1
|
Hilvers E, Matizanadzo J, McClure V, Butterick P, Morgan M. Clostridioides difficile infection following COVID-19: A nationwide analysis using routine surveillance data in Wales. J Hosp Infect 2024:S0195-6701(24)00264-0. [PMID: 39094737 DOI: 10.1016/j.jhin.2024.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 07/17/2024] [Accepted: 07/19/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND CDI incidence has increased in Wales from summer 2020 and has remained elevated. There is evidence of poorer outcomes from concurrent CDI and COVID-19 infections, but it is not clear if infection with COVID-19 directly impacts likelihood of CDI infection. AIM We investigated the relationship between CDI and COVID-19 and the impact of secondary infections. METHODS We conducted two analytical studies using routine surveillance data: i) population level ecological case control study comparing CDI cases in the Welsh population by SARS-COV-2 exposure in the previous 90 days, ii) cohort study of COVID-19 cases by secondary infection presence, investigating CDI development within 90 days. FINDINGS Case control: 12% (196/1645) of CDI cases had prior COVID-19 and were twice as likely to have had COVID-19 compared to general population controls, when controlling for other infection history (OR 2.1, CI 1.8-2.5, p<0.0001). CDI cases were 8 times more likely to have had other infections, independent of COVID-19 history (OR 8.0, CI 7.0-9.0, p<0.001). COHORT STUDY 2% (2,255/137,620)) of the COVID-19 cohort developed >1 secondary infection, and <1% (185/137620) developed CDI within 90 days. CDI risk was four times higher in those with secondary infections, after age and sex adjustment (RR 4.6, CI 3.1 - 6.1, p<0.001). CDI risk increased with age and did not differ by sex. CONCLUSIONS Findings suggest a relationship between COVID-19 and CDI. However, incidence of CDI following COVID-19 was a rare outcome generally, suggesting other factors are likely contributing to the increased rates of CDI observed since 2020.
Collapse
Affiliation(s)
- Ember Hilvers
- Welsh Healthcare Epidemiologist Network (WHEN), Public Health Wales, Cardiff, Wales.
| | - Joshua Matizanadzo
- Communicable Disease Surveillance Centre (CDSC) Field Epidemiology Team, Public Health Wales, Cardiff, Wales
| | - Victoria McClure
- Healthcare Associated Infections and Antimicrobial Resistance Team (HARP), Public Health Wales, Cardiff, Wales
| | - Philip Butterick
- Welsh Healthcare Epidemiologist Network (WHEN), Public Health Wales, Cardiff, Wales
| | - Mari Morgan
- Healthcare Associated Infections and Antimicrobial Resistance Team (HARP), Public Health Wales, Cardiff, Wales
| |
Collapse
|
2
|
Yao Y, Ba T, Bao B, Zhang S, Kong L. Sepsis as a Potential Risk Factor for Upper Gastrointestinal Bleeding in Critically Ill Patients: A Systematic Review and Meta-analysis. J Intensive Care Med 2024:8850666241252048. [PMID: 38813775 DOI: 10.1177/08850666241252048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
Purpose: Sepsis is a common and critical condition in intensive care units (ICUs) known to complicate patient outcomes. Previous studies have indicated an association between sepsis and various ICU morbidities, including upper gastrointestinal bleeding (UGIB). However, the extent of this relationship and its implications in ICU settings remain inadequately quantified. This study aims to elucidate the association between sepsis and the risk of UGIB in ICU patients. Methods: A comprehensive meta-analysis was conducted, encompassing nine studies with a total of nearly 9000 participants. These studies reported events for both sepsis and nonsepsis patients separately. Pooled odds ratios (ORs) were calculated to assess the risk of UGIB in septic versus nonseptic ICU patients. Subgroup analyses were conducted based on age and study design, and both unadjusted and adjusted ORs were examined. Results: The pooled OR indicated a significant association between sepsis and UGIB (OR = 3.276, 95% CI: 1.931 to 5.557). Moderate heterogeneity was observed (I² = 43.9%). The association was significant in adults (pooled OR = 4.083) but not in children. No difference in association was found based on the study design. Unadjusted and adjusted ORs differed slightly, indicating the influence of confounding factors. Conclusion: This meta-analysis reveals a significant association between sepsis and an increased risk of UGIB in ICU patients, particularly in adults. These findings highlight the need for vigilant monitoring and proactive management of septic ICU patients to mitigate the risk of UGIB. Future research should focus on understanding the underlying mechanisms and developing tailored preventive strategies.
Collapse
Affiliation(s)
- Yanfen Yao
- Department of Intensive Care Medicine, Shandong Provincial Third Hospital, Shandong University, Jinan, China
- The First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Tejin Ba
- Department of Emergency, International Mongolian Hospital of Inner Mongolia, Hohhot, China
| | - Bagenna Bao
- Department of Emergency, International Mongolian Hospital of Inner Mongolia, Hohhot, China
| | - Shuanglin Zhang
- Department of Emergency, International Mongolian Hospital of Inner Mongolia, Hohhot, China
| | - Li Kong
- The First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
- Department of Emergency Center, Shandong University of Traditional Chinese Medicine Affiliated Hospital, Jinan, China
| |
Collapse
|
3
|
Costigan D, Fenn J, Yen S, Ilott N, Bullers S, Hale J, Greenhalf W, Conibear E, Koycheva A, Madon K, Jahan I, Huang M, Badhan A, Parker E, Rosadas C, Jones K, McClure M, Tedder R, Taylor G, Baillie KJ, Semple MG, Openshaw PJM, Pearson C, Johnson J, Lalvani A, Thornton EE. A pro-inflammatory gut mucosal cytokine response is associated with mild COVID-19 disease and superior induction of serum antibodies. Mucosal Immunol 2024; 17:111-123. [PMID: 37995912 PMCID: PMC10884467 DOI: 10.1016/j.mucimm.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 10/25/2023] [Accepted: 11/17/2023] [Indexed: 11/25/2023]
Abstract
The relationship between gastrointestinal tract infection, the host immune response, and the clinical outcome of disease is not well understood in COVID-19. We sought to understand the effect of intestinal immune responses to SARS-CoV-2 on patient outcomes including the magnitude of systemic antibody induction. Combining two prospective cohort studies, International Severe Acute Respiratory and emerging Infections Consortium Comprehensive Clinical Characterisations Collaboration (ISARIC4C) and Integrated Network for Surveillance, Trials and Investigations into COVID-19 Transmission (INSTINCT), we acquired samples from 88 COVID-19 cases representing the full spectrum of disease severity and analysed viral RNA and host gut cytokine responses in the context of clinical and virological outcome measures. There was no correlation between the upper respiratory tract and faecal viral loads. Using hierarchical clustering, we identified a group of fecal cytokines including Interleukin-17A, Granulocyte macrophage colony-stimulating factor, Tumor necrosis factorα, Interleukin-23, and S100A8, that were transiently elevated in mild cases and also correlated with the magnitude of systemic anti-Spike-receptor-binding domain antibody induction. Receiver operating characteristic curve analysis showed that expression of these gut cytokines at study enrolment in hospitalised COVID-19 cases was associated negatively with overall clinical severity implicating a protective role in COVID-19. This suggests that a productive intestinal immune response may be beneficial in the response to a respiratory pathogen and a biomarker of a successful barrier response.
Collapse
Affiliation(s)
- Dana Costigan
- MRC Translational Immune Discovery Unit, Weatherall Institute of Molecular Medicine, University of Oxford, UK
| | - Joe Fenn
- NIHR HPRU in Respiratory Infections, Imperial College London, London, UK.
| | - Sandi Yen
- Oxford Centre for Microbiome Studies, Kennedy Institute of Rheumatology, University of Oxford, UK
| | - Nicholas Ilott
- Oxford Centre for Microbiome Studies, Kennedy Institute of Rheumatology, University of Oxford, UK
| | - Samuel Bullers
- Oxford Centre for Microbiome Studies, Kennedy Institute of Rheumatology, University of Oxford, UK; Kennedy Institute of Rheumatology, University of Oxford, UK
| | - Jessica Hale
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - William Greenhalf
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Emily Conibear
- NIHR HPRU in Respiratory Infections, Imperial College London, London, UK
| | | | - Kieran Madon
- NIHR HPRU in Respiratory Infections, Imperial College London, London, UK
| | - Ishrat Jahan
- Section of Virology, Department of Infectious Disease, Imperial College London, London, UK
| | - Ming Huang
- Section of Virology, Department of Infectious Disease, Imperial College London, London, UK
| | - Anjna Badhan
- Section of Virology, Department of Infectious Disease, Imperial College London, London, UK
| | - Eleanor Parker
- Section of Virology, Department of Infectious Disease, Imperial College London, London, UK
| | - Carolina Rosadas
- Section of Virology, Department of Infectious Disease, Imperial College London, London, UK
| | - Kelsey Jones
- Kennedy Institute of Rheumatology, University of Oxford, UK
| | - Myra McClure
- Section of Virology, Department of Infectious Disease, Imperial College London, London, UK
| | - Richard Tedder
- Section of Virology, Department of Infectious Disease, Imperial College London, London, UK
| | - Graham Taylor
- Section of Virology, Department of Infectious Disease, Imperial College London, London, UK
| | - Kenneth J Baillie
- Roslin Institute, University of Edinburgh, Easter Bush, Edinburgh, UK
| | - Malcolm G Semple
- NIHR Health Protection Research Unit, Institute of Infection, Veterinary and Ecological Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Peter J M Openshaw
- NIHR HPRU in Respiratory Infections, Imperial College London, London, UK; National Heart and Lung Institute, Imperial College London, London, UK
| | - Claire Pearson
- Oxford Centre for Microbiome Studies, Kennedy Institute of Rheumatology, University of Oxford, UK; Kennedy Institute of Rheumatology, University of Oxford, UK
| | - Jethro Johnson
- Oxford Centre for Microbiome Studies, Kennedy Institute of Rheumatology, University of Oxford, UK
| | - Ajit Lalvani
- NIHR HPRU in Respiratory Infections, Imperial College London, London, UK
| | - Emily E Thornton
- MRC Translational Immune Discovery Unit, Weatherall Institute of Molecular Medicine, University of Oxford, UK; Nuffield Department of Medicine, University of Oxford, UK.
| |
Collapse
|
4
|
Mijac D, Vucelj S, Todorovic K, Vojnovic M, Milicic B, Lukic S, Filipovic B, Marjanovic Haljilji M, Popovic D, Adzic Vukicevic T. Gastrointestinal and Hepatological Manifestations in Severe Acute Respiratory Syndrome Coronavirus 2 Infection: Results from the Major COVID Hospital in Serbia. Microorganisms 2023; 12:27. [PMID: 38257854 PMCID: PMC10819747 DOI: 10.3390/microorganisms12010027] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/12/2023] [Accepted: 12/18/2023] [Indexed: 01/24/2024] Open
Abstract
The coronavirus disease of 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2), includes a clinical spectrum of diseases from mild to severe progressive pneumonia, which has affected and still affects the human population worldwide. Most commonly, it is presented by respiratory symptoms, but studies have shown that about 50% of patients with SARS-CoV-2 infection have at least one gastrointestinal symptom (GI), predominantly nausea, diarrhea, vomiting, or loss of appetite. In addition, abnormal liver functional tests are commonly present in the SARS-CoV-2 virus. The aim of our study was to examine the GI and hepatic manifestations of COVID-19 in patients hospitalized due to COVID-19 pneumonia in "COVID hospital Batajnica", University Clinical Center of Serbia in Belgrade. The study included 498 consecutive patients, and the data was obtained from the patient's electronic medical history. GI symptoms included nausea, vomiting, diarrhea, and anorexia. Collected laboratory values included baseline and peak values of blood count, inflammatory parameters, liver function tests, renal function tests, and cardiac enzyme tests. The results have shown that GI symptoms occurred in 26% of cases at diagnosis, which indicates the great susceptibility of the GI system to SARS-CoV-2. There was a high risk of liver injury in patients with COVID-19 pneumonia (>60%). The level of AST is more often increased compared to ALT, which is different from other virus-induced liver lesions and may be a useful indicator of SARS-CoV-2 infection. Further research should focus on the causes of liver damage in SARS-CoV-2 virus and the impact on treatment and outcome of COVID-19 disease.
Collapse
Affiliation(s)
- Dragana Mijac
- Faculty of Medicine, University of Belgrade, Dr Subotica Starijeg 8, 11000 Belgrade, Serbia; (S.L.); (B.F.); (D.P.); (T.A.V.)
- Clinic for Gastroenterology and Hepatology, University Clinical Center of Serbia, Koste Todorovica No 2, 11000 Belgrade, Serbia;
| | - Samir Vucelj
- Department of Internal Medicine, General Hospital Novi Pazar, Generala Zivkovica 1, 36300 Novi Pazar, Serbia;
| | - Kristina Todorovic
- Department of Internal Medicine, General Hospital Jagodina, Karadjordjeva 4, 35000 Jagodina, Serbia;
| | - Marko Vojnovic
- Clinic for Gastroenterology and Hepatology, University Clinical Center of Serbia, Koste Todorovica No 2, 11000 Belgrade, Serbia;
| | - Biljana Milicic
- Faculty of Dental Medicine, University of Belgrade, Rankeova 4, 11000 Belgrade, Serbia;
| | - Snezana Lukic
- Faculty of Medicine, University of Belgrade, Dr Subotica Starijeg 8, 11000 Belgrade, Serbia; (S.L.); (B.F.); (D.P.); (T.A.V.)
- Clinic for Gastroenterology and Hepatology, University Clinical Center of Serbia, Koste Todorovica No 2, 11000 Belgrade, Serbia;
| | - Branka Filipovic
- Faculty of Medicine, University of Belgrade, Dr Subotica Starijeg 8, 11000 Belgrade, Serbia; (S.L.); (B.F.); (D.P.); (T.A.V.)
- Department of Gastroenterology, Clinical and Hospital Center “Dr Dragisa Misovic–Dedinje”, Heroja Milana Tepica 1, 11020 Belgrade, Serbia;
| | - Marija Marjanovic Haljilji
- Department of Gastroenterology, Clinical and Hospital Center “Dr Dragisa Misovic–Dedinje”, Heroja Milana Tepica 1, 11020 Belgrade, Serbia;
| | - Dusan Popovic
- Faculty of Medicine, University of Belgrade, Dr Subotica Starijeg 8, 11000 Belgrade, Serbia; (S.L.); (B.F.); (D.P.); (T.A.V.)
- Department of Gastroenterology, Clinical and Hospital Center “Dr Dragisa Misovic–Dedinje”, Heroja Milana Tepica 1, 11020 Belgrade, Serbia;
| | - Tatjana Adzic Vukicevic
- Faculty of Medicine, University of Belgrade, Dr Subotica Starijeg 8, 11000 Belgrade, Serbia; (S.L.); (B.F.); (D.P.); (T.A.V.)
- Clinic for Pulmology, University Clinical Center of Serbia, Dr Koste Todorovica No 6, 11000 Belgrade, Serbia
| |
Collapse
|
5
|
Muntean M, Briciu V, Lupse M, Colcear D, Macicasan RV, Csiszer A, Manole A, Radulescu A. Effects of COVID-19 on the Liver and Mortality in Patients with SARS-CoV-2 Pneumonia Caused by Delta and Non-Delta Variants: An Analysis in a Single Centre. Pharmaceuticals (Basel) 2023; 17:3. [PMID: 38275989 PMCID: PMC10820137 DOI: 10.3390/ph17010003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/15/2023] [Accepted: 12/17/2023] [Indexed: 01/27/2024] Open
Abstract
The aim of this study was to ascertain patient characteristics, outcomes, and liver injuries in patients infected with different SARS-CoV-2 variants. Data from consecutive adult patients with severe/critical COVID-19 admitted to our hospital during the peak month of the Delta wave were compared to the ancestral, Alpha, and Omicron waves. The dataset of 551 hospitalized patients was similar in the Delta/non-Delta waves. At admission and discharge, the median aminotransferase levels were normal or slightly increased. During the Delta wave (172 vs. 379 non-Delta patients), more patients died (OR 1.69, 95%CI 1.09-2.56) or had liver injury at discharge (alanine aminotransferase, ALT ≥ 2 ULN) (OR 1.97, 95%CI 1.08-3.54). In-hospital mortality was associated with age, lung injury, intensive care unit admission, number of and cardiovascular comorbidities, diabetes, chronic kidney disease, and all inflammatory biomarkers. Serious liver injury at admission (ALT ≥ 5 × ULN) was significantly associated with in-hospital mortality (OR = 7.9, 95%CI 2-28.9). At discharge, drug-induced liver injury (DILI) was found in patients treated with remdesivir, ALT ≥ 2 ULN (OR = 2.62, 95%CI 1.22-5.75). Treatment with dexamethasone, remdesivir, and immunomodulators showed improved survival, OR = 0.50 (95%CI 0.33-0.77). Regardless of the variant and treatment options, less than 2% of patients displayed serious liver injury, which was not found to be a death predictor in multivariable analysis.
Collapse
Affiliation(s)
- Monica Muntean
- Department of Infectious Diseases and Epidemiology, The “Iuliu Hatieganu” University of Medicine and Pharmacy, 400348 Cluj-Napoca, Romania; (M.M.); (M.L.); (R.V.M.); (A.C.); (A.M.); (A.R.)
- The Teaching Hospital of Infectious Diseases, 400348 Cluj-Napoca, Romania;
| | - Violeta Briciu
- Department of Infectious Diseases and Epidemiology, The “Iuliu Hatieganu” University of Medicine and Pharmacy, 400348 Cluj-Napoca, Romania; (M.M.); (M.L.); (R.V.M.); (A.C.); (A.M.); (A.R.)
- The Teaching Hospital of Infectious Diseases, 400348 Cluj-Napoca, Romania;
| | - Mihaela Lupse
- Department of Infectious Diseases and Epidemiology, The “Iuliu Hatieganu” University of Medicine and Pharmacy, 400348 Cluj-Napoca, Romania; (M.M.); (M.L.); (R.V.M.); (A.C.); (A.M.); (A.R.)
- The Teaching Hospital of Infectious Diseases, 400348 Cluj-Napoca, Romania;
| | - Doina Colcear
- The Teaching Hospital of Infectious Diseases, 400348 Cluj-Napoca, Romania;
| | - Raul Vlad Macicasan
- Department of Infectious Diseases and Epidemiology, The “Iuliu Hatieganu” University of Medicine and Pharmacy, 400348 Cluj-Napoca, Romania; (M.M.); (M.L.); (R.V.M.); (A.C.); (A.M.); (A.R.)
| | - Agnes Csiszer
- Department of Infectious Diseases and Epidemiology, The “Iuliu Hatieganu” University of Medicine and Pharmacy, 400348 Cluj-Napoca, Romania; (M.M.); (M.L.); (R.V.M.); (A.C.); (A.M.); (A.R.)
| | - Alexandra Manole
- Department of Infectious Diseases and Epidemiology, The “Iuliu Hatieganu” University of Medicine and Pharmacy, 400348 Cluj-Napoca, Romania; (M.M.); (M.L.); (R.V.M.); (A.C.); (A.M.); (A.R.)
| | - Amanda Radulescu
- Department of Infectious Diseases and Epidemiology, The “Iuliu Hatieganu” University of Medicine and Pharmacy, 400348 Cluj-Napoca, Romania; (M.M.); (M.L.); (R.V.M.); (A.C.); (A.M.); (A.R.)
- The Teaching Hospital of Infectious Diseases, 400348 Cluj-Napoca, Romania;
| |
Collapse
|
6
|
Jemmieh K, Tawengi M, Alyaarabi T, Hassona A, Ghoul I, Al Abdulla S, Elzawawi KE, Karen O, Doi SA, Chivese T. No Association Between Ct Value and COVID-19 Severity and Mortality in Qatar. Int J Gen Med 2023; 16:5323-5331. [PMID: 38021068 PMCID: PMC10658937 DOI: 10.2147/ijgm.s404696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 07/13/2023] [Indexed: 12/01/2023] Open
Abstract
Background The association between the cycle threshold (Ct) which reflects the SARS-CoV-2 viral load and the severity of COVID-19 is still not clear. We investigated the association between Ct values, symptoms and the risk of ICU admission and mortality from COVID-19 in Qatar. Methods This case-control study used data of hospitalized individuals with confirmed COVID-19 during the period March to September 2020. Cases were defined as individuals with confirmed COVID-19 who were admitted to the intensive care unit (ICU) or died and controls as those who were not admitted to the ICU. The association between Ct value, symptoms, ICU admission and mortality was investigated using Ct value as a categorical variable (below and above 25) in multivariable regression models and adjusted for relevant confounders. Results A total of 622 participants with median age 53 (IQR: 53-63), of which 69% were males, were included. There were 236 ICU admissions and 111 deaths. When categorized, Ct value (<25 vs ≥25) had no association with the odds of ICU admission (OR 0.85, 95% CI 0.56 to 1.29) or odds of mortality (OR 1.21, 95% CI 0.71 to 2.08). Respiratory (OR 2.95, 95% CI 1.57 to 5.56) and gastrointestinal symptoms (OR 1.99, 95% CI 1.18 to 3.35) were associated with higher odds of ICU admission. Similarly, respiratory (OR 4.96, 95% CI 1.10 to 22.43) and gastrointestinal symptoms (OR 3.17, 95% CI 1.29 to 7.84) were associated with higher odds of mortality. Conclusion Although RT-PCR Ct has good diagnostic value, its prognostic value appears to be unreliable. Respiratory and gastrointestinal symptoms are associated with COVID-19 criticality and mortality in this setting.
Collapse
Affiliation(s)
- Khaleed Jemmieh
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Mohamed Tawengi
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Tamader Alyaarabi
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Aseel Hassona
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Ikhlas Ghoul
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Sara Al Abdulla
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Khaled E Elzawawi
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Omar Karen
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Suhail A Doi
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Tawanda Chivese
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar
| |
Collapse
|
7
|
Mehta D, Kelkar R, Patel N, Trivedi PD, Dawoodi S, Patel D, Solanki D, Hussain A, Nagaraj S, Khayat A, Samala Venkata V, Mansuri U, Patel UK, Sacks H, Atreja A. Gastrointestinal Manifestations and Outcomes of COVID-19: A Comprehensive Systematic Review and Meta-analysis. Cureus 2023; 15:e47028. [PMID: 37965386 PMCID: PMC10642711 DOI: 10.7759/cureus.47028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 10/04/2023] [Indexed: 11/16/2023] Open
Abstract
Introduction Pulmonary symptoms are the most prominent manifestations of Coronavirus disease 2019 (COVID-19). However, gastrointestinal (GI) symptoms have been reported widely as well. Literature describing the relation of these symptoms with outcomes of COVID-19 patients is limited in terms of sample size, geographic diversity, and the spectrum of GI symptoms included. We aim to evaluate the association of GI symptoms with outcomes of hospitalized COVID-19 patients. Methods A systematic review and meta-analysis of observational studies assessing GI symptoms and outcomes in COVID-19 patients were undertaken using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria and the Meta-analysis of Observational Studies in Epidemiology (MOOSE) checklist. Details on outcomes included ICU vs. non-ICU admission, severe vs. non-severe disease, invasive mechanical ventilation (IMV) vs. no-IMV use, oxygen saturation <90% vs. >90%, in-hospital mortality vs. discharged alive and survivors. We obtained the odds ratio (OR), 95% confidence interval (95%CI), and forest plots. Sensitivity analysis was used to analyze publication bias and heterogeneity. Results In 35 studies with 7931 confirmed COVID-19 patients, we found that anorexia (pooled OR:2.05; 95%CI: 1.36-3.09, p=0.0006) and abdominal pain (OR 2.80; 95%CI: 1.41-5.54, p=0.003) were associated with a higher risk of poor outcomes and no such association was found for diarrhea (OR 1.04; 95%CI: 0.85-1.26, p=0.71), nausea (OR 0.73; 95%CI: 0.38-1.39, p=0.34) and vomiting (OR 1.24; 95%CI 0.86-1.79, p=0.25). Conclusion The meta-analysis concludes that anorexia and abdominal pain are associated with poor outcomes in hospitalized COVID-19 patients, while diarrhea, nausea, and vomiting have no association. Future research should focus on whether detecting GI invasion in conjunction with fecal polymerase chain reaction (PCR) testing can aid in the early triage of high-risk individuals and improve outcomes.
Collapse
Affiliation(s)
- Deep Mehta
- Internal Medicine, Capital Health Regional Medical Center, Trenton, USA
- Clinical Research, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Raveena Kelkar
- Internal Medicine, Cleveland Clinic Akron General, Akron, USA
- Clinical Research, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Neel Patel
- Public Health, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Parth D Trivedi
- Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Sameer Dawoodi
- Gastroenterology, State University of New York Downstate Medical Center, New York, USA
- Internal Medicine, Yale New Haven Hospital, New Haven, USA
| | - Dhruvan Patel
- Gastroenterology, Mercy Fitzgerald Hospital, Darby, USA
- Gastroenterology, University of Pennsylvania, Philadelphia, USA
| | | | - Akbar Hussain
- Internal Medicine, Appalachian Regional Healthcare, Hazard, USA
| | | | - Azadeh Khayat
- Pathology and Laboratory Medicine, Brown University, Providence, USA
| | | | - Uvesh Mansuri
- Medicine, MedStar Union Memorial Hospital, Baltimore, USA
| | - Urvish K Patel
- Public Health and Neurology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Henry Sacks
- Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Ashish Atreja
- Internal Medicine (Division of Gastroenterology), Icahn School of Medicine at Mount Sinai, New York, USA
- Digital Health, University of California Davis Health, Sacramento, USA
| |
Collapse
|
8
|
Vernia F, Ashktorab H, Cesaro N, Monaco S, Faenza S, Sgamma E, Viscido A, Latella G. COVID-19 and Gastrointestinal Tract: From Pathophysiology to Clinical Manifestations. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1709. [PMID: 37893427 PMCID: PMC10608106 DOI: 10.3390/medicina59101709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/10/2023] [Accepted: 09/21/2023] [Indexed: 10/29/2023]
Abstract
Background: Since its first report in Wuhan, China, in December 2019, COVID-19 has become a pandemic, affecting millions of people worldwide. Although the virus primarily affects the respiratory tract, gastrointestinal symptoms are also common. The aim of this narrative review is to provide an overview of the pathophysiology and clinical manifestations of gastrointestinal COVID-19. Methods: We conducted a systematic electronic search of English literature up to January 2023 using Medline, Scopus, and the Cochrane Library, focusing on papers that analyzed the role of SARS-CoV-2 in the gastrointestinal tract. Results: Our review highlights that SARS-CoV-2 directly infects the gastrointestinal tract and can cause symptoms such as diarrhea, nausea/vomiting, abdominal pain, anorexia, loss of taste, and increased liver enzymes. These symptoms result from mucosal barrier damage, inflammation, and changes in the microbiota composition. The exact mechanism of how the virus overcomes the acid gastric environment and leads to the intestinal damage is still being studied. Conclusions: Although vaccination has increased the prevalence of less severe symptoms, the long-term interaction with SARS-CoV-2 remains a concern. Understanding the interplay between SARS-CoV-2 and the gastrointestinal tract is essential for future management of the virus.
Collapse
Affiliation(s)
- Filippo Vernia
- Gastroenterology Unit, Division of Gastroenterology, Hepatology, and Nutrition, Department of Life, Health and Environmental Sciences, University of L'Aquila, Piazzale Salvatore Tommasi 1, 67100 L'Aquila, Italy
| | - Hassan Ashktorab
- Department of Medicine, Gastroenterology Division, Howard University College of Medicine, Washington, DC 20060, USA
| | - Nicola Cesaro
- Gastroenterology Unit, Division of Gastroenterology, Hepatology, and Nutrition, Department of Life, Health and Environmental Sciences, University of L'Aquila, Piazzale Salvatore Tommasi 1, 67100 L'Aquila, Italy
| | - Sabrina Monaco
- Gastroenterology Unit, Division of Gastroenterology, Hepatology, and Nutrition, Department of Life, Health and Environmental Sciences, University of L'Aquila, Piazzale Salvatore Tommasi 1, 67100 L'Aquila, Italy
| | - Susanna Faenza
- Gastroenterology Unit, Division of Gastroenterology, Hepatology, and Nutrition, Department of Life, Health and Environmental Sciences, University of L'Aquila, Piazzale Salvatore Tommasi 1, 67100 L'Aquila, Italy
| | - Emanuele Sgamma
- Gastroenterology Unit, Division of Gastroenterology, Hepatology, and Nutrition, Department of Life, Health and Environmental Sciences, University of L'Aquila, Piazzale Salvatore Tommasi 1, 67100 L'Aquila, Italy
| | - Angelo Viscido
- Gastroenterology Unit, Division of Gastroenterology, Hepatology, and Nutrition, Department of Life, Health and Environmental Sciences, University of L'Aquila, Piazzale Salvatore Tommasi 1, 67100 L'Aquila, Italy
| | - Giovanni Latella
- Gastroenterology Unit, Division of Gastroenterology, Hepatology, and Nutrition, Department of Life, Health and Environmental Sciences, University of L'Aquila, Piazzale Salvatore Tommasi 1, 67100 L'Aquila, Italy
| |
Collapse
|
9
|
Romano C, Cozzolino D, Nevola R, Abitabile M, Carusone C, Cinone F, Cuomo G, Nappo F, Sellitto A, Umano GR, Adinolfi LE, Marrone A, Rinaldi L. Liver Involvement during SARS-CoV-2 Infection Is Associated with a Worse Respiratory Outcome in COVID-19 Patients. Viruses 2023; 15:1904. [PMID: 37766310 PMCID: PMC10537641 DOI: 10.3390/v15091904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/07/2023] [Accepted: 09/09/2023] [Indexed: 09/29/2023] Open
Abstract
Coronavirus disease of 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), may be complicated by life-threatening interstitial pneumonia. SARS-CoV-2 infection may also damage several tissues and/or organs beyond the lungs, including the liver. However, controversy still exists as to whether SARS-CoV-2-induced liver alterations can have an impact on the outcome of COVID-19. The aim of this study was therefore to assess whether SARS-CoV-2-infected patients with liver abnormalities at the time of hospital referral had a worse outcome with respect to patients with no liver biochemistry alterations. To this end, the medical records of 123 patients admitted to our COVID center between the end of 2020 and spring 2021 were retrospectively reviewed. Patients were divided into two groups: those with normal liver biochemistries (group 1, 77 patients) and those with altered liver function tests (group 2, 46 patients). Serum levels of aminotransferases (AST and ALT) and bile duct cell injury markers (γ-GT and ALP) were used to dichotomize patients. A higher percentage of patients with liver enzyme alterations were found to develop COVID-19 pneumonia with respect to group 1 patients (74% vs. 65%); moreover, they needed more days of respiratory support and, more importantly, more intensive administration of supplemental oxygen. A statistically significant correlation was also found between aminotransferase levels and duration of respiratory support. The mortality rate was not superior in group 2 vs. group 1 patients. In conclusion, liver abnormalities on admission predisposed COVID-19 patients to development of more severe interstitial pneumonia, because of a longer requirement for supplemental oxygen and a more intensive respiratory support, indicative of a worse disease evolution in these patients.
Collapse
Affiliation(s)
- Ciro Romano
- COVID Center, Division of Internal Medicine, Department of Advanced Medical and Surgical Sciences, “Luigi Vanvitelli” University of Campania, 80131 Naples, Italy; (R.N.); (A.M.); (L.R.)
| | - Domenico Cozzolino
- Department of Precision Medicine, “Luigi Vanvitelli” University of Campania, 80131 Naples, Italy; (D.C.); (G.C.)
| | - Riccardo Nevola
- COVID Center, Division of Internal Medicine, Department of Advanced Medical and Surgical Sciences, “Luigi Vanvitelli” University of Campania, 80131 Naples, Italy; (R.N.); (A.M.); (L.R.)
| | - Marianna Abitabile
- COVID Center, Division of Internal Medicine, Department of Advanced Medical and Surgical Sciences, “Luigi Vanvitelli” University of Campania, 80131 Naples, Italy; (R.N.); (A.M.); (L.R.)
| | - Caterina Carusone
- COVID Center, Division of Internal Medicine, Department of Advanced Medical and Surgical Sciences, “Luigi Vanvitelli” University of Campania, 80131 Naples, Italy; (R.N.); (A.M.); (L.R.)
| | - Francesca Cinone
- COVID Center, Division of Internal Medicine, Department of Advanced Medical and Surgical Sciences, “Luigi Vanvitelli” University of Campania, 80131 Naples, Italy; (R.N.); (A.M.); (L.R.)
| | - Giovanna Cuomo
- Department of Precision Medicine, “Luigi Vanvitelli” University of Campania, 80131 Naples, Italy; (D.C.); (G.C.)
| | - Francesco Nappo
- COVID Center, Division of Internal Medicine, Department of Advanced Medical and Surgical Sciences, “Luigi Vanvitelli” University of Campania, 80131 Naples, Italy; (R.N.); (A.M.); (L.R.)
| | - Ausilia Sellitto
- COVID Center, Division of Internal Medicine, Department of Advanced Medical and Surgical Sciences, “Luigi Vanvitelli” University of Campania, 80131 Naples, Italy; (R.N.); (A.M.); (L.R.)
| | - Giuseppina Rosaria Umano
- Department of Woman & Child Health and General and Specialist Surgery, “Luigi Vanvitelli” University of Campania, 80131 Naples, Italy;
| | - Luigi Elio Adinolfi
- COVID Center, Division of Internal Medicine, Department of Advanced Medical and Surgical Sciences, “Luigi Vanvitelli” University of Campania, 80131 Naples, Italy; (R.N.); (A.M.); (L.R.)
| | - Aldo Marrone
- COVID Center, Division of Internal Medicine, Department of Advanced Medical and Surgical Sciences, “Luigi Vanvitelli” University of Campania, 80131 Naples, Italy; (R.N.); (A.M.); (L.R.)
| | - Luca Rinaldi
- COVID Center, Division of Internal Medicine, Department of Advanced Medical and Surgical Sciences, “Luigi Vanvitelli” University of Campania, 80131 Naples, Italy; (R.N.); (A.M.); (L.R.)
| |
Collapse
|
10
|
Padmaprakash KV, Thareja S, Raman N, Muthukrishnan J, Miglani A, Summi P, Reddy SN. Gastrointestinal manifestations in symptomatic Coronavirus disease - 19 patients and its relevance in predicting severity and outcome. Indian J Gastroenterol 2023; 42:485-495. [PMID: 37329490 DOI: 10.1007/s12664-023-01370-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 04/10/2023] [Indexed: 06/19/2023]
Abstract
INTRODUCTION Recent developments characterizing the pathophysiological basis of infection in the Coronavirus disease - 19 (COVID-19) have stirred great interest in studying this disease outside the purview of respiratory involvement and especially focusing on the gastrointestinal (GI) system. The present study involving a large cohort of COVID-19-infected patients reports on the characteristics of GI manifestations in patients infected with COVID-19 as well as the predictive role in their association with disease severity and adverse outcomes. METHODS A retrospective cohort study was carried out in a tertiary care hospital in northern India. Descriptive analysis of GI symptoms was carried out followed by predictive analysis assessing COVID-19 severity and with the primary endpoint of 28-day in-hospital all-cause mortality. RESULTS Of 3842 hospitalized COVID-19 patients, 2113 (55%) were symptomatic. GI symptoms were present in 163 (7.1%) patients. Common GI symptoms were diarrhea 65 (3.1%), anorexia 61 (2.9%) and vomiting 37 (1.8%). Mild and moderate-to-severe disease was seen in 1725 (81.6%) and 388 (18.4%) patients, respectively. Logistic regression showed greater odds of moderate-to-severe disease in patients with any GI symptoms (odds ratio [OR] 1.849, 95% CI 1.289-2.651 [p = 0.001]) and anorexia in particular (OR 2.797, 95% CI 1.647-4.753 [p = 0.001]); however, on multivariable-analysis, this association lost its significance. A total of 172 patients succumbed to illness. In the Cox proportional hazards model for mortality, patients with any GI symptom (HR 2.184, 95 CI 1.439-3.317 [p < 0.001]) and anorexia (HR 3.556, 95% CI 2.155-5.870 [p < 0.001]) had higher risk. In multi-variable analysis after adjustment to age, sex, oxygen saturation and comorbidities, the presence of any GI symptom was a significant predictor of mortality (hazard ratio adjusted [HRadj] 1.758, 95% CI 1.147-2.694 [p = 0.010]). CONCLUSION GI symptoms were common among patients infected with COVID-19. The presence of any GI symptom was a significant predictor of the risk of mortality after adjustment to respiratory failure, age, sex and pre-existing comorbidities. The clinical and pathophysiological basis of these associations has been explored.
Collapse
Affiliation(s)
| | | | - Nishant Raman
- Base Hospital, Delhi Cantt, New Delhi, 110 010, India
| | | | - Aman Miglani
- Base Hospital, Delhi Cantt, New Delhi, 110 010, India
| | - Pankaj Summi
- Base Hospital, Delhi Cantt, New Delhi, 110 010, India
| | | |
Collapse
|
11
|
Sigurdarson J, Eythorsson E, Bjarnason A, Bjornsson ES. Liver injury in patients with COVID-19 in comparison to patients with the pandemic influenza A (H1N1) 2009: a population-based study. Scand J Gastroenterol 2023; 58:1145-1152. [PMID: 37128725 DOI: 10.1080/00365521.2023.2204987] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 04/16/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Elevated liver tests in patients with COVID-19 are widely reported. Population-based studies utilizing a validated analysis of drug-induced liver injury (DILI), with a control group of other viral illnesses and follow-up are largely lacking. MATERIALS AND METHODS All hospitalized patients in Iceland with SARS-CoV-2 in 2020 and pandemic influenza A (H1N1) in 2009 were included in this retrospective, population-based study. Liver tests were compared between the two groups and the correlation to inflammatory markers and persistence of alanine aminotransferase (ALT) elevations were assessed. Potential DILI cases were reviewed using the Roussel Uclaf Causality Assessment Method (RUCAM). RESULTS 225 SARS-CoV-2-positive and 73 influenza A (H1N1)-positive patients were included. Liver test values were similar between the groups, except for aspartate aminotransferase (AST) which was significantly lower in COVID-19, with a mean difference of 26 U/L (95%CI 4.2-47). Ferritin elevation was positively correlated with ALT, AST and alkaline phosphatase. No patient had persistently elevated ALT in COVID-19 and none had a probable DILI. Only 3 patients had a possible DILI according to the RUCAM. CONCLUSIONS Elevated liver enzymes are not specific for COVID-19. Hyperferritinemia was associated with elevated liver tests. DILI was very rare in COVID-19 and an unlikely cause of elevated liver enzymes in COVID-19. Abnormal liver tests are nonpersistent and generally not clinically important in these patients.
Collapse
Affiliation(s)
| | - Elias Eythorsson
- Department of Internal Medicine, Landspitali University Hospital, Reykjavik, Iceland
| | - Agnar Bjarnason
- Divison of Medicine, University of Iceland, Reykjavik, Iceland
- Department of Internal Medicine, Landspitali University Hospital, Reykjavik, Iceland
| | - Einar S Bjornsson
- Divison of Medicine, University of Iceland, Reykjavik, Iceland
- Department of Internal Medicine, Landspitali University Hospital, Reykjavik, Iceland
| |
Collapse
|
12
|
Leung WY, Wu HHL, Floyd L, Ponnusamy A, Chinnadurai R. COVID-19 Infection and Vaccination and Its Relation to Amyloidosis: What Do We Know Currently? Vaccines (Basel) 2023; 11:1139. [PMID: 37514955 PMCID: PMC10383215 DOI: 10.3390/vaccines11071139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 06/19/2023] [Accepted: 06/21/2023] [Indexed: 07/30/2023] Open
Abstract
Amyloidosis is a complex disorder characterized by deposited insoluble fibrillar proteins which misfold into β-pleated sheets. The pathogenesis of amyloidosis can vary but can be the result of immune dysregulation that occurs from sustained high inflammatory states, often known as AA amyloidosis. Multi-organ involvement including hepatic, gastrointestinal, renal, cardiac and immunological pathological manifestations has been observed amongst individuals presenting with amyloidosis. The recent global pandemic of severe acute respiratory syndrome coronavirus 2, also referred to as coronavirus 2019 (COVID-19), has been shown to be associated with multiple health complications, many of which are similar to those seen in amyloidosis. Though COVID-19 is recognized primarily as a respiratory disease, it has since been found to have a range of extra-pulmonary manifestations, many of which are observed in patients with amyloidosis. These include features of oxidative stress, chronic inflammation and thrombotic risks. It is well known that viral illnesses have been associated with the triggering of autoimmune conditions of which amyloidosis is no different. Over the recent months, reports of new-onset and relapsed disease following COVID-19 infection and vaccination have been published. Despite this, the exact pathophysiological associations of COVID-19 and amyloidosis remain unclear. We present a scoping review based on our systematic search of available evidence relating to amyloidosis, COVID-19 infection and COVID-19 vaccination, evaluating current perspectives and providing insight into knowledge gaps that still needs to be addressed going forward.
Collapse
Affiliation(s)
- Wing-Yin Leung
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston PR2 9HT, UK
| | - Henry H L Wu
- Renal Research Laboratory, Kolling Institute of Medical Research, Royal North Shore Hospital & The University of Sydney, Sydney, NSW 2065, Australia
| | - Lauren Floyd
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston PR2 9HT, UK
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PG, UK
| | - Arvind Ponnusamy
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston PR2 9HT, UK
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PG, UK
| | - Rajkumar Chinnadurai
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PG, UK
- Department of Renal Medicine, Salford Royal Hospital, Northern Care Alliance Foundation Trust, Salford M6 8HD, UK
| |
Collapse
|
13
|
Cárdenas-Jaén K, Sánchez-Luna SA, Vaillo-Rocamora A, Castro-Zocchi MR, Guberna-Blanco L, Useros-Brañas D, Remes-Troche JM, Ramos-De la Medina A, Priego-Parra BA, Velarde-Ruiz Velasco JA, Martínez-Ayala P, Urzúa Á, Guiñez-Francois D, Pawlak KM, Kozłowska-Petriczko K, Gorroño-Zamalloa I, Urteaga-Casares C, Ortiz-Polo I, Del Val Antoñana A, Lozada-Hernández EE, Obregón-Moreno E, García-Rayado G, Domper-Arnal MJ, Casas-Deza D, Esteban-Cabello EI, Díaz LA, Riquelme A, Martínez-Lozano H, Navarro-Romero F, Olivas I, Iborra-Muñoz G, Calero-Amaro A, Caravaca-García I, Lacueva-Gómez FJ, Pastor-Mateu R, Lapeña-Muñoz B, Sastre-Lozano V, Pizarro-Vega NM, Melcarne L, Pedrosa-Aragón M, Mira JJ, MStat AM, Carrillo I, de-Madaria E. Gastrointestinal symptoms and complications in patients hospitalized due to COVID-19, an international multicentre prospective cohort study (TIVURON project). GASTROENTEROLOGIA Y HEPATOLOGIA 2023; 46:425-438. [PMID: 36243249 PMCID: PMC9557114 DOI: 10.1016/j.gastrohep.2022.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/12/2022] [Accepted: 10/05/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Retrospective studies suggest that coronavirus disease (COVID-19) commonly involves gastrointestinal (GI) symptoms and complications. Our aim was to prospectively evaluate GI manifestations in patients hospitalized for COVID-19. METHODS This international multicentre prospective cohort study recruited COVID-19 patients hospitalized at 31 centres in Spain, Mexico, Chile, and Poland, between May and September 2020. Patients were followed-up until 15 days post-discharge and completed comprehensive questionnaires assessing GI symptoms and complications. A descriptive analysis as well as a bivariate and multivariate analysis were performer using binary logistic regression. p<0.05 was considered significant. RESULTS Eight hundred twenty-nine patients were enrolled; 129 (15.6%) had severe COVID-19, 113 (13.7%) required ICU admission, and 43 (5.2%) died. Upon admission, the most prevalent GI symptoms were anorexia (n=413; 49.8%), diarrhoea (n=327; 39.4%), nausea/vomiting (n=227; 27.4%), and abdominal pain (n=172; 20.7%), which were mild/moderate throughout the disease and resolved during follow-up. One-third of patients exhibited liver injury. Non-severe COVID-19 was associated with ≥2 GI symptoms upon admission (OR 0.679; 95% CI 0.464-0.995; p=0.046) or diarrhoea during hospitalization (OR 0.531; 95% CI 0.328-0.860; p=0.009). Multivariate analysis revealed that worse hospital outcomes were not independently associated with liver injury or GI symptoms. CONCLUSION GI symptoms were more common than previously documented, and were mild, rapidly resolved, and not independently associated with COVID-19 severity. Liver injury was a frequent complication in hospitalized patients not independently associated with COVID-19 severity.
Collapse
Affiliation(s)
- Karina Cárdenas-Jaén
- Gastroenterology Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Sergio A Sánchez-Luna
- Basil I, Hirschowitz Endoscopic Center of Excellence, Division of Gastroenterology and Hepatology, Department of Internal Medicine, The University of Alabama at Birmingham, Birmingham, United States
| | - Alicia Vaillo-Rocamora
- Gastroenterology Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Micaela Riat Castro-Zocchi
- Gastroenterology Department, La Princesa University Hospital and IIS-Princesa & Biomedical Research Center on Liver and Digestive Diseases Network (CIBEREHD), Madrid, Spain
| | - Laura Guberna-Blanco
- Gastroenterology Department, La Princesa University Hospital and IIS-Princesa & Biomedical Research Center on Liver and Digestive Diseases Network (CIBEREHD), Madrid, Spain
| | - Daniel Useros-Brañas
- Internal Medicine Department, La Princesa University Hospital & IIS-Princesa, Madrid, Spain
| | - José M Remes-Troche
- Gastroenterology Department, Spanish Hospital of Veracruz & Medical Biological Research Institute, Veracruz University, Veracruz, Mexico
| | - Antonio Ramos-De la Medina
- Gastroenterology Department, Spanish Hospital of Veracruz & Medical Biological Research Institute, Veracruz University, Veracruz, Mexico
| | - Bryan A Priego-Parra
- Gastroenterology Department, Spanish Hospital of Veracruz & Medical Biological Research Institute, Veracruz University, Veracruz, Mexico
| | | | - Pedro Martínez-Ayala
- Gastroenterology Department, Civil Hospital of Guadalajara Fray Antonio Alcalde, Guadalajara, Mexico
| | - Álvaro Urzúa
- Gastroenterology Section, Internal Medicine Department, Clinical Hospital University of Chile, Santiago, Chile
| | | | - Katarzyna M Pawlak
- Gastroenterology Department, Endoscopy Unit, Hospital of the Ministry of Interior and Administration, Szczecin, Poland
| | | | | | | | - Inmaculada Ortiz-Polo
- Gastroenterology Unit, Digestive Diseases Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Adolfo Del Val Antoñana
- Gastroenterology Unit, Digestive Diseases Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Edgard E Lozada-Hernández
- General Surgery Service, Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajio, León-Guanajuato, Mexico
| | - Enrique Obregón-Moreno
- General Surgery Service, Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajio, León-Guanajuato, Mexico
| | - Guillermo García-Rayado
- Gastroenterology Department, Lozano Blesa University Clinical Hospital & Aragón Health Research Institute (IIS Aragón), Zaragoza, Spain
| | - María José Domper-Arnal
- Gastroenterology Department, Lozano Blesa University Clinical Hospital & Aragón Health Research Institute (IIS Aragón), Zaragoza, Spain
| | - Diego Casas-Deza
- Gastroenterology and Hepatology Department, Miguel Servet University Hospital & Health Research Institute of Aragón (IIS Aragón), Zaragoza, Spain
| | | | - Luis A Díaz
- Gastroenterology Department and Department of Health Sciences, AIRR Working Group, Faculty of Medicine, Pontifical Catholic University of Chile, Santiago, Chile
| | - Arnoldo Riquelme
- Gastroenterology Department and Department of Health Sciences, AIRR Working Group, Faculty of Medicine, Pontifical Catholic University of Chile, Santiago, Chile
| | - Helena Martínez-Lozano
- Gastroenterology Department, Gregorio Marañón General University Hospital & Gregorio Marañón Institute of Health Research, Madrid, Spain
| | | | - Ignasi Olivas
- Gastroenterology Department, Hospital Clinic of Barcelona & Centre for Biomedical Research Network on Liver and Digestive Diseases (CIBEReHD) & August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | | | | | | | | | - Rubén Pastor-Mateu
- Gastroenterology Department, Valencia General University Hospital Consortium, Valencia, Spain
| | | | | | | | - Luigi Melcarne
- Gastroenterology Department, Parc Taulí University Hospital, Sabadell, Spain
| | - Marc Pedrosa-Aragón
- Infectious Diseases Department, Parc Taulí University Hospital, Sabadell, Spain
| | - José J Mira
- ATENEA Research, The Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), Alicante, Spain; Health Psychology Department, Miguel Hernandez University, Elche, Spain
| | - Aurora Mula MStat
- ATENEA Research, The Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), Alicante, Spain
| | - Irene Carrillo
- Health Psychology Department, Miguel Hernandez University, Elche, Spain
| | - Enrique de-Madaria
- Gastroenterology Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain; Department of Clinical Medicine, Faculty of Medicine, Miguel Hernández University, Elche, Spain.
| |
Collapse
|
14
|
Al-Momani H, Aolymat I, Almasri M, Mahmoud SA, Mashal S. Prevalence of gastro-intestinal symptoms among COVID-19 patients and the association with disease clinical outcomes. Future Sci OA 2023; 9:FSO858. [PMID: 37180610 PMCID: PMC10167716 DOI: 10.2144/fsoa-2023-0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 04/11/2023] [Indexed: 05/16/2023] Open
Abstract
Aim This study examined the various manifestations of COVID-19 in people's gastro-intestinal system and how gastro-intestinal involvement relates to the progression and outcome of the disease. Methodology A questionnaire survey was used to collect data from 561 COVID-19 patients between February 6 and 6 April 2022. Laboratory data and clinical outcomes were obtained from the patients' medical records. Results 39.9% of patients presented gastro-intestinal symptoms, mainly loss of appetite, nausea, vomiting and diarrhea. Gastro-intestinal symptoms were not linked to poorer outcomes such as mortality, ICU admission or length of hospital stays. Conclusion gastro-intestinal symptoms were common among patients and may manifest with respiratory symptoms. We recommended clinicians to watch out for gastro-intestinal symptoms as related to COVID-19 infection.
Collapse
Affiliation(s)
- Hafez Al-Momani
- Department of Microbiology, Pathology & Forensic medicine, Faculty of Medicine, The Hashemite University, PO box 330127, Zarqa 13133, Jordan
| | - Iman Aolymat
- Department of Anatomy, Physiology & Biochemistry, Faculty of Medicine, The Hashemite University, PO box 330127, Zarqa 13133, Jordan
| | - Muna Almasri
- Department of Microbiology, Pathology & Forensic medicine, Faculty of Medicine, The Hashemite University, PO box 330127, Zarqa 13133, Jordan
| | - Sameer Alhaj Mahmoud
- Department of basic medical science, Faculty of Medicine, Al-Balqa’ Applied University, As-Salt, Jordan
| | - Safaa Mashal
- Department of Microbiology, Pathology & Forensic medicine, Faculty of Medicine, The Hashemite University, PO box 330127, Zarqa 13133, Jordan
| |
Collapse
|
15
|
Geng Y, Nie Q, Liu F, Pei Y, Chen Q, Zhang H, Zhou H, Zhou J, Jiang H, Xu J. Understanding clinical characteristics influencing adverse outcomes of Omicron infection: a retrospective study with propensity score matching from a Fangcang hospital. Front Cell Infect Microbiol 2023; 13:1115089. [PMID: 37228665 PMCID: PMC10203467 DOI: 10.3389/fcimb.2023.1115089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 04/13/2023] [Indexed: 05/27/2023] Open
Abstract
Objectives The epidemic of coronavirus disease 2019 (COVID-19) is causing global health concerns. The aim of this study was to evaluate influence of clinical characteristics on outcomes during the Omicron outbreak. Methods A total of 25182 hospitalized patients were enrolled, including 39 severe patients and 25143 non-severe patients. Propensity score matching (PSM) was applied to balance the baseline characteristics. Logistic regression analysis was used to assess the risk of severe disease, as well as the risk of prolonged viral shedding time (VST) and increased length of hospital stay (LOS). Results Before PSM, patients in the severe group were older, had higher symptom scores, and had a higher proportion of comorbidities (p<0.001). After PSM, there were no significant differences in age, gender, symptom score and comorbidities between severe (n=39) and non-severe (n=156) patients. Symptoms of fever (OR=6.358, 95%CI 1.748-23.119, p=0.005) and diarrhea (OR=6.523, 95%CI 1.061-40.110, p=0.043) were independent risk factors for development of severe disease. In non-severe patients, higher symptom score was associated with prolonged VST (OR=1.056, 95% CI 1.000-1.115, p=0.049) and LOS (OR=1.128, 95% CI 1.039-1.225, p=0.004); older age was associated with longer LOS (OR=1.045, 95% CI 1.007-1.084, p=0.020). Conclusion The overall condition of the Shanghai Omicron epidemic was relatively mild. Potential risk factors for fever, diarrhea, and higher symptom score can help clinicians to predict clinical outcomes in COVID-19 patients.
Collapse
Affiliation(s)
- Yanxia Geng
- Department of Intensive Care Unit, The Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, Jiangsu, China
| | - Qingfang Nie
- Department of Intensive Care Unit, The Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, Jiangsu, China
| | - Feifei Liu
- Department of Intensive Care Unit, The Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, Jiangsu, China
| | - Yinghao Pei
- Department of Intensive Care Unit, The Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, Jiangsu, China
| | - Qiuhua Chen
- Department of Intensive Care Unit, The Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, Jiangsu, China
| | - Haidong Zhang
- Department of Intensive Care Unit, The Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, Jiangsu, China
| | - Haiqi Zhou
- Department of Intensive Care Unit, The Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, Jiangsu, China
| | - Jiang Zhou
- Department of Intensive Care Unit, The Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, Jiangsu, China
| | - Hua Jiang
- Department of Intensive Care Unit, The Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, Jiangsu, China
| | - Jing Xu
- Department of Nosocomial Infection Control, The Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, Jiangsu, China
| |
Collapse
|
16
|
Tsounis EP, Triantos C, Konstantakis C, Marangos M, Assimakopoulos SF. Intestinal barrier dysfunction as a key driver of severe COVID-19. World J Virol 2023; 12:68-90. [PMID: 37033148 PMCID: PMC10075050 DOI: 10.5501/wjv.v12.i2.68] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/08/2022] [Accepted: 01/16/2023] [Indexed: 03/21/2023] Open
Abstract
The intestinal lumen harbors a diverse consortium of microorganisms that participate in reciprocal crosstalk with intestinal immune cells and with epithelial and endothelial cells, forming a multi-layered barrier that enables the efficient absorption of nutrients without an excessive influx of pathogens. Despite being a lung-centered disease, severe coronavirus disease 2019 (COVID-19) affects multiple systems, including the gastrointestinal tract and the pertinent gut barrier function. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can inflict either direct cytopathic injury to intestinal epithelial and endothelial cells or indirect immune-mediated damage. Alternatively, SARS-CoV-2 undermines the structural integrity of the barrier by modifying the expression of tight junction proteins. In addition, SARS-CoV-2 induces profound alterations to the intestinal microflora at phylogenetic and metabolomic levels (dysbiosis) that are accompanied by disruption of local immune responses. The ensuing dysregulation of the gut-lung axis impairs the ability of the respiratory immune system to elicit robust and timely responses to restrict viral infection. The intestinal vasculature is vulnerable to SARS-CoV-2-induced endothelial injury, which simultaneously triggers the activation of the innate immune and coagulation systems, a condition referred to as “immunothrombosis” that drives severe thrombotic complications. Finally, increased intestinal permeability allows an aberrant dissemination of bacteria, fungi, and endotoxin into the systemic circulation and contributes, to a certain degree, to the over-exuberant immune responses and hyper-inflammation that dictate the severe form of COVID-19. In this review, we aim to elucidate SARS-CoV-2-mediated effects on gut barrier homeostasis and their implications on the progression of the disease.
Collapse
Affiliation(s)
- Efthymios P Tsounis
- Division of Gastroenterology, Department of Internal Medicine, Medical School, University Hospital of Patras, Patras 26504, Greece
| | - Christos Triantos
- Division of Gastroenterology, Department of Internal Medicine, Medical School, University Hospital of Patras, Patras 26504, Greece
| | - Christos Konstantakis
- Division of Gastroenterology, Department of Internal Medicine, Medical School, University Hospital of Patras, Patras 26504, Greece
| | - Markos Marangos
- Division of Infectious Diseases, Department of Internal Medicine, Medical School, University of Patras, University Hospital of Patras, Patras 26504, Greece
| | - Stelios F Assimakopoulos
- Division of Infectious Diseases, Department of Internal Medicine, Medical School, University of Patras, University Hospital of Patras, Patras 26504, Greece
| |
Collapse
|
17
|
Sultan S. Gastrointestinal Endoscopy in Patients with Coronavirus Disease 2019: Indications, Findings, and Safety. Gastroenterol Clin North Am 2023; 52:157-172. [PMID: 36813423 PMCID: PMC9678816 DOI: 10.1016/j.gtc.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has changed the practice of gastroenterology and how we perform endoscopy. As with any new or emerging pathogen, early in the pandemic, there was limited evidence and understanding of disease transmission, limited testing capability, and resource constraints, especially availability of personal protective equipment (PPE). As the COVID-19 pandemic progressed, enhanced protocols with particular emphasis on assessing the risk status of patients and proper use of PPE have been incorporated into routine patient care. The COVID-19 pandemic has taught us important lessons for the future of gastroenterology and endoscopy.
Collapse
Affiliation(s)
- Shahnaz Sultan
- Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, 420 Delaware Street Southeast, MMC 36, Minneapolis, MN 55455, USA.
| |
Collapse
|
18
|
Friedel DM, Cappell MS. Diarrhea and Coronavirus Disease 2019 Infection. Gastroenterol Clin North Am 2023; 52:59-75. [PMID: 36813431 PMCID: PMC9659511 DOI: 10.1016/j.gtc.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The global coronavirus disease-2019 (COVID-19) pandemic has caused significant morbidity and mortality, thoroughly affected daily living, and caused severe economic disruption throughout the world. Pulmonary symptoms predominate and account for most of the associated morbidity and mortality. However, extrapulmonary manifestations are common in COVID-19 infections, including gastrointestinal (GI) symptoms, such as diarrhea. Diarrhea affects approximately 10% to 20% of COVID-19 patients. Diarrhea can occasionally be the presenting and only COVID-19 symptom. Diarrhea in COVID-19 subjects is usually acute but is occasionally chronic. It is typically mild-to-moderate and nonbloody. It is usually much less clinically important than pulmonary or potential thrombotic disorders. Occasionally the diarrhea can be profuse and life-threatening. The entry receptor for COVID-19, angiotensin converting enzyme-2, is found throughout the GI tract, especially in the stomach and small intestine, which provides a pathophysiologic basis for local GI infection. COVID-19 virus has been documented in feces and in GI mucosa. Treatment of COVID-19 infection, especially antibiotic therapy, is a common culprit of the diarrhea, but secondary infections including bacteria, especially Clostridioides difficile, are sometimes implicated. Workup for diarrhea in hospitalized patients usually includes routine chemistries; basic metabolic panel; and a complete hemogram; sometimes stool studies, possibly including calprotectin or lactoferrin; and occasionally abdominal CT scan or colonoscopy. Treatment for the diarrhea is intravenous fluid infusion and electrolyte supplementation as necessary, and symptomatic antidiarrheal therapy, including Loperamide, kaolin-pectin, or possible alternatives. Superinfection with C difficile should be treated expeditiously. Diarrhea is prominent in post-COVID-19 (long COVID-19), and is occasionally noted after COVID-19 vaccination. The spectrum of diarrhea in COVID-19 patients is presently reviewed including the pathophysiology, clinical presentation, evaluation, and treatment.
Collapse
Affiliation(s)
- David M. Friedel
- Division of Therapeutic Endoscopy, Division of Gastroenterology, Department of Medicine, New York University Hospital, 259 First Street, Mineola 11501, NY, USA
| | - Mitchell S. Cappell
- Department of Medicine, Gastroenterology Service, Aleda E. Lutz Veterans Administration Hospital at Saginaw, Building 1, Room 3212, 1500 Weiss Street, Saginaw, MI 48602, USA,Corresponding author
| |
Collapse
|
19
|
Abstract
SARS-CoV-2 is the viral agent of COVID-19, a pandemic that surfaced in 2019. Although predominantly a respiratory ailment, patients with COVID-19 can have gastrointestinal (GI) and hepatobiliary manifestations. These manifestations are often mild and transient, but they can be severe and consequential. In the GI tract, ischemic enterocolitis is the most common and significant consequence of COVID-19. In the liver, the reported pathologic findings may often be related to consequences of severe systemic viral infection, but reports of hepatitis presumed to be due to SARS-CoV-2 suggest that direct viral infection of the liver may be a rare complication of COVID-19. In both the GI tract and liver, lingering symptoms of GI or hepatic injury after resolution of pulmonary infection may be part of the evolving spectrum of long COVID.
Collapse
Affiliation(s)
- Angela R Shih
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
| | - Joseph Misdraji
- Department of Pathology, Yale New Haven Hospital, Yale University, New Haven, CT, 06510, USA.
| |
Collapse
|
20
|
Valsamaki A, Xanthoudaki M, Oikonomou KG, Vlachostergios PJ, Papadogoulas A, Katsiafylloudis P, Voulgaridi I, Skoura AL, Komnos A, Papamichalis P. Prevention, diagnostic evaluation, management and prognostic implications of liver disease in critically ill patients with COVID-19. World J Clin Cases 2023; 11:514-527. [PMID: 36793637 PMCID: PMC9923862 DOI: 10.12998/wjcc.v11.i3.514] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/05/2022] [Accepted: 01/10/2023] [Indexed: 01/23/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2, broke out in December 2019 in Wuhan city of China and spread rapidly worldwide. Therefore, by March 2020, the World Health Organization declared the disease a global pandemic. Apart from the respiratory system, various other organs of the human body are also seriously affected by the virus. Liver injury in patients with a severe form of COVID-19 is estimated to be 14.8%-53.0%. Elevated levels of total bilirubin, aspartate aminotransferase and alanine aminotransferase and low levels of serum albumin and prealbumin are the main laboratory findings. Patients with pre-existing chronic liver disease and cirrhosis are much more prone to develop severe liver injury. This literature review presented the recent scientific findings regarding the pathophysiological mechanisms responsible for liver injury in critically ill patients with COVID-19, the various interactions between drugs used to treat the disease and the function of the liver and the specific tests providing the possibility of early diagnosis of severe liver injury in these patients. Moreover, it highlighted the burden that COVID-19 put on health systems worldwide and its effect on transplant programs and the care provided to critically ill patients in general and particularly to those with chronic liver disease.
Collapse
Affiliation(s)
- Asimina Valsamaki
- Intensive Care Unit, General Hospital of Larissa, Larissa 41221, Greece
| | - Maria Xanthoudaki
- Intensive Care Unit, General Hospital of Larissa, Larissa 41221, Greece
| | | | - Panagiotis J Vlachostergios
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY 10065, United States
| | | | | | - Ioanna Voulgaridi
- Department of Microbiology, General Hospital of Larissa, Larissa 41221, Greece
| | | | - Apostolos Komnos
- Intensive Care Unit, General Hospital of Larissa, Larissa 41221, Greece
| | | |
Collapse
|
21
|
Farias JP, Codes L, Vinhaes D, Amorim AP, D’Oliveira RC, Farias AQ, Bittencourt PL. Impact of baseline abnormal liver enzymes in the outcome of COVID-19 infection. Transl Gastroenterol Hepatol 2023; 8:5. [PMID: 36704646 PMCID: PMC9813650 DOI: 10.21037/tgh-22-41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 10/11/2022] [Indexed: 11/07/2022] Open
Abstract
Background Little is known about the significance of liver function tests (LFT) abnormalities in COVID-19 and their impact on disease outcomes. The aims of the study were to evaluate abnormalities of LFT in patients with COVID-19 and their impact on disease severity, mortality, and correlation with leukocyte markers of inflammation. Methods All patients with COVID-19 admitted to the emergency department (ED) of a single reference center were retrospectively evaluated. Data were collected using an electronic medical database covering the following variables: demographics, baseline complete blood count (CBC) and ratios, neutrophil-lymphocyte (NLR) and monocyte-lymphocyte ratios (MLR), systemic immune-inflammation index (SII), aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels. Disease severity was defined by the presence of organ failure (OF) or requirement for intensive care unit (ICU) support. Mortality was considered as patient death during hospitalization. Results A total of 1,539 subjects (799 women, mean age 57±18 years) with COVID-19 were evaluated. Abnormal AST and/or ALT were seen in 50% of them, with a frequency and magnitude that significantly correlated with leukocyte count and ratios. Both LFT were significantly associated with requirement for hospital and ICU admission and mortality. High AST levels were significantly associated with the presence, number, and types of OFs and in-hospital length of stay (LOS). Elevated ALT was also significantly associated with the aforementioned variables, with the exception of OFs presence, circulatory failure and LOS. Conclusions LFT abnormalities are frequently seen in COVID-19 patients, reflect SARS-CoV-2 associated inflammation and may predict adverse outcomes. LFT may be useful to aid decision-making in the ED for hospital admission or scheduled outpatient reevaluation.
Collapse
Affiliation(s)
| | - Liana Codes
- Portuguese Hospital of Bahia, Salvador, Bahia, Brazil;,Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil
| | - Diana Vinhaes
- Portuguese Hospital of Bahia, Salvador, Bahia, Brazil
| | | | - Ricardo Cruz D’Oliveira
- Portuguese Hospital of Bahia, Salvador, Bahia, Brazil;,Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil
| | | | - Paulo Lisboa Bittencourt
- Portuguese Hospital of Bahia, Salvador, Bahia, Brazil;,Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil
| |
Collapse
|
22
|
Grigoriev KI, Kharitonova LA. COVID-19 and the digestive system lesions in children. ROSSIYSKIY VESTNIK PERINATOLOGII I PEDIATRII (RUSSIAN BULLETIN OF PERINATOLOGY AND PEDIATRICS) 2022. [DOI: 10.21508/1027-4065-2022-67-5-6-17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Initially, doctors did not pay much attention to gastrointestinal symptoms in patients with COVID-19. Fever and respiratory syndrome were monitored. A more prolonged observation period revealed gastrointestinal disorders to be an important element of the new coronavirus infection. In scientific publications, a stable term appeared — gastrointestinal coronavirus disease 2019. The tropism of the SARS-CoV-2 virus to the epitheliocytes of the gastrointestinal tract, the presence and long-term persistence of the virus in the feces were found. The frequent detection of gastrointestinal symptoms in infected patients, the frequent involvement of the liver and pancreas in the pathological process determine the importance of clinical and laboratory assessment of the state of the digestive system due to its undoubted impact on the status, course, and the overall disease prognosis. Based on the analysis of scientific publications, the article presents the results of the latest observations regarding the development of a new disease, its diagnosis, treatment options using modern drugs when combined with dyspeptic syndrome and other gastroenterological symptoms. The role of the use of standards, in particular the clinical recommendations of the Ministry of Health of Russia, is emphasized.
Collapse
|
23
|
Clinical predictors of recovery of COVID-19 associated-abnormal liver function test 2 months after hospital discharge. Sci Rep 2022; 12:17972. [PMID: 36289394 PMCID: PMC9606373 DOI: 10.1038/s41598-022-22741-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 10/19/2022] [Indexed: 01/24/2023] Open
Abstract
This study investigated whether acute liver injury (ALI) persisted and identified predictors of ALI recovery [as indicated by alanine aminotransferase (ALT) level] at hospital discharge and 2 months post-discharge for 7595 hospitalized COVID-19 patients from the Montefiore Health System (03/11/2020-06/03/2021). Mild liver injury (mLI) was defined as ALT = 1.5-5 ULN, and severe livery injury (sLI) was ALT ≥ 5 ULN. Logistic regression was used to identify predictors of ALI onset and recovery. There were 4571 (60.2%), 2306 (30.4%), 718 (9.5%) patients with no liver injury (nLI), mLI and sLI, respectively. Males showed higher incidence of sLI and mLI (p < 0.05). Mortality odds ratio was 4.15 [95% CI 3.41, 5.05, p < 0.001] for sLI and 1.69 [95% CI 1.47, 1.96, p < 0.001] for mLI compared to nLI. The top predictors (ALT, lactate dehydrogenase, ferritin, lymphocytes) accurately predicted sLI onset up to three days prior. Only 33.5% of mLI and 17.1% of sLI patients (survivors) recovered completely at hospital discharge. Most ALI patients (76.7-82.4%) recovered completely ~ 2 months post-discharge. The top predictors accurately predicted recovery post discharge with 83.2 ± 2.2% accuracy. In conclusion, most COVID-19 patients with ALI recovered completely ~ 2 months post discharge. Early identification of patients at-risk of persistent ALI could help to prevent long-term liver complications.
Collapse
|
24
|
Liakina V, Stundiene I, Milaknyte G, Bytautiene R, Reivytyte R, Puronaite R, Urbanoviciute G, Kazenaite E. Effects of COVID-19 on the liver: The experience of a single center. World J Gastroenterol 2022; 28:5735-5749. [PMID: 36338891 PMCID: PMC9627423 DOI: 10.3748/wjg.v28.i39.5735] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/12/2022] [Accepted: 09/21/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) was perhaps the most severe global health crisis in living memory. Alongside respiratory symptoms, elevated liver enzymes, abnormal liver function, and even acute liver failure were reported in patients suffering from severe acute respiratory disease coronavirus 2 pneumonia. However, the precise triggers of these forms of liver damage and how they affect the course and outcomes of COVID-19 itself remain unclear.
AIM To analyze the impact of liver enzyme abnormalities on the severity and outcomes of COVID-19 in hospitalized patients.
METHODS In this study, 684 depersonalized medical records from patients hospitalized with COVID-19 during the 2020-2021 period were analyzed. COVID-19 was diagnosed according to the guidelines of the National Institutes of Health (2021). Patients were assigned to two groups: those with elevated liver enzymes (Group 1: 603 patients), where at least one out of four liver enzymes were elevated (following the norm of hospital laboratory tests: alanine aminotransferase (ALT) ≥ 40, aspartate aminotransferase (AST) ≥ 40, gamma-glutamyl transferase ≥ 36, or alkaline phosphatase ≥ 150) at any point of hospitalization, from admission to discharge; and the control group (Group 2: 81 patients), with normal liver enzymes during hospitalization. COVID-19 severity was assessed according to the interim World Health Organization guidance (2022). Data on viral pneumonia complications, laboratory tests, and underlying diseases were also collected and analyzed.
RESULTS In total, 603 (88.2%) patients produced abnormal liver test results. ALT and AST levels were elevated by a factor of less than 3 in 54.9% and 74.8% of cases with increased enzyme levels, respectively. Patients in Group 1 had almost double the chance of bacterial viral pneumonia complications [odds ratio (OR) = 1.73, P = 0.0217], required oxygen supply more often, and displayed higher biochemical inflammation indices than those in Group 2. No differences in other COVID-19 complications or underlying diseases were observed between groups. Preexisting hepatitis of a different etiology was rarely documented (in only 3.5% of patients), and had no impact on the severity of COVID-19. Only 5 (0.73%) patients experienced acute liver failure, 4 of whom died. Overall, the majority of the deceased patients (17 out of 20) had elevated liver enzymes, and most were male. All deceased patients had at least one underlying disease or combination thereof, and the deceased suffered significantly more often from heart diseases, hypertension, and urinary tract infections than those who made recoveries. Alongside male gender (OR = 1.72, P = 0.0161) and older age (OR = 1.02, P = 0.0234), diabetes (OR = 3.22, P = 0.0016) and hyperlipidemia (OR = 2.67, P = 0.0238), but not obesity, were confirmed as independent factors associated with more a severe COVID-19 infection in our cohort.
CONCLUSION In our study, the presence of liver impairment allows us to predict a more severe inflammation with a higher risk of bacterial complication and worse outcomes of COVID-19. Therefore, patients with severe disease forms should have their liver tests monitored regularly and their results should be considered when selecting treatment to avoid further liver damage or even insufficiency.
Collapse
Affiliation(s)
- Valentina Liakina
- Centre of Hepatology, Gastroenterology and Dietetics, Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius 01513, Lithuania
- Department of Chemistry and Bioengineering, Faculty of Fundamental Sciences, VILNIUS TECH, Vilnius 10223, Lithuania
| | - Ieva Stundiene
- Centre of Hepatology, Gastroenterology and Dietetics, Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius 01513, Lithuania
| | - Gabriele Milaknyte
- Centre of Hepatology, Gastroenterology and Dietetics, Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius 01513, Lithuania
| | - Ramune Bytautiene
- Centre of Hepatology, Gastroenterology and Dietetics, Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius 01513, Lithuania
| | - Rosita Reivytyte
- Faculty of Medicine, Vilnius University, Vilnius 01513, Lithuania
| | - Roma Puronaite
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius 01513, Lithuania
- Institute of Data Science and Digital Technologies, Faculty of Mathematics and Informatics, Vilnius University, Vilnius 01513, Lithuania
| | | | - Edita Kazenaite
- Centre of Hepatology, Gastroenterology and Dietetics, Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius 01513, Lithuania
- Department of Pathology, Forensic Medicine and Pharmacology, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius 01513, Lithuania
| |
Collapse
|
25
|
Chen D, Ning M, Feng Y, Liu J. The early stage of COVID-19 pandemic: Gastrointestinal manifestations and liver injury in COVID-19 patients in Wuhan, China. Front Med (Lausanne) 2022; 9:997000. [PMID: 36341271 PMCID: PMC9630730 DOI: 10.3389/fmed.2022.997000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 09/27/2022] [Indexed: 12/15/2022] Open
Abstract
There are few and inconsistent data focusing on gastrointestinal (GI) manifestations and liver injury in China's early stage of COVID-19 pandemic. In this study, we research the prevalence and role of GI symptoms and liver injury in COVID-19 patients in Wuhan during the disease's first outbreak. We conducted a cross-sectional observational study in a non-ICU unit in Wuhan, China. COVID-19 patients were consecutively admitted from 23 February 2020 to 5 April 2020. Demographic and clinical data were retrieved and analyzed throughout the disease course. A total of 93 patients were enrolled, including 45.2% moderate, 54.8% severe, and 2.2% critical type patients. 69.9% of patients had at least one GI symptom; if excluding hyporexia/anorexia, 49.5% of patients showed at least one GI symptom. The incidence rate of hyporexia/anorexia, diarrhea, nausea/vomiting, abdominal discomfort/pain, and elevated liver enzymes were 67.7, 29.0, 28.0, 21.5, and 23.7%, respectively. Patients with GI symptoms or elevated liver enzymes have a higher risk of severe type disease than patients without GI symptoms or elevated liver enzymes (67.7 vs. 25.0%, p < 0.001; 77.3 vs. 47.9%, p = 0.016, respectively), and experienced longer disease duration. In multivariate analysis, hyporexia/anorexia was confirmed as an independent predictive factor of severe type disease (odds ratio: 5.912; 95% confidence interval: 2.247–15.559; p < 0.001). In conclusion, in the early stage of the COVID-19 pandemic, GI symptoms and elevated liver enzymes are common throughout the disease course, and associated with severer disease and longer disease duration.
Collapse
Affiliation(s)
- Dafan Chen
- Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Digestive Endoscopic Center, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Dafan Chen
| | - Min Ning
- Digestive Endoscopic Center, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yun Feng
- Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Liu
- Department of Nephrology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Jun Liu
| |
Collapse
|
26
|
Zaman S, Hajibandeh S, Hajibandeh S, Mohamedahmed AYY, El‐Asrag ME, Quraishi N, Iqbal TH, Beggs AD. Meta-analysis of the demographic and prognostic significance of gastrointestinal symptoms in COVID-19 patients. JGH Open 2022; 6:JGH312812. [PMID: 36247233 PMCID: PMC9538713 DOI: 10.1002/jgh3.12812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 08/01/2022] [Accepted: 08/10/2022] [Indexed: 01/08/2023]
Abstract
Background and Aim To evaluate the demographic and prognostic significance of gastrointestinal (GI) symptoms in patients with coronavirus disease 2019 (COVID-19). Methods A systematic search of electronic information sources was conducted. Combined overall effect sizes were calculated using random-effects models for baseline demographic factors and outcomes including mortality, intensive care unit (ICU) admission, and length of hospital stay. Results Twenty-four comparative observational studies reporting a total of 51 522 COVID-19 patients with (n = 6544) or without (n = 44 978) GI symptoms were identified. The patients with GI symptoms were of comparable age (mean difference [MD]: 0.25, 95% confidence interval [CI] -2.42 to 2.92, P = 0.86), rate of pre-existing hypertension (odds ratio [OR]: 1.11, 95% CI 0.86-1.42, P = 0.42), diabetes mellitus (OR: 1.14, 95% CI 0.91-1.44, P = 0.26), and coronary artery disease (OR: 1.00, 95% CI 0.86-1.16, P = 0.98) compared with those without GI symptoms. However, there were significantly more male patients in the GI symptoms group (OR: 0.85, 95% CI 0.75-0.95, P = 0.005). The presence of GI symptoms was associated with similar risk of mortality (OR: 0.73; 95% CI 0.47-1.13, P = 0.16), ICU admission (OR: 1.15; 95% CI 0.67-1.96, P = 0.62), and length of hospital stay (MD: 0.43; 95% CI -0.73 to 1.60, P = 0.47) when compared with their absence. Conclusion Meta-analysis of the best possible available evidence demonstrated that GI symptoms in COVID-19 patients do not seem to affect patients with any specific demographic patterns and may not have any important prognostic significance. Although no randomized studies can be conducted on this topic, future high-quality studies can provide stronger evidence to further understand the impact of GI symptoms on outcomes of COVID-19 patients.
Collapse
Affiliation(s)
- Shafquat Zaman
- Institute of Cancer and Genomic Science, College of Medical and Dental ScienceUniversity of BirminghamBirminghamUK
| | - Shahin Hajibandeh
- Hepatobiliary and Pancreatic Surgery and Liver Transplant UnitUniversity Hospitals BirminghamBirminghamUK
| | - Shahab Hajibandeh
- Department of General SurgeryRoyal Glamorgan Hospital, Cwm Taf University Health BoardPontyclunUK
| | | | - Mohammed E El‐Asrag
- Institute of Cancer and Genomic Science, College of Medical and Dental ScienceUniversity of BirminghamBirminghamUK
- Faculty of ScienceBenha UniversityBenhaEgypt
| | - Nabil Quraishi
- Institute of Cancer and Genomic Science, College of Medical and Dental ScienceUniversity of BirminghamBirminghamUK
| | - Tariq H Iqbal
- Institute of Immunology and Immunotherapy, College of Medical and Dental ScienceUniversity of BirminghamBirminghamUK
| | - Andrew D Beggs
- Institute of Cancer and Genomic Science, College of Medical and Dental ScienceUniversity of BirminghamBirminghamUK
| |
Collapse
|
27
|
Jo S, Nam HK, Kang H, Cho SI. Associations of symptom combinations with in-hospital mortality of coronavirus disease-2019 patients using South Korean National data. PLoS One 2022; 17:e0273654. [PMID: 36018890 PMCID: PMC9417015 DOI: 10.1371/journal.pone.0273654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 08/11/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND There are various risk factors for death in coronavirus disease-2019 (COVID-19) patients. The effects of symptoms on death have been investigated, but symptoms were considered individually, rather than in combination, as predictors. We examined the effects of symptom combinations on in-hospital mortality. METHODS Data from the Korea Disease Control and Prevention Agency were analyzed. A cohort of 5,153 patients confirmed with COVID-19 in South Korea was followed from hospitalization to death or discharge. An exploratory factor analysis was performed to identify symptom combinations, and the hazard ratios (HRs) of death were estimated using the Cox proportional hazard model. RESULTS Three sets of symptom factors were isolated for symptom combination. Factor 1 symptoms were cold-like symptoms, factor 2 were neurological and gastrointestinal symptoms, and factor 3 were more severe symptoms such as dyspnea and altered state of consciousness. Factor 1 (HR 1.14, 95% confidence interval [95% CI] 1.01-1.30) and factor 3 (HR 1.25, 95% CI 1.19-1.31) were associated with a higher risk for death, and factor 2 with a lower risk (HR 0.71, 95% CI 0.71-0.96). CONCLUSIONS The effect on in-hospital mortality differed according to symptom combination. The results are evidence of the effects of symptoms on COVID-19 mortality and may contribute to lowering the COVID-19 mortality rate. Further study is needed to identify the biological mechanisms underlying the effects of symptom combinations on mortality.
Collapse
Affiliation(s)
- Suyoung Jo
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, Korea
| | - Hee-kyoung Nam
- Institute of Health and Environment, Graduate School of Public Health, Seoul National University, Seoul, Korea
| | - Heewon Kang
- Institute of Health and Environment, Graduate School of Public Health, Seoul National University, Seoul, Korea
| | - Sung-il Cho
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, Korea
- Institute of Health and Environment, Graduate School of Public Health, Seoul National University, Seoul, Korea
| |
Collapse
|
28
|
Shehab M, Alrashed F, Alfadhli A. COVID-19 Vaccine Booster Dose Willingness among Patients with Inflammatory Bowel Disease on Infliximab and Vedolizumab: A Cross-Sectional Study. Vaccines (Basel) 2022; 10:vaccines10081166. [PMID: 35893815 PMCID: PMC9331669 DOI: 10.3390/vaccines10081166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/18/2022] [Accepted: 07/19/2022] [Indexed: 11/25/2022] Open
Abstract
Background: Vaccination has been effective in preventing COVID-19 infections and related mortality. However, waning immunity after two-dose vaccination prompted health authorities to recommend a third dose of COVID-19 vaccine to boost immunity. The aim of our study was to assess willingness to receive a third (booster) dose among patients with inflammatory bowel disease (IBD). Methods: A cross-sectional study was performed at an IBD tertiary care center. Patients were recruited at the infusion room from 1 January 2022 to 31 March 2022. The primary outcome was the prevalence of a third (booster) dose of the BNT162b2 vaccine in infliximab- or vedolizumab-treated patients with IBD. The secondary outcome evaluated whether the prevalence of a third (booster) dose of the BNT162b2 vaccine differed based on type of COVID-19 vaccine, gender, age, type of biologic therapy, and citizenship. Results: In total, 499 patients with IBD were included in this study. The median age was 34.5 years, and 60% had ulcerative colitis (UC). Among the study participants, 302 (60.5%) patients were vaccinated with BNT162b2, and 197 (39.5%) were vaccinated with ChAdOx1 nCoV-19. Of the total number of participants, 400 (80.2%) were receiving infliximab, and 99 (19.8%) were receiving vedolizumab. Overall, 290 (58.1%) of the included patients were willing to receive the third (booster) dose. Patients vaccinated with BNT162b2 were more likely to be willing to receive a booster dose compared to patients vaccinated with ChAdOx1 nCoV-19 (201 (66.5%) vs. 103 (52.0%), p = 0.014). Infliximab-treated patients were more likely to be willing to receive a booster dose compared to patients receiving vedolizumab (310 (77.5%) vs. 62 (62.6%), p = 0.002). There was no statistical difference in willingness to receive a booster dose in terms of age, nationality, or gender. Conclusions: The percentage of patients with IBD willing to receive or having already received a third (booster) dose of BNT162b2 vaccine was lower compared to the general population. In addition, patients who received two doses of BNT162b2 vaccines were more likely to be willing to receive a third (booster) dose compared to patients who received ChAdOx1 nCoV-19. Patients treated with infliximab were more likely to be willing to receive a third (booster) dose of COVID-19 vaccine.
Collapse
Affiliation(s)
- Mohammad Shehab
- Department of Internal Medicine, Mubarak Al-Kabeer University Hospital, Jabriya 46300, Kuwait;
- Correspondence: ; Tel.: +965-99633181
| | - Fatema Alrashed
- Department of Pharmacy Practice, Faculty of Pharmacy, Health Sciences Center (HSC), Kuwait University, Jabriya 46300, Kuwait;
| | - Ahmad Alfadhli
- Department of Internal Medicine, Mubarak Al-Kabeer University Hospital, Jabriya 46300, Kuwait;
| |
Collapse
|
29
|
Adenomesenteritis following SARS-CoV-2 Vaccination in Children: A Case Report and Review of The Literature. CHILDREN 2022; 9:children9070993. [PMID: 35883977 PMCID: PMC9321070 DOI: 10.3390/children9070993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/17/2022] [Accepted: 06/28/2022] [Indexed: 11/17/2022]
Abstract
At present, the vaccine authorized in children aged 5 years and older is the BNT162b2 messenger RNA COVID-19 vaccine. Unlike adults, there is limited data available in the pediatric age describing adverse events after vaccine. We report a case of adenomesenteritis in a young girl following the first dose of vaccine.
Collapse
|
30
|
Kaiyasah H, Fardan H, Bashir O, Hussein M, Alsubbah H, Dabal LA. Hepatic and gastrointestinal manifestations in patients with COVID-19 and relationship with disease severity: a single-centre experience. IJID REGIONS 2022; 3:143-149. [PMID: 35720151 PMCID: PMC8975601 DOI: 10.1016/j.ijregi.2022.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 03/28/2022] [Accepted: 03/30/2022] [Indexed: 06/15/2023]
Abstract
Background and aims Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), emerged in late 2019. While the infection is commonly perceived as a respiratory disease, gastrointestinal complaints have been described in a significant number of patients since the beginning of the pandemic. This study investigated the prevalence of hepatic and gastrointestinal manifestations among patients with COVID-19 in terms of symptoms and biochemical findings, and the relationship with disease severity and outcomes. Methods Patients admitted to a tertiary medical centre in Dubai, United Arab Emirates, between March and June 2020, with COVID-19 were analysed retrospectively. Patients were stratified into two main groups based on the presence or absence of hepatic and gastrointestinal manifestations. Results Among 521 eligible patients, 119 patients (22.8%) had gastrointestinal manifestations, and the majority of patients were middle-aged males (90%). The most common symptom was diarrhoea, followed by vomiting and abdominal pain. The most commonly observed biochemical abnormality was raised alanine transferase. No differences in the severity of COVID-19 pneumonia or overall mortality rate were found between the two groups. However, patients with COVID-19 pneumonia, even those without hepatic or gastrointestinal manifestations, had longer hospital stays (P<0.05) and other infection-related complications. Conclusion This paper adds to the literature on the extrapulmonary manifestations of SARS-CoV- 2 with a focus on the hepatic and gastrointestinal systems. The presence of hepatic and gastrointestinal manifestations in patients with COVID-19 at hospital admission was not associated with increased severity of COVID-19 pneumonia or overall mortality.
Collapse
Affiliation(s)
- Hadiel Kaiyasah
- Department of General Surgery, Rashid Hospital, Dubai, United Arab Emirates
| | - Hana Fardan
- Department of General Surgery, Rashid Hospital, Dubai, United Arab Emirates
| | - Oghowan Bashir
- Department of Cardiology, Rashid Hospital, Dubai, United Arab Emirates
| | - Mawada Hussein
- Department of Internal Medicine, Rashid Hospital, Dubai, United Arab Emirates
| | - Hamzeh Alsubbah
- Department of Internal Medicine, Rashid Hospital, Dubai, United Arab Emirates
| | - Laila Al Dabal
- Infectious Disease Unit, Rashid Hospital, Dubai, United Arab Emirates
| |
Collapse
|
31
|
Gastrointestinal Involvement in SARS-CoV-2 Infection. Viruses 2022; 14:v14061188. [PMID: 35746659 PMCID: PMC9228950 DOI: 10.3390/v14061188] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/26/2022] [Accepted: 05/27/2022] [Indexed: 02/06/2023] Open
Abstract
SARS-CoV-2 has evolved into a virus that primarily results in mild or asymptomatic disease, making its transmission more challenging to control. In addition to the respiratory tract, SARS-CoV-2 also infects the digestive tract. Some gastrointestinal symptoms occur with or before respiratory symptoms in patients with COVID-19. Respiratory infections are known to cause intestinal immune impairment and gastrointestinal symptoms. When the intestine is inflamed, cytokines affect the lung immune response and inflammation through blood circulation. The gastrointestinal microbiome may be a modifiable factor in determining the risk of SARS-CoV-2 infection and disease severity. The development of oral SARS-CoV-2 vaccine candidates and the maintenance of gut microbiota profiles may contribute to the early control of COVID-19 outbreaks. To this end, this review summarizes information on the gastrointestinal complications caused by SARS-CoV-2, SARS-CoV-2 infection, the gastrointestinal–lung axis immune response, potential control strategies for oral vaccine candidates and maintaining intestinal microbiota homeostasis.
Collapse
|
32
|
Muzalyova A, Ebigbo A, Kahn M, Zellmer S, Beyer A, Rosendahl J, Zenk J, Al-Nawas B, Frankenberger R, Hoffmann J, Arens C, Lammert F, Traidl-Hoffmann C, Messmann H, Roemmele C. SARS-CoV-2 Vaccination Rate and SARS-CoV-2 Infection of Health Care Workers in Aerosol-Generating Medical Disciplines. J Clin Med 2022; 11:jcm11102751. [PMID: 35628879 PMCID: PMC9144158 DOI: 10.3390/jcm11102751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/06/2022] [Accepted: 05/09/2022] [Indexed: 11/16/2022] Open
Abstract
Healthcare workers (HCW) who perform aerosol-generating procedures (AGP) are at high risk of SARS-CoV-2 infection. Data on infection rates and vaccination are limited. A nationwide, cross-sectional study focusing on AGP-related specialties was conducted between 3 May 2021 and 14 June 2021. Vaccination rates among HCW, perception of infection risk, and infection rates were analyzed, focusing on the comparison of gastrointestinal endoscopy (GIE) and other AGP-related specialties (NON-GIE), from the beginning of the pandemic until the time point of the study. Infections rates among HCW developed similarly to the general population during the course of the pandemic, however, with significantly higher infections rates among the GIE specialty. The perceived risk of infection was distributed similarly among HCW in GIE and NON-GIE (91.7%, CI: 88.6−94.4 vs. 85.8%, CI: 82.4−89.0; p < 0.01) with strongest perceived threats posed by AGPs (90.8%) and close patient contact (70.1%). The very high vaccination rate (100−80%) among physicians was reported at 83.5%, being significantly more frequently reported than among nurses (56.4%, p < 0.01). GIE had more often stated very high vaccination rate compared with NON-GIE (76.1% vs. 65.3%, p < 0.01). A significantly higher rate of GIE was reported to have fewer concerns regarding infection risk after vaccination than NON-GIE (92.0% vs. 80.3%, p < 0.01).
Collapse
Affiliation(s)
- Anna Muzalyova
- Clinic for Internal Medicine III—Gastroenterology and Infectious Diseases, University Hospital of Augsburg, 86156 Augsburg, Germany; (A.E.); (M.K.); (S.Z.); (H.M.); (C.R.)
- Correspondence: ; Tel.: +49-821-400-165905
| | - Alanna Ebigbo
- Clinic for Internal Medicine III—Gastroenterology and Infectious Diseases, University Hospital of Augsburg, 86156 Augsburg, Germany; (A.E.); (M.K.); (S.Z.); (H.M.); (C.R.)
| | - Maria Kahn
- Clinic for Internal Medicine III—Gastroenterology and Infectious Diseases, University Hospital of Augsburg, 86156 Augsburg, Germany; (A.E.); (M.K.); (S.Z.); (H.M.); (C.R.)
| | - Stephan Zellmer
- Clinic for Internal Medicine III—Gastroenterology and Infectious Diseases, University Hospital of Augsburg, 86156 Augsburg, Germany; (A.E.); (M.K.); (S.Z.); (H.M.); (C.R.)
| | - Albert Beyer
- Medical Practice for Gastroenterology and Gastrointestinal Oncology, 84503 Altoetting, Germany;
| | - Jonas Rosendahl
- Clinic for Internal Medicine I—Gastroenterology and Pneumology, University Hospital Halle, 06120 Halle (Saale), Germany;
| | - Johannes Zenk
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Augsburg, 86156 Augsburg, Germany;
| | - Bilal Al-Nawas
- Clinic and Polyclinic for Oral and Maxillofacial Surgery, Plastic Surgery, University Hospital Mainz, 55131 Mainz, Germany;
| | - Roland Frankenberger
- Department for Operative Dentistry, Endodontics, and Pediatric Dentistry, Philipps University Marburg and University Hospital Giessen and Marburg, 35039 Marburg, Germany;
| | - Juergen Hoffmann
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany;
| | - Christoph Arens
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Magdeburg, 39120 Magdeburg, Germany;
| | - Frank Lammert
- Saarland University Medical Center, Department of Medicine II, Saarland University, 66421 Homburg, Germany;
- Hannover Medical School (MHH), 30625 Hannover, Germany
| | - Claudia Traidl-Hoffmann
- Department of Environmental Medicine, Faculty of Medicine, University of Augsburg, 86156 Augsburg, Germany;
| | - Helmut Messmann
- Clinic for Internal Medicine III—Gastroenterology and Infectious Diseases, University Hospital of Augsburg, 86156 Augsburg, Germany; (A.E.); (M.K.); (S.Z.); (H.M.); (C.R.)
| | - Christoph Roemmele
- Clinic for Internal Medicine III—Gastroenterology and Infectious Diseases, University Hospital of Augsburg, 86156 Augsburg, Germany; (A.E.); (M.K.); (S.Z.); (H.M.); (C.R.)
| |
Collapse
|
33
|
Singh S, Samanta J, Suri V, Bhalla A, Puri GD, Sehgal R, Kochhar R. Presence of diarrhea associated with better outcomes in patients with COVID-19 - A prospective evaluation. Indian J Med Microbiol 2022; 40:404-408. [PMID: 35483999 PMCID: PMC9271117 DOI: 10.1016/j.ijmmb.2022.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 04/02/2022] [Accepted: 04/08/2022] [Indexed: 01/08/2023]
Abstract
Purpose Gastrointestinal (GI) manifestations have been well documented in patients with coronavirus disease 2019 (COVID-19), but its clinical impact on the course of the disease is debatable. Majority of the available data is retrospective, and hence this prospective study was planned to study the impact of GI symptoms on COVID-19 outcome. Methods All COVID-19 patients admitted in a tertiary care centre from August–October 2020 were screened and patients without pre-existing GI diseases were included. A detailed history of the various symptoms including duration was documented. Various baseline laboratory investigations and inflammatory markers were conducted as per the protocol. Patients with and without diarrhea were compared for the various disease outcome parameters. Results Of the 244 patients screened, 203 patients (128 males; 63.1%) were included. Respiratory symptoms alone were present in 49 (24.1%), GI symptoms alone in 20 (9.9%) and 117 (57.6%) had both. Overall GI symptoms was noted in 137 (67.5%) cases with the commonest being diarrhea (61; 30.0%). Patients with both respiratory and any GI symptoms showed a lower trend towards need for mechanical ventilation (12.2% vs 7.7%; p = 0.35) and mortality (10.2% vs 4.3%; p = 0.14) compared to respiratory symptoms alone, although not statistically significant. Patients with diarrhea (n = 61) had no mortality (0% vs 7.7%; p = 0.036) or need for mechanical ventilation and shorter hospital stay compared to those who did not have diarrhea. Conclusion GI symptoms are frequent in patients with SARS-CoV-2 infection and the commonest is diarrhea. Diarrhea is a harbinger of better outcome with lower mortality among COVID-19 positive patients.
Collapse
Affiliation(s)
- Seerat Singh
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Jayanta Samanta
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Vikas Suri
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashish Bhalla
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Goverdhan Dutt Puri
- Department of Anesthesia, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rakesh Sehgal
- Department of Virology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rakesh Kochhar
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
34
|
Ebrahim Nakhli R, Shanker A, Sarosiek I, Boschman J, Espino K, Sigaroodi S, Al Bayati I, Elhanafi S, Sadeghi A, Sarosiek J, Zuckerman MJ, Rezaie A, McCallum RW, Schmulson MJ, Bashashati A, Bashashati M. Gastrointestinal symptoms and the severity of COVID-19: Disorders of gut-brain interaction are an outcome. Neurogastroenterol Motil 2022; 34:e14368. [PMID: 35383423 PMCID: PMC9115309 DOI: 10.1111/nmo.14368] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 02/24/2022] [Accepted: 03/17/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND Many of the studies on COVID-19 severity and its associated symptoms focus on hospitalized patients. The aim of this study was to investigate the relationship between acute GI symptoms and COVID-19 severity in a clustering-based approach and to determine the risks and epidemiological features of post-COVID-19 Disorders of Gut-Brain Interaction (DGBI) by including both hospitalized and ambulatory patients. METHODS The study utilized a two-phase Internet-based survey on: (1) COVID-19 patients' demographics, comorbidities, symptoms, complications, and hospitalizations and (2) post-COVID-19 DGBI diagnosed according to Rome IV criteria in association with anxiety (GAD-7) and depression (PHQ-9). Statistical analyses included univariate and multivariate tests. RESULTS Five distinct clusters of symptomatic subjects were identified based on the presence of GI symptoms, loss of smell, and chest pain, among 1114 participants who tested positive for SARS-CoV-2. GI symptoms were found to be independent risk factors for severe COVID-19; however, they did not always coincide with other severity-related factors such as age >65 years, diabetes mellitus, and Vitamin D deficiency. Of the 164 subjects with a positive test who participated in Phase-2, 108 (66%) fulfilled the criteria for at least one DGBI. The majority (n = 81; 75%) were new-onset DGBI post-COVID-19. Overall, 86% of subjects with one or more post-COVID-19 DGBI had at least one GI symptom during the acute phase of COVID-19, while 14% did not. Depression (65%), but not anxiety (48%), was significantly more common in those with post-COVID-19 DGBI. CONCLUSION GI symptoms are associated with a severe COVID-19 among survivors. Long-haulers may develop post-COVID-19 DGBI. Psychiatric disorders are common in post-COVID-19 DGBI.
Collapse
Affiliation(s)
- Ramin Ebrahim Nakhli
- School of Biomedical EngineeringUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Aaron Shanker
- Division of GastroenterologyDepartment of MedicineTexas Tech University Health Sciences Center El PasoEl PasoTexasUSA
| | - Irene Sarosiek
- Division of GastroenterologyDepartment of MedicineTexas Tech University Health Sciences Center El PasoEl PasoTexasUSA
| | - Jeffrey Boschman
- School of Biomedical EngineeringUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Karina Espino
- Division of GastroenterologyDepartment of MedicineTexas Tech University Health Sciences Center El PasoEl PasoTexasUSA
| | - Solmaz Sigaroodi
- Division of GastroenterologyDepartment of MedicineTexas Tech University Health Sciences Center El PasoEl PasoTexasUSA
| | - Ihsan Al Bayati
- Division of GastroenterologyDepartment of MedicineTexas Tech University Health Sciences Center El PasoEl PasoTexasUSA
| | - Sherif Elhanafi
- Division of GastroenterologyDepartment of MedicineTexas Tech University Health Sciences Center El PasoEl PasoTexasUSA
| | - Amin Sadeghi
- Qatar Computing Research InstituteHamad bin Khalifa UniversityDohaQatar
| | - Jerzy Sarosiek
- Division of GastroenterologyDepartment of MedicineTexas Tech University Health Sciences Center El PasoEl PasoTexasUSA
| | - Marc J. Zuckerman
- Division of GastroenterologyDepartment of MedicineTexas Tech University Health Sciences Center El PasoEl PasoTexasUSA
| | - Ali Rezaie
- Division of GastroenterologyDepartment of MedicineGI Motility ProgramCedars‐SinaiLos AngelesCaliforniaUSA
| | - Richard W. McCallum
- Division of GastroenterologyDepartment of MedicineTexas Tech University Health Sciences Center El PasoEl PasoTexasUSA
| | - Max J. Schmulson
- Laboratory of Liver, Pancreas and Motility (HIPAM)Unit of Research in Experimental MedicineFaculty of Medicine‐Universidad Nacional Autónoma de México (UNAM)Mexico CityMexico
| | - Ali Bashashati
- School of Biomedical EngineeringUniversity of British ColumbiaVancouverBritish ColumbiaCanada,Department of Pathology and Laboratory Medicine, of the University of British ColumbiaVancouverBritish ColumbiaCanada
| | - Mohammad Bashashati
- Division of GastroenterologyDepartment of MedicineTexas Tech University Health Sciences Center El PasoEl PasoTexasUSA
| |
Collapse
|
35
|
Alrashed F, Alasfour H, Shehab M. Impact of biologics and small molecules for inflammatory bowel disease on COVID-19-related hospitalization and mortality: A systematic review and meta-analysis. JGH Open 2022; 6:241-250. [PMID: 35475207 PMCID: PMC9021715 DOI: 10.1002/jgh3.12728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/31/2022] [Accepted: 03/07/2022] [Indexed: 11/05/2022]
Abstract
Background and Aim The use of biologics and small molecules has been a concern for patients with inflammatory bowel disease (IBD) during the COVID-19 pandemic. We aimed to assess the association between the risk of COVID-19-related hospitalization and these agents. Methods We made a systematic review and meta-analysis of all published studies from December 2019 to September 2021 to identify studies that reported COVID-19-related hospitalization in IBD patients receiving biologic therapies or tofacitinib. We calculated the risk ratio (RR) to compare the relative risk of COVID-19-related hospitalization in patients receiving these medications to those who were not, at the time of the study. Results Eighteen studies were included. The relative risk of hospitalization was significantly lower in patients with IBD and COVID-19 who were receiving biologic therapy (RR = 0.47 [95% confidence interval, CI: 0.42-0.52, P < 0.00001]) compared to patients not receiving biologics. The RR was lower in patients receiving anti-tumor necrosis factors (TNFs) compared to those who were not (RR = 0.48 [95% CI: 0.41-0.55, P < 0.00001]). A similar finding was observed in patients taking ustekinumab (RR = 0.55 [95% CI: 0.43-0.72, P < 0.00001]). Combination therapy involving anti-TNF and an immunomodulator did not lower the risk of COVID-19-related hospitalization (RR = 0.98 [95% CI: 0.82-1.18, P = 0.84]). The use of vedolizumab (RR = 1.13 [95% CI: 0.75-1.73, P = 0.56]) or tofacitinib (RR = 0.81 [95% CI: 0.49-1.33, P = 0.40]) was not associated with a lower risk of COVID-19-related hospitalization. Conclusion Regarding COVID-19-related hospitalization in IBD, anti-TNFs and ustekinumab were associated with decreased risk of hospitalization. In addition, vedolizumab and tofacitinib were not associated with COVID-19-related hospitalization.
Collapse
Affiliation(s)
- Fatema Alrashed
- Department of Pharmacy PracticeKuwait UniversityJabriyaKuwait
| | - Hajer Alasfour
- Department of Pharmacy PracticeKuwait UniversityJabriyaKuwait
| | - Mohammad Shehab
- Division of Gastroenterology, Department of Internal Medicine, Mubarak Alkabeer University HospitalKuwait UniversityJabriyaKuwait
| |
Collapse
|
36
|
Patel AP, Sanders TK, Prakash P, Law J, Alvencar S, Choi A, Shah J, Patel K, Srivoleti P, Chauhan K, Weissman S, Holzwanger E, Dhingra R, Nguyen M, Kim D, Sidhu T, Stallwood C, Dickstein A, Parekh N, Altayar O, Ciorba MA, Yu J, Chen LA, Tabibian JH, Limketkai BN. Gastrointestinal Manifestations of Coronavirus Disease 2019 Across the United States: A Multicenter Cohort Study. GASTRO HEP ADVANCES 2022; 1:909-915. [PMID: 35874930 PMCID: PMC9293374 DOI: 10.1016/j.gastha.2022.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 07/06/2022] [Indexed: 01/25/2023]
Abstract
Background and Aims Gastrointestinal (GI) symptoms occur among patients diagnosed with coronavirus disease 2019 (COVID-19), and there is clear evidence that SARS-CoV-2, the causative pathogen, infects the GI tract. In this large, multicenter cohort study, we evaluated variations in gastrointestinal and hepatic manifestations of COVID-19 throughout the United States (US). Methods Patients hospitalized with a positive COVID-19 test prior to October 2020 were identified at 7 US academic centers. Demographics, presenting symptoms, laboratory data, and hospitalization outcomes were abstracted. Descriptive and regression analyses were used to evaluate GI manifestations and their potential predictors. Results Among 2031 hospitalized patients with COVID-19, GI symptoms were present in 18.9%; diarrhea was the most common (15.2%), followed by nausea and/or vomiting (12.6%) and abdominal pain (6.0%). GI symptoms were less common in the Western cohort (16.0%) than the Northeastern (25.6%) and Midwestern (26.7%) cohorts. Compared to nonintensive care unit (ICU) patients, ICU patients had a higher prevalence of abnormal aspartate aminotransferase (58.1% vs 37.3%; P < .01), alanine aminotransferase (37.5% vs 29.3%; P = .01), and total bilirubin (12.7% vs 9.0%; P < .01). ICU patients also had a higher mortality rate (22.7% vs 4.7%; P < .01). Chronic liver disease was associated with the development of GI symptoms. Abnormal aspartate aminotransferase or alanine aminotransferase was associated with an increased risk of ICU admission. Conclusion We present the largest multicenter cohort of patients with COVID-19 across the United States. GI manifestations were common among patients hospitalized with COVID-19, although there was significant variability in prevalence and predictors across the United States.
Collapse
Key Words
- ALT, alanine aminotransferase
- AST, aspartate aminotransferase
- BMI, body mass index
- CI, confidence interval
- COVID-19
- COVID-19, coronavirus disease 2019
- Coronavirus Disease 2019
- GI, gastrointestinal
- Gastrointestinal
- ICU, intensive care unit
- OR, odds ratio
- SARS-CoV-2
- SD, standard deviation
- UCLA, University of California Los Angeles
- aOR, adjusted odds ratio
Collapse
Affiliation(s)
- Ankur P. Patel
- Vatche & Tamar Manoukian Division of Digestive Diseases, UCLA School of Medicine, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California,Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Troy K. Sanders
- Vatche & Tamar Manoukian Division of Digestive Diseases, UCLA School of Medicine, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California
| | - Preeti Prakash
- Vatche & Tamar Manoukian Division of Digestive Diseases, UCLA School of Medicine, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California
| | - Jade Law
- Division of Gastroenterology, Department of Medicine, Olive View-UCLA Medical Center, Sylmar, California
| | - Sujay Alvencar
- Division of Gastroenterology, Tufts Medical Center, Boston, Massachusetts
| | - Alyssa Choi
- Division of Gastroenterology, University of California Irvine, Irvine, California
| | - Janaki Shah
- Inflammatory Bowel Diseases Center, Washington University in St. Louis, Saint Louis, Missouri
| | - Karishma Patel
- Division of Gastroenterology and Hepatology, Oregon Health & Science University, Portland, Oregon
| | - Padmavathi Srivoleti
- Department of Medicine, Saint Elizabeth’s Medical Center, Brighton, Massachusetts
| | - Kirtan Chauhan
- Department of Medicine, Baylor College of Medicine, Houston, Texas,Division of Gastroenterology and Hepatology, NYU Langone Health, New York, New York
| | - Simcha Weissman
- Department of Medicine, Hackensack University Medical Center, Hackensack, New Jersey
| | - Erik Holzwanger
- Division of Gastroenterology, Tufts Medical Center, Boston, Massachusetts
| | - Rohit Dhingra
- Division of Gastroenterology, Tufts Medical Center, Boston, Massachusetts
| | - Michelle Nguyen
- Division of Gastroenterology, Tufts Medical Center, Boston, Massachusetts
| | - Daniel Kim
- Division of Gastroenterology, University of California Irvine, Irvine, California
| | - Tahnee Sidhu
- Department of Medicine, Saint Elizabeth’s Medical Center, Brighton, Massachusetts
| | | | - Aaron Dickstein
- Division of Gastroenterology, Tufts Medical Center, Boston, Massachusetts
| | - Nimisha Parekh
- Division of Gastroenterology, University of California Irvine, Irvine, California
| | - Osama Altayar
- Inflammatory Bowel Diseases Center, Washington University in St. Louis, Saint Louis, Missouri
| | - Matthew A. Ciorba
- Inflammatory Bowel Diseases Center, Washington University in St. Louis, Saint Louis, Missouri
| | - Jessica Yu
- Division of Gastroenterology and Hepatology, Oregon Health & Science University, Portland, Oregon
| | - Lea Ann Chen
- Division of Gastroenterology and Hepatology, Rutgers University New Brunswick, New Jersey
| | - James H. Tabibian
- Vatche & Tamar Manoukian Division of Digestive Diseases, UCLA School of Medicine, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California,Division of Gastroenterology, Department of Medicine, Olive View-UCLA Medical Center, Sylmar, California
| | - Berkeley N. Limketkai
- Vatche & Tamar Manoukian Division of Digestive Diseases, UCLA School of Medicine, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California,Vatche & Tamar Manoukian Division of Digestive Diseases, UCLA School of Medicine, Los Angeles, California,Correspondence: Address correspondence to: Berkeley N. Limketkai, MD, PhD, Westwood Digestive Diseases, 100 Medical Plaza, Suite 345, Los Angeles, California 90024
| |
Collapse
|
37
|
Khan MU, Mushtaq K, Alsoub DH, Iqbal P, Ata F, Chaudhry HS, Iqbal F, Balaraju G, Maslamani MAA, Varughese B, Singh R, Ejji KA, Kaabi SA, Kamel YM, Butt AA. Digestive system involvement and clinical outcomes among COVID-19 patients: A retrospective cohort study from Qatar. World J Gastroenterol 2021; 27:7995-8009. [PMID: 35046626 PMCID: PMC8678823 DOI: 10.3748/wjg.v27.i46.7995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/29/2021] [Accepted: 11/28/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 virus most commonly presents with respiratory symptoms. While gastrointestinal (GI) manifestations either at presentation or during hospitalization are also common, their impact on clinical outcomes is controversial. Some studies have described worse outcomes in COVID-19 patients with GI symptoms, while others have shown either no association or a protective effect. There is a need for consistent standards to describe GI symptoms in COVID-19 patients and to assess their effect on clinical outcomes, including mortality and disease severity.
AIM To investigate the prevalence of GI symptoms in hospitalized COVID-19 patients and their correlation with disease severity and clinical outcomes.
METHODS We retrospectively reviewed 601 consecutive adult COVID-19 patients requiring hospitalization between May 1-15, 2020. GI symptoms were recorded at admission and during hospitalization. Demographic, clinical, laboratory, and treatment data were retrieved. Clinical outcomes included all-cause mortality, disease severity at presentation, need for intensive care unit (ICU) admission, development of acute respiratory distress syndrome, and need for mechanical ventilation. Multivariate logistic regression model was used to identify independent predictors of the adverse outcomes.
RESULTS The prevalence of any GI symptom at admission was 27.1% and during hospitalization was 19.8%. The most common symptoms were nausea (98 patients), diarrhea (76 patients), vomiting (73 patients), and epigastric pain or discomfort (69 patients). There was no difference in the mortality between the two groups (6.21% vs 5.5%, P = 0.7). Patients with GI symptoms were more likely to have severe disease at presentation (33.13% vs 22.5%, P < 0.001) and prolonged hospital stay (15 d vs 14 d, P = 0.04). There was no difference in other clinical outcomes, including ICU admission, development of acute respiratory distress syndrome, or need for mechanical ventilation. Drugs associated with the development of GI symptoms during hospitalization were ribavirin (diarrhea 26.37% P < 0.001, anorexia 17.58%, P = 0.02), hydroxychloroquine (vomiting 28.52%, P = 0.009) and lopinavir/ritonavir (nausea 32.65% P = 0.049, vomiting 31.47% P = 0.004, and epigastric pain 12.65% P = 0.048). In the multivariate regression analysis, age > 65 years was associated with increased mortality risk [odds ratio (OR) 7.53, confidence interval (CI): 3.09-18.29, P < 0.001], ICU admission (OR: 1.79, CI: 1.13-2.83, P = 0.012), and need for mechanical ventilation (OR: 1.89, CI:1.94-2.99, P = 0.007). Hypertension was an independent risk factor for ICU admission (OR: 1.82, CI:1.17-2.84, P = 0.008) and need for mechanical ventilation (OR: 1.66, CI: 1.05-2.62, P = 0.028).
CONCLUSION Patients with GI symptoms are more likely to have severe disease at presentation; however, mortality and disease progression is not different between the two groups.
Collapse
Affiliation(s)
- Muhammad Umair Khan
- Department of Gastroenterology and Hepatology, Hamad Medical Corporation, Doha 3050, Qatar
- ECPE- Executive and Continuing Professional Education, Harvard T.H Chan School of Public Health, Boston, MA 02115-5810, United States
| | - Kamran Mushtaq
- Department of Gastroenterology and Hepatology, Hamad Medical Corporation, Doha 3050, Qatar
- ECPE- Executive and Continuing Professional Education, Harvard T.H Chan School of Public Health, Boston, MA 02115-5810, United States
| | - Deema Hussam Alsoub
- ECPE- Executive and Continuing Professional Education, Harvard T.H Chan School of Public Health, Boston, MA 02115-5810, United States
- Department of Palliative Care, National Center for Cancer Care & Research, Hamad Medical Corporation, Doha 3050, Qatar
| | - Phool Iqbal
- Department of Medicine, Hamad Medical Corporation, Doha 3050, Qatar
| | - Fateen Ata
- Department of Medicine, Hamad Medical Corporation, Doha 3050, Qatar
| | | | - Fatima Iqbal
- ECPE- Executive and Continuing Professional Education, Harvard T.H Chan School of Public Health, Boston, MA 02115-5810, United States
- Department of Infectious Disease, Communicable Disease Center, Hamad Medical Corporation, Doha 3050, Qatar
| | - Girisha Balaraju
- Department of Gastroenterology and Hepatology, Hamad Medical Corporation, Doha 3050, Qatar
| | - Muna A Al Maslamani
- Department of Infectious Disease, Communicable Disease Center, Hamad Medical Corporation, Doha 3050, Qatar
| | - Betsy Varughese
- Department of Gastroenterology and Hepatology, Hamad Medical Corporation, Doha 3050, Qatar
| | - Rajvir Singh
- Department of Cardiology Research, Heart Hospital, Hamad Medical Corporation, Doha 3050, Qatar
| | - Khalid Al Ejji
- Department of Gastroenterology and Hepatology, Hamad Medical Corporation, Doha 3050, Qatar
| | - Saad Al Kaabi
- Department of Gastroenterology and Hepatology, Hamad Medical Corporation, Doha 3050, Qatar
| | - Yasser Medhat Kamel
- Department of Gastroenterology and Hepatology, Hamad Medical Corporation, Doha 3050, Qatar
| | - Adeel Ajwad Butt
- Department of Medicine, Hamad Medical Corporation, Doha 3050, Qatar
- Department of Medicine, Division of Infectious Diseases, Weill Cornell Medical College, New York, NY 10075, United States
- Department of Medicine, Weill Cornell Medical College - Qatar, Doha 24144, Qatar
| |
Collapse
|
38
|
Alrashed F, Battat R, Abdullah I, Charabaty A, Shehab M. Impact of medical therapies for inflammatory bowel disease on the severity of COVID-19: a systematic review and meta-analysis. BMJ Open Gastroenterol 2021; 8:bmjgast-2021-000774. [PMID: 34725056 PMCID: PMC8561831 DOI: 10.1136/bmjgast-2021-000774] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 10/15/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND During COVID-19 pandemic, the safety of medical therapies for inflammatory bowel disease (IBD) in relation to COVID-19 has emerged as an area of concern. This study aimed to evaluate the association between IBD therapies and severe COVID-19 outcomes. METHOD We performed a systematic review and meta-analysis of all published studies from December 2019 to August 2021 to identify studies that reported severe COVID-19 outcomes in patients on current IBD therapies including 5-aminosalicylic acid (5-ASA), immunomodulators, corticosteroids, biologics, combination therapy, or tofacitinib. RESULTS Twenty-two studies were identified. Corticosteroids (risk ratio (RR) 1.91 (95% CI 1.25 to 2.91, p=0.003)) and 5-ASA (RR 1.50 (95% CI 1.17 to 1.93, p=0.001)) were associated with increased risk of severe COVID-19 outcomes in patients with IBD patients. However, possible confounders for 5-ASA use were not controlled for. Sub-analysis showed that corticosteroids increased the risk of intensive care unit (ICU) admission but not mortality. Immunomodulators alone (RR 1.18 (95% CI 0.87 to 1.59, p=0.28)) or in combination with anti-TNFs ((RR 0.96 (95% CI 0.80 to 1.15, p=0.63)), tofacitinib (RR 0.81 (95% CI 0.49 to 1.33, p=0.40)) and vedolizumab ((RR 1.02 (95% CI 0.79 to 1.31, p=0.89)) were not associated with severe disease. Anti-TNFs (RR 0.47 (95% CI 0.40 to 0.54, p<0.00001)) and ustekinumab (RR 0.55 (95% CI 0.43 to 0.72, p<0.00001)) were associated with decreased risk of severe COVID-19. CONCLUSION In patients with IBD, the risk of severe COVID-19 is higher among patients receiving corticosteroids. Corticosteroid use was associated with ICU admission but not mortality. The risk is also higher among patients receiving 5-ASAs. However, patient-level data were lacking and insufficient data existed for meta-regression analyses to adjust for confounding. Vedolizumab, tofacitinib, and immunomodulators alone or in combination with anti-TNF were not associated with severe disease. Anti-TNFs, and ustekinumab were associated with favourable outcomes.
Collapse
Affiliation(s)
- Fatema Alrashed
- Pharmacy Practice, MCPHS University, Boston, Massachusetts, USA
| | - Robert Battat
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Israa Abdullah
- Department of Pharmacy Practice, Kuwait University, Kuwait, Kuwait
| | - Aline Charabaty
- Division of gastroenterology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Mohammad Shehab
- Department of Internal Medicine, Kuwait University, Kuwait, Kuwait
| |
Collapse
|
39
|
Abstract
PURPOSE OF REVIEW The ubiquitous expression of angiotensin-converting enzyme-2 receptors and its significance as the origin of viral entry have assisted in comprehending the pathophysiology of extrapulmonary manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In this review, we focus on the clinical significance of gastrointestinal manifestations. RECENT FINDINGS The global pandemic, a result of the widespread implications of SARS-CoV-2, remains a significant burden to current healthcare systems. Fever, dyspnea, and tussive symptoms have primarily been recognized as the most common presenting signs/symptoms. During the past one year our scope of practice has transcended beyond the management of the respiratory system to incorporate other varying systemic manifestations such as anorexia, nausea, vomiting, diarrhea, and abdominal pain. The outcomes reported by recent studies suggest an association between the presence of gastrointestinal symptoms and important clinical factors such as delay in presentation, disease severity, and mortality. SUMMARY We provide a summarization of the most recent in-depth investigations of coronavirus disease 2019 with gastrointestinal manifestations and their conclusions. Although the pathophysiology remains an area of evolving interest, a better understanding of this disease process may allow for early recognition, efficient triage, and improved prognostication for those presenting with gastrointestinal manifestations of SARS-CoV-2.
Collapse
|
40
|
Russo T, Pizuorno A, Oskrochi G, Latella G, Massironi S, Schettino M, Aghemo A, Pugliese N, Brim H, Ashktorab H. Gastrointestinal Manifestations, Clinical Characteristics and Outcomes of COVID-19 in Adult and Pediatric Patients. SOJ MICROBIOLOGY & INFECTIOUS DISEASES 2021; 8:109. [PMID: 35611315 PMCID: PMC9126507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Italy was the first country in Europe to report a SARS-CoV-2 case. Since then, the country has suffered a large number of COVID-19 infections both in adults and children. This disease has been shown to lead to different outcomes in these two groups, which often present varying symptoms and comorbidities. AIM Therefore, we aimed to evaluate the symptoms, comorbidities and laboratory values in adults and children. METHODS We present the characteristics of 1,324 adults and 563 pediatric COVID-19 Italian patients. The data was retrieved from studies published in Italy and found via PubMed and Google Scholar. RESULTS The virus appeared to affect adults more than children and men more than women, and to result in more severe outcomes in patients with abnormal laboratory values and a higher number of comorbidities. Adults are at higher risk for complications and death, and they usually present with fever, respiratory symptoms, cough, fatigue, diarrhea, myalgia, and/or loss of taste, smell, or appetite. Children usually have a milder disease progression and usually present with fever, cough, rhinorrhea, pharyngitis, sore throat, pneumonia, GI symptoms (diarrhea, vomiting, abdominal pain), fatigue, and dyspnea. CONCLUSION Our findings support early reports that showed that SARS-CoV-2 is associated with more common asymptomatic cases and milder clinical outcome in children than in adults. Acute respiratory distress syndrome and Multisystem inflammatory syndrome in children (systemic vasculitis) are the most severe disease progressions for adults and children, respectively.
Collapse
Affiliation(s)
- Tiziano Russo
- Department of Medicine, Department of Pathology and Cancer Center, Department of Biochemistry & Molecular Biology, Howard University College of Medicine, Washington DC
| | - Antonio Pizuorno
- College of Engineering and Technology, American University of the Middle East, Kuwait
| | - Gholamreza Oskrochi
- College of Engineering and Technology, American University of the Middle East, Kuwait
| | - Giovanni Latella
- Gastroenterology Unit, Department of Life, Health and Environmental Sciences, University of L’Aquila, Italy
| | - Sara Massironi
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, and European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Monza, Italy
| | - Mario Schettino
- Gastroenterology Unit, ASST Rhodense, Garbagnate Milanese, Lombardia, Italy
| | - Alessio Aghemo
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy
| | - Nicola Pugliese
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy
| | - Hassan Brim
- Department of Medicine, Department of Pathology and Cancer Center, Department of Biochemistry & Molecular Biology, Howard University College of Medicine, Washington DC
| | - Hassan Ashktorab
- Department of Medicine, Department of Pathology and Cancer Center, Department of Biochemistry & Molecular Biology, Howard University College of Medicine, Washington DC
| |
Collapse
|
41
|
Burhamah W, Qahi I, Oroszlányová M, Shuaibi S, Alhunaidi R, Alduwailah M, Alhenaidi M, Mohammad Z. Prognostic Factors and Predictors of In-Hospital Mortality Among COVID-19 Patients Admitted to the Intensive Care Unit: An Aid for Triage, Counseling, and Resource Allocation. Cureus 2021; 13:e16577. [PMID: 34322358 PMCID: PMC8299433 DOI: 10.7759/cureus.16577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remains today a global health pandemic. Those with severe infection are at risk of rapid clinical deterioration; as a result, intensive care unit (ICU) admission is not uncommon in such patients. A number of determinants have been identified as predictors of poor prognosis and in-hospital mortality, ranging from demographic characteristics, laboratory and/or radiological findings. AIM To identify determinants of in-hospital mortality and examine the accuracy of seven early warning scores in predicting in-hospital mortality. METHODS This is a retrospective study conducted in Kuwait from July 2020 to March 2021, and participants were adult patients with a positive test on the real-time polymerase chain reaction (RT-PCR) for SARS-CoV-2 and who met the criteria for ICU admission. Data collected included: demographics, clinical status on hospital arrival, laboratory test results, and ICU course. Furthermore, we calculated seven early warning scores for each of our patients. RESULTS A total of 133 patients were admitted to our COVID-19 ICU with a median age of 59 years. Arrival to ICU on mechanical ventilation (MV), developing in-hospital complications, having chronic kidney disease (CKD), having a high white blood count (WBC), lactate dehydrogenase (LDH), lactate, or urea levels were found to be significant predictors of in-hospital mortality. Furthermore, the 4C mortality score for COVID-19, VACO index for COVID-19 mortality, and the PRIEST COVID-19 clinical severity score proved to be the most superior in predicting in-hospital mortality. CONCLUSION Identifying high-risk patients and those with a poor prognosis allows for efficient triaging and the delivery of high-standard care while minimizing the strain on the healthcare system.
Collapse
Affiliation(s)
- Waleed Burhamah
- School of Medicine, Royal College of Surgeons in Ireland, Dublin, IRL
| | - Iman Qahi
- Department of General Surgery, Mubarak AlKabeer Hospital, Kuwait, KWT
| | - Melinda Oroszlányová
- College of Engineering and Technology, American University of the Middle East, Kuwait, KWT
| | - Sameera Shuaibi
- Department of Internal Medicine, Al-Adan Hospital, Kuwait, KWT
| | - Razan Alhunaidi
- Department of Internal Medicine, Kuwait University, Health Sciences Center, School of Medicine, Kuwait, KWT
| | - May Alduwailah
- Department of Internal Medicine, Kuwait University, Health Sciences Center, School of Medicine, Kuwait, KWT
| | - Maryam Alhenaidi
- Department of Internal Medicine, Kuwait University, Health Sciences Center, School of Medicine, Kuwait, KWT
| | - Zahraa Mohammad
- Department of Internal Medicine, Kuwait University, Health Sciences Center, School of Medicine, Kuwait, KWT
| |
Collapse
|
42
|
Martinez MA, Franco S. Impact of COVID-19 in Liver Disease Progression. Hepatol Commun 2021; 5:1138-1150. [PMID: 34533001 PMCID: PMC8239862 DOI: 10.1002/hep4.1745] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/12/2021] [Accepted: 04/28/2021] [Indexed: 02/06/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is a novel coronavirus that causes coronavirus disease 19 (COVID-19), which has infected millions of people worldwide in only a few months. A minority, but significant number, of infected individuals require hospitalization and intensive care. From the start of this new virus pandemic, it was apparent that obese and/or diabetic individuals had a bad prognosis for COVID-19 progression, strongly suggesting an association between liver disease and severe COVID-19. Because chronic liver disease (CLD) is associated with immune dysregulation and inflammation, it is unsurprising that patients with CLD may carry a greater risk of adverse outcomes following SARS-CoV-2 infection. Initial COVID-19 data have also indicated that healthy infected individuals display abnormal liver function tests, suggesting a possible direct implication of SARS-CoV-2 in liver damage. Here we show that COVID-19 affects the liver metabolism and increases the morbidity and mortality of individuals with underlying CLD.
Collapse
Affiliation(s)
- Miguel Angel Martinez
- IrsiCaixaHospital Universitari Germans Trias i PujolUniversitat Autònoma de BarcelonaBadalonaSpain
| | - Sandra Franco
- IrsiCaixaHospital Universitari Germans Trias i PujolUniversitat Autònoma de BarcelonaBadalonaSpain
| |
Collapse
|
43
|
Xu Z, Tang M, Chen P, Cai H, Xiao F. SARS-CoV-2 Gastrointestinal Infection Prolongs the Time to Recover From COVID-19. Front Med (Lausanne) 2021; 8:683551. [PMID: 34150815 PMCID: PMC8212954 DOI: 10.3389/fmed.2021.683551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 04/20/2021] [Indexed: 01/08/2023] Open
Abstract
Objectives: We previously reported that SARS-CoV-2 infects the gastrointestinal (GI) epithelium. In this study, we aimed to explore the impact of SARS-CoV-2 GI infection on clinical outcomes of COVID-19. Materials and Methods: For this retrospective cohort study, 104 patients with COVID-19 were classified into a SARS-CoV-2 GI infection group and a non-infection group. The primary endpoint was the time of negative conversion of SARS-CoV-2 RNA in respiratory tract samples. The secondary outcome was the time of hospitalization for COVID-19. Results: Patients with SARS-CoV-2 GI infection had a longer duration of positive SARS-CoV-2 RNA in respiratory tract samples (median 12.0 days [95% CI: 10.0–13.2] vs. 9.0 days [95% CI: 7.5–10.5]; HR 0.575 [95% CI: 0.386–0.857]; P = 0.003) and hospitalization (median 28.0 days [95% CI: 23.2–32.8] vs. 15.0 days [95% CI: 13.6–16.4]; HR 0.149 [95% CI: 0.087–0.252]; P < 0.001) than patients without SARS-CoV-2 GI infection. Subgroup analyses for sex, age, epidemiological history, clinical classification and antiviral treatment showed consistent results. Conclusion: Our study indicates that SARS-CoV-2 GI infection prolongs the duration of SARS-CoV-2 shedding and hospitalization in the patients with COVID-19. More attention should be paid to SARS-CoV-2 GI infection of COVID-19 and fecal SARS-CoV-2 RNA test should be completed in time.
Collapse
Affiliation(s)
- Zhijie Xu
- Department of Infectious Diseases, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, China.,Guangdong Provincial key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, China.,Guangdong Provincial Engineering Research Center of Molecular Imaging, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, China
| | - Meiwen Tang
- Guangdong Provincial key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, China.,Guangdong Provincial Engineering Research Center of Molecular Imaging, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, China.,Department of Hematology, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, China
| | - Ping Chen
- Department of Infectious Diseases, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, China
| | - Hongyu Cai
- Department of Infectious Diseases, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, China
| | - Fei Xiao
- Department of Infectious Diseases, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, China.,Guangdong Provincial key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, China.,Guangdong Provincial Engineering Research Center of Molecular Imaging, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, China
| |
Collapse
|
44
|
Rogers HK, Choi WW, Gowda N, Nawal S, Gordon B, Onyilofor C, Rogers CM, Yamane D, Borum ML. Frequency and outcomes of gastrointestinal symptoms in patients with Corona Virus Disease-19. Indian J Gastroenterol 2021; 40:502-511. [PMID: 34569014 PMCID: PMC8475883 DOI: 10.1007/s12664-021-01191-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/03/2021] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To characterize the frequency and association of gastrointestinal (GI) symptoms with outcomes in patients with corona virus disease 2019 (COVID-19) admitted to the hospital. METHODS Records were retrospectively collected from patients admitted to a tertiary care center in Washington, D.C., with confirmed COVID-19 from March 15, 2020 to July 15, 2020. After adjusting for clinical demographics and comorbidities, multivariate logistic regression analysis was performed. RESULTS The most common presenting symptoms of COVID-19 in patients that were admitted to the hospital were cough (38.4%), shortness of breath (37.5%), and fever (34.3%), followed by GI symptoms in 25.9% of patients. The most common GI symptom was diarrhea (12.8%) followed by nausea or vomiting (10.5%), decreased appetite (9.3%), and abdominal pain (3.8%). Patients with diarrhea were more likely to die (odds ratio [OR] 2.750; p = 0.006; confidence interval [CI] 1.329-5.688), be admitted to the intensive care unit (ICU) (OR 2.242; p = 0.019; CI 1.139-4.413), and be intubated (OR 3.155; p = 0.002; CI 1.535-6.487). Additional outcomes analyzed were need for vasopressors, presence of shock, and acute kidney injury. Patients with diarrhea were 2.738 (p = 0.007; CI 1.325-5.658), 2.467 (p = 0.013; CI 1.209-5.035), and 2.694 (p = 0.007; CI 1.305-5.561) times more likely to experience these outcomes, respectively. CONCLUSIONS Screening questions should be expanded to include common GI symptoms in patients with COVID-19. Health care providers should note whether their patient is presenting with diarrhea due to the potential implications on disease severity and outcomes.
Collapse
Affiliation(s)
- Hayley K. Rogers
- Department of Internal Medicine, George Washington University, 2150 Pennsylvania Avenue, NW Suite 5-416, Washington, D.C. 20037 USA
| | - WonSeok W. Choi
- Department of Internal Medicine, George Washington University, 2150 Pennsylvania Avenue, NW Suite 5-416, Washington, D.C. 20037 USA
| | - Niraj Gowda
- Department of Internal Medicine, George Washington University, 2150 Pennsylvania Avenue, NW Suite 5-416, Washington, D.C. 20037 USA
| | - Saadia Nawal
- Department of Internal Medicine, George Washington University, 2150 Pennsylvania Avenue, NW Suite 5-416, Washington, D.C. 20037 USA
| | - Brittney Gordon
- School of Medicine and Health Sciences, George Washington University, Ross Hall, 2300 Eye Street, NW, Washington, D.C. 20037 USA
| | - Chinelo Onyilofor
- School of Medicine and Health Sciences, George Washington University, Ross Hall, 2300 Eye Street, NW, Washington, D.C. 20037 USA
| | - Callie M. Rogers
- College of Veterinary Medicine and Biomedical Sciences, Texas A and M University, Veterinary and Biomedical Education Complex, 660 Raymond Stotzer Pkwy, College Station, 77843 TX USA
| | - David Yamane
- Department of Emergency Medicine, Department of Anesthesia and Critical Care, George Washington University, 900 23rd St NW, Washington, D.C. 20037 USA
| | - Marie L. Borum
- Division of Gastroenterology and Liver Diseases, George Washington University, 22nd and I Street, NW, 3rd Floor, Washington, D.C. 20037 USA
| |
Collapse
|
45
|
Chen H, Tong Z, Ma Z, Luo L, Tang Y, Teng Y, Yu H, Meng H, Peng C, Zhang Q, Zhu T, Zhao H, Chu G, Li H, Lu H, Qi X. Gastrointestinal Bleeding, but Not Other Gastrointestinal Symptoms, Is Associated With Worse Outcomes in COVID-19 Patients. Front Med (Lausanne) 2021; 8:759152. [PMID: 34722595 PMCID: PMC8548414 DOI: 10.3389/fmed.2021.759152] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 09/15/2021] [Indexed: 02/05/2023] Open
Abstract
Background: Patients with coronavirus disease 2019 (COVID-19) can present with gastrointestinal (GI) symptoms. However, the prevalence of GI symptoms and their association with outcomes remain controversial in COVID-19 patients. Methods: All COVID-19 patients consecutively admitted to the Wuhan Huoshenshan hospital from February 2020 to April 2020 were collected. Disease severity and outcomes were compared between COVID-19 patients with and without GI symptoms. Logistic regression analyses were performed to evaluate the association of GI symptoms with the composite endpoint and death in COVID-19 patients. A composite endpoint was defined as transfer to intensive care unit, requirement of mechanical ventilation, and death. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Results: Overall, 2,552 COVID-19 patients were included. The prevalence of GI symptoms was 21.0% (537/2,552). Diarrhea (8.9%, 226/2,552) was the most common GI symptom. Patients with GI symptoms had significantly higher proportions of severe COVID-19 and worse outcomes than those without. Univariate logistic regression analyses demonstrated that GI symptoms were significantly associated with the composite endpoint (OR = 2.426, 95% CI = 1.608-3.661; P < 0.001) and death (OR = 2.137, 95% CI = 1.209-3.778; P = 0.009). After adjusting for age, sex, and severe/critical COVID-19, GI symptoms were still independently associated with the composite endpoint (OR = 2.029, 95% CI = 1.294-3.182; P = 0.002), but not death (OR = 1.726, 95% CI = 0.946-3.150; P = 0.075). According to the type of GI symptoms, GI bleeding was an independent predictor of the composite endpoint (OR = 8.416, 95% CI = 3.465-20.438, P < 0.001) and death (OR = 6.640, 95% CI = 2.567-17.179, P < 0.001), but not other GI symptoms (i.e., diarrhea, abdominal discomfort, nausea and/or vomiting, constipation, acid reflux and/or heartburn, or abdominal pain). Conclusion: GI symptoms are common in COVID-19 patients and may be associated with their worse outcomes. Notably, such a negative impact of GI symptoms on the outcomes should be attributed to GI bleeding.
Collapse
Affiliation(s)
- Hongxin Chen
- COVID-19 Study Group, General Hospital of Northern Theater Command, Shenyang, China
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China
- Postgraduate College, Liaoning University of Traditional Chinese Medicine, Shenyang, China
| | - Zhenhua Tong
- COVID-19 Study Group, General Hospital of Northern Theater Command, Shenyang, China
- Section of Medical Service, General Hospital of Northern Theater Command, Shenyang, China
| | - Zhuang Ma
- COVID-19 Study Group, General Hospital of Northern Theater Command, Shenyang, China
- Department of Respiratory Medicine, General Hospital of Northern Theater Command, Shenyang, China
- Department of Infectious Diseases, Wuhan Huoshenshan Hospital, Wuhan, China
| | - Li Luo
- COVID-19 Study Group, General Hospital of Northern Theater Command, Shenyang, China
| | - Yufu Tang
- COVID-19 Study Group, General Hospital of Northern Theater Command, Shenyang, China
- Department of Infectious Diseases, Wuhan Huoshenshan Hospital, Wuhan, China
| | - Yue Teng
- COVID-19 Study Group, General Hospital of Northern Theater Command, Shenyang, China
- Department of Infectious Diseases, Wuhan Huoshenshan Hospital, Wuhan, China
| | - Hao Yu
- COVID-19 Study Group, General Hospital of Northern Theater Command, Shenyang, China
- Department of Infectious Diseases, Wuhan Huoshenshan Hospital, Wuhan, China
| | - Hao Meng
- COVID-19 Study Group, General Hospital of Northern Theater Command, Shenyang, China
- Department of Infectious Diseases, Wuhan Huoshenshan Hospital, Wuhan, China
| | - Chengfei Peng
- COVID-19 Study Group, General Hospital of Northern Theater Command, Shenyang, China
- Department of Infectious Diseases, Wuhan Huoshenshan Hospital, Wuhan, China
| | - Quanyu Zhang
- COVID-19 Study Group, General Hospital of Northern Theater Command, Shenyang, China
- Department of Infectious Diseases, Wuhan Huoshenshan Hospital, Wuhan, China
| | - Tianyi Zhu
- COVID-19 Study Group, General Hospital of Northern Theater Command, Shenyang, China
- Section of Medical Service, General Hospital of Northern Theater Command, Shenyang, China
- Department of Infectious Diseases, Wuhan Huoshenshan Hospital, Wuhan, China
| | - Haitao Zhao
- COVID-19 Study Group, General Hospital of Northern Theater Command, Shenyang, China
- Section of Medical Service, General Hospital of Northern Theater Command, Shenyang, China
- Department of Respiratory Medicine, General Hospital of Northern Theater Command, Shenyang, China
| | - Guiyang Chu
- COVID-19 Study Group, General Hospital of Northern Theater Command, Shenyang, China
- Information Section of Medical Security Center, General Hospital of Northern Theater Command, Shenyang, China
| | - Hongyu Li
- COVID-19 Study Group, General Hospital of Northern Theater Command, Shenyang, China
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China
- *Correspondence: Hongyu Li
| | - Hui Lu
- COVID-19 Study Group, General Hospital of Northern Theater Command, Shenyang, China
- Hui Lu
| | - Xingshun Qi
- COVID-19 Study Group, General Hospital of Northern Theater Command, Shenyang, China
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China
- Xingshun Qi
| |
Collapse
|