Disease Course and Outcomes of COVID-19 Among Hospitalized Patients with Gastrointestinal Manifestations

Laszkowska, Monika; Faye, Adam S.; Kim, Judith; Truong, Han; Silver, Elisabeth R.; Ingram, Myles; May, Benjamin; Ascherman, Benjamin; Bartram, Logan; Zucker, Jason; Sobieszczyk, Magdalena E.; Abrams, Julian A.; Lebwohl, Benjamin; Freedberg, Daniel E.; Hur, Chin

Background & Aims Our understanding of outcomes and disease time course of COVID-19 in patients with gastrointestinal (GI) symptoms remains limited. In this study we characterize the disease course and severity of COVID-19 among hospitalized patients with gastrointestinal manifestations in a large, diverse cohort from the Unites States. Methods This retrospective study evaluated hospitalized individuals with COVID-19 between March 11 and April 28, 2020 at two affiliated hospitals in New York City. We evaluated the association between GI symptoms and death, and also explored disease duration, from symptom onset to death or discharge. Results Of 2,804 patients hospitalized with COVID-19, the 1,084 (38.7%) patients with GI symptoms were younger (aOR for age≥75 0.59, 95% CI 0.45-0.77) and had more co-morbidities (aOR for modified Charlson comorbidity score ≥2 1.22, 95% CI 1.01-1.48) compared to those without GI symptoms. Individuals with GI symptoms had better outcomes, with a lower likelihood of intubation (aHR 0.66, 95% CI 0.55-0.79) and death (aHR 0.71, 95% CI 0.59-0.87), after adjusting for clinical factors. These patients had a longer median disease course from symptom onset to discharge (13.8 vs. 10.8 days, log-rank p=0.048; among 769 survivors with available symptom onset time), which was driven by longer time from symptom onset to hospitalization (7.4 vs. 5.4 days, log-rank p<0.01). Conclusion Hospitalized patients with GI manifestations of COVID-19 have a reduced risk of intubation and death, but may have a longer overall disease course driven by duration of symptoms prior to hospitalization.