Prevalence and clinical significance of gastrointestinal manifestations in COVID-19

OBJECTIVE The goal of this study was to determine the prevalence of gastrointestinal manifestations in coronavirus disease 2019 (COVID-19) and to show the identification of potential connections between gastrointestinal manifestations and outcomes. METHOD This was a retrospective single-centre cohort study, enrolling 205 COVID-19 patients at Saiful Anwar Genera Hospital in Malang, Indonesia, from October 2020 to February 2021. All patients were confirmed by real-time polymerase chain reaction (real-time PCR). Demographics and clinical characteristics, laboratory data, and clinical outcomes were analyzed. RESULTS Among 205 patients, 163 patients (79.5%) had gastrointestinal manifestations, including 145 (89.0%) nausea and vomiting, 132 (81.0%) hyporexia/anorexia, 48 (29.4%) abdominal pain, 38 (23.3%) diarrhea, 13 (8.0%) dysphagia, 12 (7.4%) hematemesis/melena, and 4 (2.5%) constipation. In our findings, we revealed that patients with gastrointestinal manifestations were significantly associated with higher body mass index, a longer length of stay, decreased albumin level and increased several parameters, including fibrinogens, D-Dimer, alanine aminotransferase, total bilirubin, random blood glucose, lactate dehydrogenase, ferritin, C-reactive protein, and lactate acid compared to those without gastrointestinal manifestations. Gastrointestinal manifestation in COVID-19 patients was associated with severe/critical degree (odds ratio [OR]: 4.09; 95% confidence interval [CI]: 1.52–10.97; p=0.00) of COVID-19, intensive care unit (ICU) admission (OR: 4.23; 95% CI: 1.24–14.43), and in-hospital mortality (OR: 4.51; 95% CI: 1.41–16.35; p=0.01). CONCLUSIONS Gastrointestinal manifestations are frequent in COVID-19 patients and associated with an increased hypercoagulable and inflammatory marker, longer length of stay, severe and critical degree of COVID-19, ICU admission, and in-hospital mortality.