tetano
Editor, Senior Moderator
Gastro Hep Adv
. 2022 Aug 7.
doi: 10.1016/j.gastha.2022.06.015. Online ahead of print.
Associations Between Gastrointestinal Symptoms and COVID-19 Severity Outcomes, Based on a Propensity Score-Weighted Analysis of a Nationwide Cohort
Shailja C Shah[SUP] 1 2 [/SUP], Andrew Canakis[SUP] 3 [/SUP], Alese E Halvorson[SUP] 4 [/SUP], Chad Dorn[SUP] 5 [/SUP], Otis Wilson[SUP] 6 7 [/SUP], Jason Denton[SUP] 5 [/SUP], Richard Hauger[SUP] 8 9 [/SUP], Christine Hunt[SUP] 10 11 [/SUP], Ayako Suzuki[SUP] 10 11 [/SUP], Michael E Matheny[SUP] 5 7 12 [/SUP], Edward Siew[SUP] 7 13 [/SUP], Adriana Hung[SUP] 7 13 [/SUP], Robert A Greevy Jr[SUP] 4 6 [/SUP], Christianne L Roumie[SUP] 6 12 14 [/SUP]
Affiliations
Abstract
Background and aims: Gastrointestinal (GI) symptoms are well-recognized manifestations of coronavirus disease 2019 (COVID-19). Our primary objective was to evaluate the association between GI symptoms and COVID-19 severity.
Methods: In this nationwide cohort of US veterans, we evaluated GI symptoms (nausea/vomiting/diarrhea) reported 30 days prior to and including the date of positive SARS-CoV-2 testing (March 1, 2020-February 20, 2021). All patients had >1 year of prior baseline data and >60 days follow-up relative to the test date. We used propensity score (PS)-weighting to balance covariates in patients with vs. without GI symptoms. The primary composite outcome was severe COVID-19, defined as hospital admission, intensive care unit (ICU) admission, mechanical ventilation, or death within 60-days of positive testing.
Results: Of 218,045 SARS-CoV-2 positive patients, 29,257 (13.4%) had GI symptoms. After PS-weighting, all covariates were balanced. In the PS-weighted cohort, patients with vs. without GI symptoms had severe COVID-19 more often (29.0% vs. 17.1%, P<0.001). When restricted to hospitalized patients (14.9%; n=32,430), patients with GI symptoms had similar frequencies of ICU admission and mechanical ventilation compared to patients without symptoms. There was a significant age interaction; among hospitalized patients >70 years old, lower COVID-19 associated mortality was observed in patients with vs. without GI symptoms, even after accounting for COVID-19-specific medical treatments.
Conclusion: In the largest integrated US healthcare system, SARS-CoV-2 positive patients with GI symptoms experienced severe COVID-19 outcomes more often than those without symptoms. Additional research on COVID-19 associated GI symptoms may inform preventive efforts and interventions to reduce severe COVID-19.
Keywords: Corporate Data Warehouse, CDW; International Classification of Diseases, ICD; Observational Medical Outcomes Partnership, OMOP; Shared Data Resource, SDR; VA Informatics and Computing Infrastructure, VINCI; Veterans Affairs, VA; Veterans Health Administration, VHA; angiotensin II receptor blockers, ARBs; angiotensin-converting enzyme 2, ACE2; angiotensin-converting enzyme-inhibitors, ACEi; body mass index, BMI; confidence intervals, CI; coronavirus Disease 2019, COVID-19; gastrointestinal, GI; odds ratios, OR; propensity-score, PS; renin-angiotensin-aldosterone system inhibitors, RAASi; severe acute respiratory syndrome coronavirus 2, SARS-CoV-2; standard deviations, SD; standardized mean differences, SMDs.
. 2022 Aug 7.
doi: 10.1016/j.gastha.2022.06.015. Online ahead of print.
Associations Between Gastrointestinal Symptoms and COVID-19 Severity Outcomes, Based on a Propensity Score-Weighted Analysis of a Nationwide Cohort
Shailja C Shah[SUP] 1 2 [/SUP], Andrew Canakis[SUP] 3 [/SUP], Alese E Halvorson[SUP] 4 [/SUP], Chad Dorn[SUP] 5 [/SUP], Otis Wilson[SUP] 6 7 [/SUP], Jason Denton[SUP] 5 [/SUP], Richard Hauger[SUP] 8 9 [/SUP], Christine Hunt[SUP] 10 11 [/SUP], Ayako Suzuki[SUP] 10 11 [/SUP], Michael E Matheny[SUP] 5 7 12 [/SUP], Edward Siew[SUP] 7 13 [/SUP], Adriana Hung[SUP] 7 13 [/SUP], Robert A Greevy Jr[SUP] 4 6 [/SUP], Christianne L Roumie[SUP] 6 12 14 [/SUP]
Affiliations
- PMID: 35966642
- PMCID: PMC9357443
- DOI: 10.1016/j.gastha.2022.06.015
Abstract
Background and aims: Gastrointestinal (GI) symptoms are well-recognized manifestations of coronavirus disease 2019 (COVID-19). Our primary objective was to evaluate the association between GI symptoms and COVID-19 severity.
Methods: In this nationwide cohort of US veterans, we evaluated GI symptoms (nausea/vomiting/diarrhea) reported 30 days prior to and including the date of positive SARS-CoV-2 testing (March 1, 2020-February 20, 2021). All patients had >1 year of prior baseline data and >60 days follow-up relative to the test date. We used propensity score (PS)-weighting to balance covariates in patients with vs. without GI symptoms. The primary composite outcome was severe COVID-19, defined as hospital admission, intensive care unit (ICU) admission, mechanical ventilation, or death within 60-days of positive testing.
Results: Of 218,045 SARS-CoV-2 positive patients, 29,257 (13.4%) had GI symptoms. After PS-weighting, all covariates were balanced. In the PS-weighted cohort, patients with vs. without GI symptoms had severe COVID-19 more often (29.0% vs. 17.1%, P<0.001). When restricted to hospitalized patients (14.9%; n=32,430), patients with GI symptoms had similar frequencies of ICU admission and mechanical ventilation compared to patients without symptoms. There was a significant age interaction; among hospitalized patients >70 years old, lower COVID-19 associated mortality was observed in patients with vs. without GI symptoms, even after accounting for COVID-19-specific medical treatments.
Conclusion: In the largest integrated US healthcare system, SARS-CoV-2 positive patients with GI symptoms experienced severe COVID-19 outcomes more often than those without symptoms. Additional research on COVID-19 associated GI symptoms may inform preventive efforts and interventions to reduce severe COVID-19.
Keywords: Corporate Data Warehouse, CDW; International Classification of Diseases, ICD; Observational Medical Outcomes Partnership, OMOP; Shared Data Resource, SDR; VA Informatics and Computing Infrastructure, VINCI; Veterans Affairs, VA; Veterans Health Administration, VHA; angiotensin II receptor blockers, ARBs; angiotensin-converting enzyme 2, ACE2; angiotensin-converting enzyme-inhibitors, ACEi; body mass index, BMI; confidence intervals, CI; coronavirus Disease 2019, COVID-19; gastrointestinal, GI; odds ratios, OR; propensity-score, PS; renin-angiotensin-aldosterone system inhibitors, RAASi; severe acute respiratory syndrome coronavirus 2, SARS-CoV-2; standard deviations, SD; standardized mean differences, SMDs.