An analysis of gi and non-gi manifestations of covid-19 during the first wave of the covid-19 pandemic in darlington, united kingdom

ABSTRACT

Introduction: Gastrointestinal (GI) manifestations of COVID-19 have been increasingly reported from many centres but it is not clear as to whether the presence of GI manifestations influences the outcomes of COVID-19. The data from the UK is still emerging and there is significant variability between the North of England and the rest of the UK. Aims & Methods: DarCoVE was a single centre epidemiological study initiated over a 3 week period during the peak of the first wave of the COVID- 19 pandemic in the United Kingdom. This prospective cohort analysis evaluated the GI and non-GI manifestations of the disease and produced a multi-variate analysis of prognosticators for COVID-19. Consecutive patients admitted with fever, cough or shortness of breath to the Acute Medical Admissions Service of Darlington Memorial Hospital between 26 March 2020-12 April 2020 were recruited to an electronic database, and divided into two cohorts RT-PCR positive for SARS-CoV-2 (COVID+) and negative (COVID-). Demographic parameters, underlying co-morbidities, GI and non-GI symptoms, BMI, haematological and biochemical laboratory parameters, chest radiology, need for supplemental oxygen, need for high dependency and intensive care treatment, length of hospital stay and mortality were recorded. Univariate survival analysis was performed by Cox proportional hazard model in R, multi variate analysis was done by forward selection model, cumulative survival by Kaplan- Meier method using log-rank test. Results: 275 patients formed the dataset for analysis, 130 COVID+. Median age of COVID+ was 70(range 23-95yrs), 63% were over age 65yrs, MF=1.28. 73% had at least one co-morbidity, diabetes commonest. Median BMI 29.7 (range 13.9-44.9). 60.8% patients had a BMI>30, compared to UK average of 10.9% (p<0.001). GI manifestations included diarrhoea in 10.1%, vomiting 13%, abdominal discomfort 9.4%, loss of appetite 5.7%, abnormal liver functions 37%, mean ALT 52.4 IU/L, ALT >150 in 5.1%. Of 43 clinical and biochemical factors investigated for prognostic value, 9 factors were associated with outcome at p<0.05 with cough and diarrhoea associated with lower risk of death compared to the other 7 factors. On multivariate analysis, high frailty score > 5, worst oxygenation SpO2 < 93%, platelets < 100 x 109/L and immunocompromised were poor prognosticators. None of the GI manifestations co-related with risk of death in this analysis, with a trend for ALT >150 to be associated with higher mortality. Overall mortality was 30.8% compared to UK national mortality of 26%, with ITU mortality higher at 37%. Conclusion: This study has shown a regional variation in the outcome of COVID-19, with slightly different prognosticators. GI manifestations continue to be significant in COVID-19, with a trend seen with high ALT. The data from this analysis will help management in future pandemics.