ABSTRACT
Coronavirus disease 2019 (COVID-19) has taken hundreds of thousands of lives globally. Besides the respiratory tract, the virus can affect the gastrointestinal (GI) tract. Data regarding the significance of GI symptoms in the COVID-19 course are limited. In this largest US study to date, the authors reviewed electronic encounters of 1003 consecutive patients who were tested positive for the virus between March 12 and April 3, 2020. Initial GI symptoms were present in up to 22.4% of patients and were associated with worse outcomes after adjustment for demographics, comorbidities, and other clinical symptoms. COVID-19 with GI involvement may define a more severe phenotype.
Subject(s)
COVID-19 , Gastrointestinal Diseases , Comorbidity , Gastrointestinal Diseases/diagnosis , Gastrointestinal Diseases/epidemiology , Humans , SARS-CoV-2ABSTRACT
BACKGROUND: No study to date has analyzed the progression of sinonasal symptoms over time in COVID-19 patients. The purpose of this study is to analyze the progression of sinonasal symptoms and risk factors for olfactory dysfunction in the mild severity COVID-19 patient. METHODS: An internet survey was used to assess sinonasal symptoms in patients with COVID-19. Changes in rhinologic domain and symptom-specific Sinonasal Outcome Test (SNOT-22) scores were compared at five time points: two weeks before diagnosis, at diagnosis, two weeks after diagnosis, four weeks after diagnosis, and six months after diagnosis. RESULTS: 521 responses were collected. Rhinologic domain SNOT-22 scores increased significantly (p < 0.001) to 8.94 at the time of diagnosis, remained elevated two weeks post-diagnosis (5.14, p = 0.004), and decreased significantly four weeks post-diagnosis (3.14, p = 0.004). Smell-specific SNOT-22 scores peaked at the time of diagnosis (2.05, p < 0.001), remained elevated two weeks after diagnosis (1.19, p < 0.001), and returned to baseline four weeks post-diagnosis (0.64, p > 0.999). Taste-specific SNOT-22 scores also peaked at diagnosis (2.06, p < 0.001), remained elevated two weeks after diagnosis (1.19, p < 0.001), and returned to baseline four weeks after diagnosis (0.71, p > 0.999). There were no significant differences in sense of smell or taste between 1-month and 6-month timepoints. CONCLUSION: Sinonasal symptoms, particularly loss of smell and taste, may be important presenting symptoms in the mild severity COVID-19 patient. Our findings support incorporating these symptoms into screening protocols. LEVEL OF EVIDENCE: 4.
Subject(s)
COVID-19/diagnosis , COVID-19/physiopathology , Paranasal Sinuses/physiopathology , Adult , COVID-19/complications , COVID-19/virology , Female , Humans , Male , Middle Aged , Olfaction Disorders/etiology , Risk Factors , SARS-CoV-2 , Severity of Illness Index , Sino-Nasal Outcome Test , Taste Disorders/etiology , Time FactorsSubject(s)
Asthma/diagnosis , Coronavirus Infections/diagnosis , Eczema/diagnosis , Food Hypersensitivity/diagnosis , Olfaction Disorders/diagnosis , Pandemics , Pneumonia, Viral/diagnosis , Rhinitis, Allergic/diagnosis , Sinusitis/diagnosis , Adult , Age Factors , Aged , Asthma/complications , Asthma/epidemiology , Asthma/physiopathology , Betacoronavirus/pathogenicity , COVID-19 , Cohort Studies , Comorbidity , Coronavirus Infections/complications , Coronavirus Infections/epidemiology , Coronavirus Infections/physiopathology , Eczema/complications , Eczema/epidemiology , Eczema/physiopathology , Female , Food Hypersensitivity/complications , Food Hypersensitivity/epidemiology , Food Hypersensitivity/physiopathology , Humans , Male , Middle Aged , Olfaction Disorders/complications , Olfaction Disorders/epidemiology , Olfaction Disorders/physiopathology , Pneumonia, Viral/complications , Pneumonia, Viral/epidemiology , Pneumonia, Viral/physiopathology , Prognosis , Rhinitis, Allergic/complications , Rhinitis, Allergic/epidemiology , Rhinitis, Allergic/physiopathology , Risk Assessment , SARS-CoV-2 , Severity of Illness Index , Sex Factors , Sinusitis/complications , Sinusitis/epidemiology , Sinusitis/physiopathologySubject(s)
Asthma/physiopathology , Coronavirus Infections/physiopathology , Eczema/physiopathology , Food Hypersensitivity/physiopathology , Hospitalization/statistics & numerical data , Pandemics , Pneumonia, Viral/physiopathology , Rhinitis, Allergic/physiopathology , Anti-Inflammatory Agents/therapeutic use , Asthma/epidemiology , Asthma/therapy , Asthma/virology , Betacoronavirus/drug effects , Betacoronavirus/immunology , Betacoronavirus/pathogenicity , COVID-19 , Cohort Studies , Comorbidity , Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Coronavirus Infections/virology , Disease Management , Eczema/epidemiology , Eczema/therapy , Eczema/virology , Food Hypersensitivity/epidemiology , Food Hypersensitivity/therapy , Food Hypersensitivity/virology , Humans , Intubation/statistics & numerical data , Pneumonia, Viral/epidemiology , Pneumonia, Viral/therapy , Pneumonia, Viral/virology , Rhinitis, Allergic/epidemiology , Rhinitis, Allergic/therapy , Rhinitis, Allergic/virology , SARS-CoV-2 , Treatment OutcomeABSTRACT
INTRODUCTION: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing the pandemic of coronavirus disease 2019 (COVID-19) is a global health crisis. Possible pancreatic involvement has recently been observed in these patients; however, its significance is unclear. The aim of this study was to evaluate the association of significantly elevated lipase with disease outcomes. METHODS: Data about demographics, symptoms, laboratory values, and clinical outcomes were collected for 1,003 consecutive patients testing positive for COVID-19. Elevated lipase was defined as greater than 3 times the upper limit of normal (>3 × ULN). Baseline characteristics among patients with or without elevated lipase were compared using Fisher exact test or Student t-test for categorical or numerical variables, respectively. Logistic regression was used to evaluate the association of lipase levels with primary clinical outcomes (intensive care unit admission and intubation) adjusted for age, sex, body mass index, history of diabetes, and hypertension. RESULTS: Of 1,003 patients with COVID-19, 83 had available lipase levels and were all admitted to the hospital. Of 83, 14 (16.8%) had elevated lipase (>3 × ULN), which was associated with higher rates of leukocytosis (P < 0.001) and abnormal liver enzymes (P < 0.01). Compared with lower lipase levels (<3 × ULN), patients with elevated lipase had higher rates of ICU admission (92.9% vs 32.8%; P < 0.001) and intubation (78.6% vs 23.5%; P 0.002). In a multivariable-adjusted model, higher lipase levels were significantly associated with admission to the ICU and rate of intubation. DISCUSSION: Lipase elevation is seen in COVID-19 and is associated with worse disease outcomes.