Copyright
©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
Digestive system involvement and clinical outcomes among COVID-19 patients: A retrospective cohort study from Qatar
Muhammad Umair Khan, Kamran Mushtaq, Deema Hussam Alsoub, Phool Iqbal, Fateen Ata, Hammad Shabir Chaudhry, Fatima Iqbal, Girisha Balaraju, Muna A Al Maslamani, Betsy Varughese, Rajvir Singh, Khalid Al Ejji, Saad Al Kaabi, Yasser Medhat Kamel, Adeel Ajwad Butt
Muhammad Umair Khan, Kamran Mushtaq, Girisha Balaraju, Betsy Varughese, Khalid Al Ejji, Saad Al Kaabi, Yasser Medhat Kamel, Department of Gastroenterology and Hepatology, Hamad Medical Corporation, Doha 3050, Qatar
Muhammad Umair Khan, Kamran Mushtaq, Deema Hussam Alsoub, Fatima Iqbal, ECPE- Executive and Continuing Professional Education, Harvard T.H Chan School of Public Health, Boston, MA 02115-5810, United States
Deema Hussam Alsoub, Department of Palliative Care, National Center for Cancer Care & Research, Hamad Medical Corporation, Doha 3050, Qatar
Phool Iqbal, Fateen Ata, Hammad Shabir Chaudhry, Adeel Ajwad Butt, Department of Medicine, Hamad Medical Corporation, Doha 3050, Qatar
Fatima Iqbal, Muna A Al Maslamani, Department of Infectious Disease, Communicable Disease Center, Hamad Medical Corporation, Doha 3050, Qatar
Rajvir Singh, Department of Cardiology Research, Heart Hospital, Hamad Medical Corporation, Doha 3050, Qatar
Adeel Ajwad Butt, Department of Medicine, Division of Infectious Diseases, Weill Cornell Medical College, New York, NY 10075, United States
Adeel Ajwad Butt, Department of Medicine, Weill Cornell Medical College - Qatar, Doha 24144, Qatar
Author contributions: Khan MU and Mushtaq K conceived and designed the study and performed data analysis, literature review, and manuscript writing; Alsoub DH, Iqbal P, Ata F, Chaudhry HS, Iqbal F, Balaraju G, Maslamani MAA, Varughese B, Ejji KA, Kaabi SA, and Kamel YM performed data collection, data analysis, manuscript writing, and literature review; Singh R reviewed the statistical part of the manuscript; Butt AA performed the literature review and revised the final manuscript; all authors verified the final version of the study.
Supported by Hamad Medical Corporation, No. MRC-01-20-631.
Institutional review board statement: The study was approved by the Medical Research Center of Hamad Medical Corporation (MRC-01-20-631).
Informed consent statement: Due to the retrospective design of the study, the requirement of informed consent was waived by the Institutional Review Board.
Conflict-of-interest statement: All authors and study participants declare no potential conflicting interests related to this paper.
Data sharing statement: The authors confirm that the data supporting the findings of this study are available within the article.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Adeel Ajwad Butt, MBBS, MS, Doctor, Professor, Department of Medicine, Hamad Medical Corporation, PO Box 3050, Hamad Medical Corporation, Doha, Qatar, Doha 3050, Qatar.
aabutt@hamad.qa
Received: April 28, 2021
Peer-review started: April 28, 2021
First decision: June 13, 2021
Revised: June 29, 2021
Accepted: November 28, 2021
Article in press: November 28, 2021
Published online: December 14, 2021
Processing time: 226 Days and 7.5 Hours
ARTICLE HIGHLIGHTS
Research background
Gastrointestinal (GI) manifestations are present in 7%-15% of the patients with coronavirus disease 2019 (COVID-19). The association of GI manifestations with adverse clinical outcomes remains controversial, with some studies suggesting protective effects while others have reported adverse outcomes.
Research motivation
Previous studies reporting the association of GI symptoms with clinical outcomes in COVID-19 patients varied in determining the timing of symptoms development. We planned this study to clearly define GI symptoms in COVID-19 patients and distinguish between GI symptoms on admission and symptoms that develop during the hospital stay. We wanted to determine if there is any correlation of GI symptoms with disease severity and adverse clinical outcomes.
Research objectives
We aimed to determine the prevalence of GI symptoms in COVID-19 patients at admission and during hospitalization. We also aimed to study the correlation of GI symptoms with all-cause mortality, and disease severity at admission and disease progression during hospitalization defined by admission to the intensive care unit, development of acute respiratory distress syndrome, and need for mechanical ventilation.
Research methods
We conducted a retrospective cohort study investigating the epidemiological and clinical characteristics and outcomes among 601 consecutive adult patients with SARS-CoV-2 infection who were admitted to one of the dedicated COVID-19 hospitals in the state of Qatar between May 1-15, 2020. Clinical characteristics, laboratory parameters, treatment data, and disease outcome, including mortality, were compared between patients with and without GI symptoms. A multivariate logistic regression model with the forward method to identify independent predictors of the adverse outcomes.
Research results
The prevalence of any GI symptom at admission was 27.1% and during hospitalization was 19.8%. Nausea, vomiting, and diarrhea were the most common GI symptoms on presentation. There was no difference in mortality between the two groups (6.21% vs 5.50%, P = 0.7). However, patients with GI symptoms were more likely to have severe disease at presentation (33.13% vs 22.50%, P < 0.001) and prolonged hospital stay (15 d vs 14 d, P = 0.04). Age > 65 years was the single risk factor associated with increased mortality on multivariate regression analysis.
Research conclusions
Patients with GI symptoms are more likely to have severe disease at presentation. However, there is no difference in mortality between patients with and without GI symptoms.
Research perspectives
Future studies are needed to elucidate the mechanism of GI symptoms development in COVID-19 patients. Long-term effects and follow-up of COVID-19 patients with GI symptoms are needed.
