Gastro Hep Adv . Factors associated with poor outcomes among COVID-19 patients with gastrointestinal symptoms

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Gastro Hep Adv


. 2022 Aug 26.
doi: 10.1016/j.gastha.2022.08.004. Online ahead of print.
Factors associated with poor outcomes among COVID-19 patients with gastrointestinal symptoms


Nikita Patil ¹ , Pankush Kalgotra ² , Suneha Sundaram ³ , Stephanie Melquist ^{4 5} , Sravanthi Parasa ⁶ , Madhav Desai ^{4 7} , Prateek Sharma ^{4 7}



Affiliations

• PMID: 36043056
• PMCID: PMC9411817
• DOI: 10.1016/j.gastha.2022.08.004

Abstract

Background & aims: Gastrointestinal (GI) symptoms are present in 20% of patients with COVID-19. We studied the association of GI symptoms (in COVID-19 patients) with adverse outcomes and factors associated with poor outcomes in these patients.
Methods: The study cohort included 100,902 patients from the Cerner Real World Data (CRWD) COVID-19 Database of hospital encounters and emergency department (ER) visits with COVID-19 infection from December 1, 2019, to November 30, 2020. Multivariate analysis was used to study the effect of GI symptoms on adverse outcomes, and the factors associated with acute respiratory distress syndrome (ARDS), sepsis, and ventilator requirement or oxygen dependence in COVID-19 patients with GI symptoms.
Results: Patients with COVID-19 and GI symptoms were significantly more likely to have ARDS (OR 1.20, 95% CI 1.11, 1.29), sepsis (OR 1.19, 95% CI 1.14, 1.24), acute kidney injury (OR 1.30, 95% CI 1.24, 1.36), venous thromboembolism (OR 1.36, 95% CI 1.22, 1.52) or GI bleed (OR 1.62, 95% CI 1.47, 1.79); and less likely to experience cardiomyopathy (OR 0.87, 95% CI 0.77, 0.99) or death (OR 0.71, 95% CI 0.67, 0.75). Among those with GI symptoms, older age, higher Charlson comorbidity index scores, and use of proton pump inhibitors (PPI)/ H2 receptor antagonists (H2RA) were associated with higher mortality, ARDS, sepsis, and ventilator or oxygen requirement.
Conclusion: Patients with COVID-19 who have GI symptoms have overall worse in-hospital complications, but less cardiomyopathy and mortality. Older age, higher comorbidity scores, and the use of PPI and H2RA are associated with poor outcomes in these patients.

Keywords: AKI, Acute kidney injury; ARDS, acute respiratory distress syndrome; Acute respiratory distress syndrome; CCI, Charlson comorbidity index; CI, confidence interval; COVID-19, SARS-CoV-2 coronavirus infection; CRWD, Cerner real-world data; ER, Emergency Department; GERD, gastroesophageal reflux disease; GI, gastrointestinal; H2 receptor antagonist; H2RA, H2 receptor antagonist; ICD-10-CM, The International Classification of Diseases, Tenth Revision, Clinical Modification; ICD-9-CM, The International Classification of Diseases, Ninth Revision, Clinical Modification; Mortality; OR, Odds ratio; PPI, proton pump inhibitors; VTE, Venous thromboembolism; proton pump inhibitor.