A retrospective analysis of the prevalence, duration, and severity of gastrointestinal symptoms among non-hospitalized patients with COVID-19

ABSTRACT

Introduction: COVID-19 gastrointestinal (GI) symptoms have significant heterogeneity in prevalence, duration, and severity, but limited data are available on patients who do not require hospitalization. We aimed to elucidate the characteristics of GI symptoms in the outpatient setting and define symptoms from onset to resolution compared to the recommended isolation guidelines. Methods: The study included all adults with a positive COVID-19 test in an outpatient setting over a 2-month period. Data were collected from electronic health records and included symptoms upon diagnosis that were followed to their resolution. Descriptive analyses used means and standard deviations or medians and inter-quartile ranges (depending on data distribution) for continuous variables and frequencies with proportions for categorical data. Mann-Whitney U tests, chi square tests, and Spearman Rho correlations were used for statistical analysis. Results: We screened 1165 patients and included 299 in the study. The mean age was 47.19 years old, with women showing predominance (57.7%). No correlation was found between age and time to resolutions of GI symptoms diarrhea (r=-0.022, n = 40, p =0.892), nausea (r=0.097, n=26, p =0.636), and vomiting (r=-0.207, n=6, p =0.694). Fever was present in 65.6% (196/299) of the patients. Diarrhea was the most prevalent GI symptom (21.1%;63/299), followed by nausea (13.4%;40/299) and vomiting (4.7%;14/299). Diarrhea was significantly more prevalent in patients with fever (25.5%;50/196) compared to patients with no fever (12.6%;13/103) [p =0.009]. Median time to resolution of GI symptoms was 17.5 days (11.75-33.25) compared to 17 days (12-23.5) for non-GI symptoms [p =0.569] (Figure 1a). Median time to resolution of diarrhea was 13 days (11-20) among smokers and 24 days (13-36) among non-smokers [p =0.042] (Figure 1b). Conclusion: No demographic data led to prolonged GI symptoms in patients with COVID-19 in the outpatient setting. Diarrhea lasted longer in patients who had fever, increasing the risk of possible fecal-oral viral transmission. Despite its established negative impact on health, smoking was correlated with a shorter duration of diarrhea. The median symptom duration was higher than the CDCrecommended isolation time of 10 days. Despite vaccine availability, COVID-19 spread continues to pose a challenge. Larger scale studies are needed to corroborate these findings to guide recommendations for length of quarantine and care escalation in non-hospitalized patients..