GI symptoms do not predict outcomes in adult COVID-19 patients

The presence of gastrointestinal (GI) symptoms does not appear to significantly contribute to any clinical outcomes in adult patients admitted for COVID-19, reveals a retrospective study in the Philippines.

The study was presented at the virtual Asian Pacific Digestive Disease Week (APDW) 2021 by co-author Jhebe Imperial, MD, Department of Internal Medicine – Section of Gastroenterology, Vicente Sotto Memorial Medical Center, Cebu City, Philippines.

Imperial and co-author Dennis Entera, also from the same institution, sought to determine the GI manifestations, baseline laboratory profiles, and clinical outcomes of adult symptomatic patients admitted for COVID-19 at their institution from March to August 2020. They also tried to find out whether laboratory profiles and GI symptoms correlated with patient outcomes.

In this retrospective analytical study, the authors employed binary logistic regression, with 5-percent margin of error, and chi-square test for independence to determine the relationship of laboratory parameters as predictors and GI manifestations with patient’s clinical outcomes. They also computed the incidence rate of GI manifestations.

A total of 571 symptomatic COVID-19 patients (median age 53 years, 53.24 percent male) were included in the analysis, of whom 67.78 percent had comorbidities, 82.31 percent were nonsmokers, and 69.35 percent were nonalcoholic drinkers. Healthcare workers accounted for 15.06 percent of these patients. [APDW 2021, abstract 1266-821]

Among 387 COVID-19 patients with comorbidities, 249 (64.34 percent) had hypertension, 147 (37.98 percent) had type 2 diabetes, and 69 (17.83 percent) had chronic kidney disease. Fever (n=332, 58.14 percent), cough (n=330, 57.79 percent), and dyspnoea (n=318, 55.69 percent) were the most common non-GI symptoms.

On the other hand, 110 (19.26 percent) patients presented with GI manifestations, of which diarrhoea (n=45, 40.91 percent) was the most common, followed by abdominal pain (n=34, 30.91 percent) and loss of appetite (n=26, 23.64 percent).

Other GI symptoms were as follows: vomiting (n=16, 14.55 percent), abdominal distention (n=8, 7.27 percent), melena (n=6, 5.45 percent), jaundice (n=5, 4.55 percent), nausea (n=4, 3.64 percent), hematemesis (n=2, 1.82 percent), and hematochezia (n=1, 0.91 percent).

Overall mortality rate stood at 31.17 percent (n=178), with a median hospitalization of 11 days (interquartile range, 5–17). Among patients who expired, 17.4 percent (n=31) had GI manifestations. Acute respiratory failure (n=28, 90.32 percent) was the most common cause of death in this cohort. Of note, the presence of GI symptoms did not significantly affect patients’ clinical outcomes (p=0.493).

Furthermore, prolonged prothrombin time (p=0.0001), elevated C-reactive protein (p=0.0001), and procalcitonin >2 ng/mL (p=0.0038) were significantly observed in expired compared with discharged patients. In binary logistic regression analyses, eosinophil count (p=0.005) was significantly associated with mortality. Death was most likely to occur among patients with increased eosinophil count.

“[A] prospective study is recommended for better analysis,” the authors said. “Further studies are needed to support the use of eosinophils as predictor of death in COVID-19 patients.”