Gastrointestinal symptoms and complications in patients hospitalized due to COVID-19, an international multicentre prospective cohort study (TIVURON project)
Karina Cárdenas-Jaén, Sergio A Sánchez-Luna, Alicia Vaillo-Rocamora, Micaela Riat Castro-Zocchi, Laura Guberna-Blanco, Daniel Useros-Brañas, José M Remes-Troche, Antonio Ramos-De La Medina, Bryan A Priego-Parra, José A Velarde-Ruiz Velasco, Pedro Martínez-Ayala, Álvaro Urzúa, Dannette Guiñez-Francois, Katarzyna M Pawlak, Katarzyna Kozłowska-Petriczko, Irati Gorroño-Zamalloa, Clara Urteaga-Casares, Inmaculada Ortiz-Polo, Adolfo Del Val Antoñana, Edgard E Lozada-Hernández, Enrique Obregón-Moreno, Guillermo García-Rayado, María José Domper-Arnal, Diego Casas-Deza, Elena I Esteban-Cabello, Luis A Díaz, Arnoldo Riquelme, Helena Martínez-Lozano, Francisco Navarro-Romero, Ignasi Olivas, Guillem Iborra-Muñoz, Alicia Calero-Amaro, Ibán Caravaca-García, Francisco J Lacueva-Gómez, Rubén Pastor-Mateu, Berta Lapeña-Muñoz, Violeta Sastre-Lozano, Nazaret M Pizarro-Vega, Luigi Melcarne, Marc Pedrosa-Aragón, José J Mira, Aurora Mula Mstat, Irene Carrillo, Enrique De-Madaria
Gastroenterología y Hepatología, doi:10.1016/j.gastrohep.2022.10.007
Background: Retrospective studies suggest that coronavirus disease (COVID-19) commonly involves gastrointestinal (GI) symptoms and complications. Our aim was to prospectively evaluate GI manifestations in patients hospitalized for COVID-19. Methods: This international multicentre prospective cohort study recruited COVID-19 patients hospitalized at 31 centres in Spain, Mexico, Chile, and Poland, between May and September 2020. Patients were followed-up until 15 days post-discharge and completed comprehensive questionnaires assessing GI symptoms and complications. A descriptive analysis as well as a bivariate and multivariate analysis were performer using binary logistic regression. p < 0.05 was considered significant. Results: Eight hundred twenty-nine patients were enrolled; 129 (15.6%) had severe COVID-19, 113 (13.7%) required ICU admission, and 43 (5.2%) died. Upon admission, the most prevalent GI symptoms were anorexia (n = 413; 49.8%), diarrhoea (n = 327; 39.4%), nausea/vomiting (n = 227; 27.4%), and abdominal pain (n = 172; 20.7%), which were mild/moderate throughout the disease and resolved during follow-up. One-third of patients exhibited liver injury. Non-severe COVID-19 was associated with ≥2 GI symptoms upon admission (OR 0.679; 95% CI 0.464---0.995; p = 0.046) or diarrhoea during hospitalization (OR 0.531; 95% CI 0.328---0.860; p = 0.009). Multivariate analysis revealed that worse hospital outcomes were not independently associated with liver injury or GI symptoms. Conclusion: GI symptoms were more common than previously documented, and were mild, rapidly resolved, and not independently associated with COVID-19 severity. Liver injury was a frequent complication in hospitalized patients not independently associated with COVID-19 severity.
Authors' contributions All authors were involved in data acquisition and critical revision of the manuscript. E. de-Madaria and K. Cárdenas-Jaén conceptualized and designed the study. A. Vaillo monitored the study. K. Cárdenas-Jaén, J.J. Mira, A. Mula, I. Carrillo, and E. de-Madaria performed the primary analysis and interpretation of the data. K. Cárdenas-Jaén, S.A. Sánchez-Luna, J.J. Mira, A. Mula, I. Carrillo, and E. de-Madaria prepared the initial draft of the manuscript. All authors have approved the final version of the manuscript.
Competing interests The authors declare no conflict of interests for this article.
Appendix A. Supplementary data Supplementary data associated with this article can be found, in the online version, at doi:10.1016/j. gastrohep.2022.10.007.
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