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

OBJECTIVE: The SARS-CoV-2-infected disease (COVID-19) outbreak is a major threat to human beings. Previous studies mainly focused on Wuhan and typical symptoms. We analysed 74 confirmed COVID-19 cases with GI symptoms in the Zhejiang province to determine epidemiological, clinical and virological characteristics. DESIGN: COVID-19 hospital patients were admitted in the Zhejiang province from 17 January 2020 to 8 February 2020. Epidemiological, demographic, clinical, laboratory, management and outcome data of patients with GI symptoms were analysed using multivariate analysis for risk of severe/critical type. Bioinformatics were used to analyse features of SARS-CoV-2 from Zhejiang province. RESULTS: Among enrolled 651 patients, 74 (11.4%) presented with at least one GI symptom (nausea, vomiting or diarrhoea), average age of 46.14 years, 4-day incubation period and 10.8% had pre-existing liver disease. Of patients with COVID-19 with GI symptoms, 17 (22.97%) and 23 (31.08%) had severe/critical types and family clustering, respectively, significantly higher than those without GI symptoms, 47 (8.14%) and 118 (20.45%). Of patients with COVID-19 with GI symptoms, 29 (39.19%), 23 (31.08%), 8 (10.81%) and 16 (21.62%) had significantly higher rates of fever >38.5°C, fatigue, shortness of breath and headache, respectively. Low-dose glucocorticoids and antibiotics were administered to 14.86% and 41.89% of patients, respectively. Sputum production and increased lactate dehydrogenase/glucose levels were risk factors for severe/critical type. Bioinformatics showed sequence mutation of SARS-CoV-2 with m(6)A methylation and changed binding capacity with ACE2. CONCLUSION: We report COVID-19 cases with GI symptoms with novel features outside Wuhan. Attention to patients with COVID-19 with non-classic symptoms should increase to protect health providers.