Gastrointestinal manifestations of COVID-19 and their association with disease severity and death in the Dominican Republic

ABSTRACT

Background. The COVID-19 pandemic has strained healthcare systems worldwide. The disease spectrum of COVID-19 is wide, ranging from asymptomatic to respiratory distress and critical illness. A wide range of associated symptoms have been described, including gastrointestinal manifestations. Defining clinical characteristics that can help identify and triage cases towards COVID-19 treatment pathways early in low-and-middle income countries is of priority. Methods. Single center retrospective review of cases admitted to a tertiary center with COVID-19 and gastrointestinal symptoms between March 2020 and November 2021. Inclusion criteria was defined as molecular diagnosis of SARS-CoV-2 with symptomatic gastrointestinal disease. Demographic and clinical characteristics were tabulated, and statistics of association and mortality were performed. Results. A total of 95 cases admitted with SARS-COV2 pneumonia met the inclusion criteria. Cases were predominantly male (65.3%). Age distribution was 48.4% >61 years, followed by 51-60 (17.9%), 31-40 (15.8%) and 41-50 years (13.7%). The gastrointestinalfindings associated with COVID-19 were transaminitis (48.4%), Nausea and diarrhea (29.5%), anorexia (28.4%) and abdominal pain (13.7%). Patients with abdominal pain had 46% with respiratory decompensation and 23% critical illness (Figure 1) compared to 39% and 17.9% in patients with diarrhea. Transaminitis was associated with highest association with progression to critical illness (30%) and death (55%). Respiratory decompensation, critical illness and death by gastrointestinalfindings Conclusion. Gastrointestinal symptoms in COVID-19 have a wide range of clinical presentation and can be associated with severity of illness and decompensation. Transaminitis had the highest association with severe disease and death. These associations, if confirmed in larger studies, can help guide triage and prognostication in resource limited settings. Further studies are needed to validate thesefindings.