Gastrointestinal Symptoms Are Associated with the Increased Risk of Progression from Non-Severe to Severe Illness in COVID-19 Patients: A Multicenter, Retrospective Study (preprint)

ABSTRACT

Background: The involvement of gastrointestinal (GI) symptoms in the progression of COVID-19 patients has not been illustrated, with the association between GI symptoms and severity of illness remaining controversial. The present study aimed to evaluate the association between GI symptoms and the illness progression, severity, and prognosis of COVID-19 patients. Design: This retrospective study recruited 1024 consecutive patients with laboratory-confirmed COVID-19 from three hospitals in Wuhan. The severity of illness was classified as non-severe and severe for analyses. The primary outcome was the association between GI symptoms and the progression from non-severe to severe illness (PNTS) in COVID-19 patients. Results: Of the 934 COVID-19 patients (mean age 59.3 years; 43.7% males), the prevalence of overall and specific GI symptoms at/prior to admission were 59.9% and 13.0%, respectively. Patients with GI symptoms were associated with increased risk of fever (56.1% vs. 48.1%; P=0.02), increased IL-6 (18.2% vs. 11.7%; P=0.04), ground-glass opacity (56.8% vs. 43.1%; P<0.001), bilateral pneumonia (80.4% vs. 72.3%; P=0.005), secondary infections (12.6% vs. 6.5%;, P=0.003), and hypoalbuminemia (26.2% vs. 18.4%; P=0.01). Patients with GI symptoms had a higher risk for PNTS (2.9% vs. 0.6%; P=0.02), even after full adjustments (OR, 6.50; (95%CI1.34-31.6); P=0.02), but no risk for severe illness or deaths. GI symptoms and the specific GI symptoms were identified as the independent risk factors for PNTS. Conclusion: The occurrence of GI symptoms is proved to be the independent risk factor for PNTS, which might be a crucial indicator in the early prevention of illness deterioration.Funding Statement National Key R&D Program of China (2018YFC1313103), and National Natural Science Foundation of China (Grant No. 81670473 and 81873546), "Shu Guang" project of Shanghai Municipal Education Commission and Shanghai Education Development Foundation (No. 19SG30).Declaration of Interests There is no conflict of interests for each authorEthics Approval Statement This study was approved by the Ethics Committee of the Changhai hospitals. The requirement for informed patient consent was waived by the ethics committee due to the retrospective design and as the data analyzed were considered as a part of a continuing investigation of a public health emergency of international concern by the National Health Commission (NHC) of the People's Republic of China.