ABSTRACT
Background/Aims: Digestive symptoms are common in patients with COVID-19. Neverthe-less, the evidence available so far is based on retrospective and observational studies. This prospective multicenter cohort study aimed to describe the frequency, intensity, evolution, and impact of digestive symptoms and complications, during hospitalization and after dis-charge, of patients with COVID-19. Methods: Patients hospitalized due to COVID-19 (posi-tive PCR for SARS-CoV-2) from May to August 2020, were prospectively recruited in 31 centers. Follow-up included the period between admission and 15 days after discharge. Results: 829 patients (mean age 56.7±17.9 years;42% of females) were enrolled in this study. Of these, 7.2% were active smokers and the mean BMI was 29.1±5.7. Proton pump inhibitors were used by 21.5% (n=178). The most prevalent symptoms on admission were diarrhea (39.4%), nausea (27.4%), and abdominal pain (20.7%). Anorexia, a non-specific symptom, was present in 49.8% of hospitalized patients. At discharge and 15 days after discharge, most symptoms resolved, returning to the baseline prevalence of patients (<5%). Digestive complications during admission were infrequent, except for liver injury defined as hypertransaminasemia which was present in 267 patients (32.3%). The mean length of hospital stay was 8 days (5-12) and 13.6% needed ICU admission. Death happened in 5.2%of patients. On multivariate analysis, diarrhea on admission was associated with a shorter hospital stay (<10 days) ORa 0.508 (0.350-0.739) p=0.000. During hospitalization, diarrhea, constipation, and abdominal bloating were associated with shorter hospital stay ORa 0.531 (0.298-0.946) p=0.032, ORa 0.384 (0.167-0.885) p=0.025, ORa 0.163 (0.057-0.466) p= 0.00, respectively.Odynophagia and dysphagia during hospitalization were associated with a higher need for ICU admission, ORa 6.518 (2.255-18.835) p=0.001 and ORa 4.035 (1.453-11.204) p=0.007, respectively. Liver injury during hospitalization was associated with a higher hospital stay (>10 days) ORa 1.442 (1.019-2.041) p=0.039. In the linear regression analysis, the set of GI symptoms and complications, along with age, comorbidity, and respiratory symptoms, were able to predict 43% (R2 0.43) of the observed variability in the speed of ICU admission;in this case, digestive symptoms slowed it down (more days until ICU admission). Conclusions: Gastrointestinal manifestations of COVID-19 are common in hospitalized patients, while complications are infrequent. Gastrointestinal symptoms seemed to predict a shorter hospital stay and slower speed of ICU admission. These tend to resolve to their baseline prevalence 15 days after discharge, while elevated transaminases were associated with a longer hospital stay. Odynophagia and dysphagia during hospitaliza-tion were associated with an increased need for ICU admission.
ABSTRACT
Background: COVID-19 is the pandemic most affected since the 1918 influenza. In order to control its effects, the governments of different countries, including Spain, adopted exceptional measures such as lockdown and the suspension of non-essential economic activity. Studies carried out in China, where the population was also confined, have found an increase in the prevalence of post-traumatic stress symptom among the most affected regions compared to other less affected [1] Aim: To describe the presence of post-traumatic symptom among a large sample from the general population in the different regions of Spain after two weeks from the declaration of the state of alarm in Spain. Methods. The data was obtained through an online questionnaire two weeks after the declaration of the state of alarm in Spain (performed between 19 and 26 March, 2020) addressed to general population over eighteen years old [2]. It was spread using an online “snowball” method. Assessment sociodemographic, clinical variables and psychometric scales. Post-traumatic stress symptoms were measured by the Stressful Impact Scale (EIE), which consists of 15 items, divided into two subscales related to symtoms of intrusion and avoidance. The SPSS v24.0 program was used in the statistical analysis. Results: The sample consists of 21,153 individuals [30.3% men] with an average age of 39.75 ± 14.04 (18 to 100 years). A) Intrusive response: regions with the highest prevalence of intrusive response are Castilla La Mancha (31.2%), Andalusia (30.7%) and Extremadura (26.2%);regions with the lowest prevalence of intrusive response are Aragon (18.9%), Navarra (16.0%) and La Rioja (21.4%). B)Avoidance response: regions with the highest prevalence of avoidance response are Andalusia (55.7%), Extremadura (53.7%) and Castilla La Mancha (51.3%);regions with the lowest prevalence of avoidance response are Galicia (39%), Aragon (37.6%) and Navarra (32.7%). In Madrid, the prevalence of avoidant and intrusive symptoms was 43.1% and 26.0%, respectively. Conclussions: Avoidance symptoms were more frequent than intrusion symptoms in all regions. Andalusia, Extremadura and Castilla La Mancha are the regions with the highest prevalence of post-traumatic stress symptoms, both intrusive and avoidant. In addition, Aragon and Navarra presented low post-traumatic symptoms prevalence. The situation in the Community of Madrid is particularly garish. Despite being the region most affected by the COVID-19 pandemic in Spain, the prevalence of post-traumatic stress symptoms, both intrusive and avoidant, is close to average. The representativeness of the regions in the sample is a limitation of our study. However, the Madrid region is well represented in terms of the percentage share of the total sample. The results obtained do not seem consistent with the epidemiological situation of these regions at that time. It neither are according to the findings of other studies, so it would be necessary to investigate the existence of other factors that contribute to explaining these results. No conflict of interest