PREVALENCE OF GASTROINTESTINAL SYMPTOMS AND RELATIONSHIP WITH POOR OUTCOMES AMONG PATIENTS WITH COVID-19 PRESENTING TO THE HOSPITAL: A NATIONAL DATABASE STUDY

ABSTRACT

BACKGROUND: Gastrointestinal (GI) symptoms such as nausea and diarrhea have been reported in patients with SARS-CoV-2 coronavirus (COVID-19). However, outcomes of patients with COVID-19 and GI symptoms and risk factors associated with poor outcomes in this patient population have not been assessed. METHODS: The study cohort was derived from the Cerner Real World Data (CRWD) COVID-19 Database inclusive of emergency department and hospital encounters with COVID-19 infection from December 1, 2019, to November 30, 2020. Baseline demographics, comorbidities, hospital characteristics, and GI symptoms were obtained. The outcomes of interest were mortality, acute respiratory distress syndrome (ARDS), sepsis, and ventilator requirement/oxygen dependence. Multivariate logistic regression analysis was performed to assess predictors of poor outcomes in hospitalized COVID-19 patients with GI symptoms. RESULTS: Of 100,902 patients with COVID-19 infection, 19.7% reported GI symptoms. Those with GI symptoms had a significantly higher prevalence of comorbidities and underlying chronic GI conditions (Table 1). In patients with COVID-19 and GI symptoms, advanced age was associated with a higher risk of overall mortality, ARDS, sepsis, and ventilator requirement/oxygen dependence (Table 2);whereas the female gender was associated with a lower risk of mortality (OR 0.68, 95% CI 0.61, 0.76), ARDS (OR 0.68, 95% CI 0.60, 0.77), and sepsis (OR 0.70, 95% CI 0.64, 0.75). A higher Charlson Comorbidity Index was also associated with higher mortality, ARDS, sepsis, and ventilator requirement/oxygen dependence-Table 2. Finally, history of PPI and H2RA use (minimum duration 1 month) was associated with an increased risk of mortality (OR 1.48, 95% CI 1.32, 1.66) and (OR 1.78, 95% CI 1.57, 2.02), ARDS (OR 2.19, 95% CI 1.91, 2.50) and (OR 3.75, 95% CI 3.29, 4.28), sepsis (OR 1.88, 95% CI 1.73, 2.05) and (OR 2.50, 95% CI 2.28, 2.73);and ventilator requirement/oxygen dependence (OR 1.73, 95% CI 1.48, 2.02) and (OR 1.97, 95% CI 1.68, 2.30) respectively. CONCLUSION: GI symptoms are reported by 1 in 5 patients admitted to the hospital with COVID-19. Advanced age, male gender, a higher comorbidity score, and use of acid suppression medications (PPI/ H2RA) were associated with poor outcomes including death