Epidemiological, clinical and virological characteristics of 74 cases of coronavirus-infected disease 2019 (COVID-19) with gastrointestinal symptoms

Jin, Xi; Lian, Jiang-Shan; Hu, Jian-Hua; Gao, Jianguo; Zheng, Lin; Zhang, Yi-Min; Hao, Shao-Rui; Jia, Hong-Yu; Cai, Huan; Zhang, Xiao-Li; Yu, Guo-Dong; Xu, Kai-Jin; Wang, Xiao-Yan; Gu, Jue-Qing; Zhang, Shan-Yan; Ye, Chan-Yuan; Jin, Ci-Liang; Lu, Ying-Feng; Yu, Xia; Yu, Xiao-Peng; Huang, Jian-Rong; Xu, Kang-Li; Ni, Qin; Yu, Cheng-Bo; Zhu, Biao; Li, Yong-Tao; Liu, Jun; Zhao, Hong; Zhang, Xuan; Yu, Liang; Guo, Yong-Zheng; Su, Jun-Wei; Tao, Jing-Jing; Lang, Guan-Jing; Wu, Xiao-Xin; Wu, Wen-Rui; Qv, Ting-Ting; Xiang, Dai-Rong; Yi, Ping; Shi, Ding; Chen, Yanfei; Ren, Yue; Qiu, Yun-Qing; Li, Lan-Juan; Sheng, Jifang; Yang, Yida

We further analysed the epidemiological and clinical characteristics of patients with COVID-19 with GI symptoms. We identified a significantly higher rate of >38.5°C fever and family clustering, increased complications of ARDS and a high severity tendency (rate of severe/critical type, mechanical ventilation and ICU admission) in patients with COVID-19 with GI symptoms, when compared with those without GI symptoms. We suspect that GI symptoms may cause patients with COVID-19 to be more prone to electrolyte disturbance, such as significantly decreased serum sodium levels (p=0.016), and hence they trend towards the severe/critical type of the disease. Other reasons should be considered and explored based on future data. In addition, the higher rates of familial clustering may be related to faecal shedding in shared toilets in households. Further multivariate analysis revealed sputum production from infected areas and increased LDH/glucose levels as independent risk factors for the disease. In addition, symptoms of fatigue, shortness of breath and headache were also significantly higher in patients with COVID-19 with GI symptoms, which may be caused by their higher fevers and increased electrolyte imbalance. Liver damage should be carefully monitored, as we found significantly increased AST levels and coexisting conditions of liver disease in patients with COVID-19 with GI symptoms. Since the ratio of chronic liver disease was higher in patients with COVID-19 with GI symptoms, it could lead to increased levels of ALT and AST. Although there were no significant differences in glucocorticoid and antibiotic therapy between patients with COVID-19 with and without GI symptoms, they were both lower than their counterparts in Wuhan, 4 showing our own experience in effective therapy.