used to study the effect of GI symptoms on adverse outcomes and the factors associated with mortality, acute respiratory distress syndrome (ARDS), sepsis, and ventilator requirement or oxygen dependence in patients with COVID-19 and GI symptoms. RESULTS: Patients with COVID-19 and GI symptoms were significantly more likely to have ARDS (odds ratio [OR] 1.20, 95% confidence interval [CI] 1.11, 1.29), sepsis (OR 1.19, 95% CI 1.14, 1.24), acute kidney injury (OR 1.30, 95% CI 1.24, 1.36), venous thromboembolism (OR 1.36, 95% CI 1.22, 1.52), or GI bleed (OR 1.62, 95% CI 1.47, 1.79) and less likely to experience cardiomyopathy (OR 0.87, 95% CI 0.77, 0.99) or death (OR 0.71, 95% CI 0.67, 0.75). Among those with GI symptoms, older age, higher Charlson comorbidity index scores, and use of proton pump inhibitors/H2 receptor antagonists were associated with higher mortality, ARDS, sepsis, and ventilator or oxygen requirement. CONCLUSION: Patients with COVID-19 who have GI symptoms have overall worse in-hospital complications but less cardiomyopathy and mortality. Older age, higher comorbidity scores, and the use of proton pump inhibitors and H2 receptor antagonists are associated with poor outcomes in these patients.
Supplementary Materials Material associated with this article can be found in the online version at https://doi.org/10.1016/j.gastha.2022.08. 004. Authors' Contributions: Nikita Patil contributed to conceptualization, methodology, and writing, reviewing, and editing the article. Pankush Kalgotra contributed to data curation, formal analysis, software, and reviewing and editing the article. Suneha Sundaram contributed to conceptualization, methodology, and reviewing and editing the article. Stephanie Melquist contributed to methodology and writing, reviewing, and editing the article. Sravanthi Parasa contributed to conceptualization, methodology, supervision, and reviewing and editing the article. Madhav Desai contributed to conceptualization, methodology, and reviewing and editing the article. Prateek Sharma contributed to conceptualization, methodology, supervision, and reviewing and editing the article.
Conflicts of Interest: These authors disclose the following: P.S. is a consultant for Medtronic, Olympus, Boston Scientific, Fujifilm, and Lumendi; and received grant support from Ironwood, Erbe, Docbot, Cosmo pharmaceuticals, and CDx labs. S.P. is a member of Medical Advisory Board, Fujifilm. M.D. contributed to grant support from Intercept Pharma. The remaining authors disclose no conflicts.
Ethical Statement: The corresponding author, on behalf of all authors, jointly and severally, certifies that their institution has approved the protocol for any investigation..
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