Hospital das Clinicas (HCFMUSP), Faculdade de Medicina, Universidade de Sao Paulo, SP, Brazil.
Brigham and Women's Hospital - Harvard Medical School, Boston 02115, MA, United States.
Clinics (Sao Paulo). 2020 Oct 26;75:e2271. doi: 10.6061/clinics/2020/e2271. eCollection 2020.
Brazil has rapidly developed the second-highest number of COVID-19 cases in the world. As such, proper symptom identification, including gastrointestinal manifestations, and relationship to health outcomes remains key. We aimed to assess the prevalence and impact of gastrointestinal symptoms associated with COVID-19 in a large quaternary referral center in South America.
This was a single-center cohort study in a COVID-19 specific hospital in São Paulo, Brazil. Consecutive adult patients with laboratory confirmed SARS-CoV-2 were included. Baseline patient history, presenting symptoms, laboratory results, and clinically relevant outcomes were recorded. Regression analyses were performed to determine significant predictors of the gastrointestinal manifestations of COVID-19 and hospitalization outcomes.
Four-hundred patients with COVID-19 were included. Of these, 33.25% of patients reported ≥1 gastrointestinal symptom. Diarrhea was the most common gastrointestinal symptom (17.25%). Patients with gastrointestinal symptoms had higher rates of concomitant constitutional symptoms, notably fatigue and myalgia (p<0.05). Gastrointestinal symptoms were also more prevalent among patients on chronic immunosuppressants, ACE/ARB medications, and patient with chronic kidney disease (p<0.05). Laboratory results, length of hospitalization, ICU admission, ICU length of stay, need for mechanical ventilation, vasopressor support, and in-hospital mortality did not differ based upon gastrointestinal symptoms (p>0.05). Regression analyses showed older age [OR 1.04 (95% CI, 1.02-1.06)], male gender [OR 1.94 (95% CI, 1.12-3.36)], and immunosuppression [OR 2.60 (95% CI, 1.20-5.63)], were associated with increased mortality.
Based upon this Brazilian study, gastrointestinal manifestations of COVID-19 are common but do not appear to impact clinically relevant hospitalization outcomes including the need for ICU admission, mechanical ventilation, or mortality.
巴西迅速成为全球 COVID-19 病例第二多的国家。因此，正确识别症状，包括胃肠道表现，以及与健康结果的关系仍然是关键。我们旨在评估南美洲一家四级转诊中心 COVID-19 患者中与 COVID-19 相关的胃肠道症状的患病率和影响。
这是巴西圣保罗一家 COVID-19 专科医院的单中心队列研究。纳入了实验室确诊 SARS-CoV-2 的连续成年患者。记录了患者的基线病史、就诊症状、实验室结果和临床相关结局。回归分析用于确定 COVID-19 胃肠道表现和住院结局的显著预测因素。
共纳入 400 例 COVID-19 患者。其中，33.25%的患者报告存在≥1 种胃肠道症状。腹泻是最常见的胃肠道症状（17.25%）。有胃肠道症状的患者更常伴有全身症状，尤其是疲劳和肌痛（p<0.05）。胃肠道症状在接受慢性免疫抑制剂、ACE/ARB 药物治疗以及患有慢性肾脏病的患者中更为常见（p<0.05）。基于胃肠道症状，实验室结果、住院时间、入住 ICU、ICU 住院时间、机械通气需求、血管加压素支持和住院死亡率无差异（p>0.05）。回归分析显示，年龄较大[比值比（OR）1.04（95%置信区间，1.02-1.06）]、男性[OR 1.94（95%置信区间，1.12-3.36）]和免疫抑制[OR 2.60（95%置信区间，1.20-5.63）]与死亡率增加相关。
基于这项巴西研究，COVID-19 的胃肠道表现很常见，但似乎不会影响包括入住 ICU、机械通气或死亡率在内的临床相关住院结局。
