Hospitalized COVID-19 People With GI Symptoms Have Worse Outcomes
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Patients with COVID-19 who experience gastrointestinal indications have general even worse in-healthcare facility problems but fewer cardiomyopathy and mortality, in accordance to a new study.
Dr Nikita Patil
About 20% of COVID-19 patients encounter gastrointestinal indicators, these kinds of as belly pain, diarrhea, nausea, and vomiting, which clinicians must take into consideration when treating their hospitalized people, wrote researchers led by Nikita Patil, MD, a hospitalist at Nash Standard Hospital–UNC Nash Healthcare in Rocky Mount, N.C., in Gastro Hep Innovations.
“It is significant to know that sure difficulties are increased in men and women with GI signs or symptoms,” she stated in an interview. “Even without the need of an elevated risk of death, there are lots of issues that have an impact on high quality of lifestyle and guide to folks not getting in a position to do the points they had been ready to do in advance of.”
Patil and colleagues analyzed the affiliation of GI signs or symptoms with adverse outcomes in 100,902 clients from the Cerner Serious-Entire world Details COVID-19 Database, which included medical center encounters and ED visits for COVID-19 involving December 2019 to November 2020 the info were taken from EMRs at facilities with which Cerner has a knowledge use settlement. They also seemed at variables linked with weak outcomes these as acute respiratory distress syndrome, sepsis, and ventilator need or oxygen dependence.
The regular age of the people was 52, and a greater proportion of clients with GI indications were 50 and older. Of people with GI symptoms, 54.5% were females. In general, clients with GI indications were being extra possible to have increased Charlson Comorbidity Index scores and have comorbidities these kinds of as acute liver failure, gastroesophageal reflux sickness, GI malignancy, and inflammatory bowel disorder.
The exploration crew observed that COVID-19 individuals with GI signs and symptoms have been additional likely to have acute respiratory distress syndrome (odds ratio, 1.20 95% self confidence interval, 1.11-1.29), sepsis (OR, 1.19 95% CI, 1.14-1.24), acute kidney injuries (OR, 1.30 95% CI, 1.24-1.36), venous thromboembolism (OR, 1.36 95% CI, 1.22-1.52), and GI bleeding (OR 1.62 95% CI, 1.47-1.79), as compared with COVID-19 sufferers with no GI indicators (P < .0001 for all comparisons). At the same time, those with GI symptoms were less likely to experience cardiomyopathy (OR, 0.87 95% CI, 0.77-0.99 P = .027), respiratory failure (OR, 0.92 95% CI, 0.88-0.95 P < .0001), or death (OR, 0.71 95% CI, 0.67-0.75 P < .0001).
GI bleed was the most common GI complication, found among 2% of all patients, and was more likely in patients with GI symptoms than in those without (3.5% vs. 1.6%). Intestinal ischemia, pancreatitis, acute liver injury, and intestinal pseudo-obstruction weren’t associated with GI symptoms.
Among the 19,915 patients with GI symptoms, older age, higher Charlson Comorbidity Index scores, use of proton pump inhibitors, and use of H2 receptor antagonists were associated with higher mortality, acute respiratory distress syndrome, sepsis, and ventilator or oxygen requirement. Men with GI symptoms also had a higher risk of mortality, acute respiratory distress syndrome, and sepsis.
In particular, proton pump inhibitor use was associated with more than twice the risk of acute respiratory distress syndrome (OR, 2.19 95% CI, 1.32-1.66 P < .0001). Similarly, H2 receptor antagonist use was associated with higher likelihood of death (OR, 1.78 95% CI, 1.57-2.02), as well as more than three times the risk of acute respiratory distress syndrome (OR, 3.75 95% CI, 3.29-4.28), more than twice the risk of sepsis (OR, 2.50 95% CI, 2.28-2.73), and nearly twice the risk of ventilator or oxygen dependence (OR, 1.97 95% CI, 1.68-2.30) (P < .0001 for all).
The findings could guide risk stratification, prognosis, and treatment decisions in COVID-19 patients with GI symptoms, as well as inform future research focused on risk mitigation and improvement of COVID-19 outcomes, Patil said.
“The protocols for COVID-19 treatment have changed over the past 2 years with blood thinners and steroids,” she said. “Although we likely can’t avoid anti-reflux medicines entirely, it’s something we need to be cognizant of and look out for in our hospitalized patients.”
One study limitation was its inclusion of only inpatient or ED encounters and, therefore, omission of those treated at home this confers bias toward those with more aggressive disease, according to the authors.
The authors reported no grant support or funding sources for this study. One author declared grant support and consultant fees from several companies, including some medical and pharmaceutical companies, which were unrelated to this research. Patil reported no disclosures.
This article originally appeared on MDedge.com, part of the Medscape Professional Network.