COVID-19 Patients’ Symptoms: Gastrointestinal Presentations, Comorbidities and Outcomes in a Canadian Hospital Setting

Abstract

Background

The Coronavirus disease 2019 (COVID-19) pandemic has had significant global impact. While public health interventions and universal health insurance has been credited with minimizing transmission rates in Canada relative to neighboring countries, significant morbidity and mortality have occurred nationwide. We sought to determine factors associated with differences in gastrointestinal outcomes in COVID-19 patients at a Canadian hospital.

Methods

We collected data from 192 hospital records of COVID-19 patients across seven Hamilton Health Sciences hospitals, a network of academic health centres serving one of the largest metropolitan areas in Canada. Statistical and correlative analysis of symptoms, comorbidities, and mortality were performed.

Results

There were 192 patients. The mean age was 57.6 years (SD=21.0). For patients who died (n=27, 14%), mean age was 79.2 years old (SD=10.6) versus 54 years for survivors (SD=20.1). There was a higher mortality among patients with older age ( p= 0.000), long hospital stay ( p= 0.004), male patients ( p= 0.032), and patients in nursing homes ( p= 0.000). Patients with dyspnea ( p= 0.028) and hypertension ( p= 0.004) were more likely to have a poor outcome. Laboratory test values that were significant in determining outcomes were an elevated INR ( p= 0.007) and elevated creatinine ( p= 0.000). Cough and hypertension were the most common symptom and comorbidity, respectively. Diarrhea was the most prevalent (14.5%) gastrointestinal symptom. Impaired liver function was related to negative outcome (LR 5.6; p =0.018).

Conclusions

In a Canadian cohort, elevated liver enzymes, prolonged INR and elevated creatinine were associated with poor prognosis. Hypertension was also linked to a higher likelihood of negative outcome.

SUMMARY BOX

What is already known about this subject?

The prevalence of gastrointestinal symptoms in COVID-19 patients across Canada is lacking
Gastrointestinal manifestations of COVID-19 are well described, and longterm sequelae of gastrointestinal tract involvement are an ongoing concern

What are the new findings?

There was a significant prevalence of gastrointestinal symptoms in patients with a confirmed diagnosis of COVID-19 at one of the largest metropolitan regions across Canada
Liver enzyme abnormalities were common in patients at diagnosis
This report, over an 8-month period, represents the largest cohort of COVID-19 patients reported in Canada

How might these results impact on clinical practice in the foreseeable future?

Baseline gastrointestinal symptoms and laboratory abnormalities correlate with patient outcome in Canadian COVID-19 patients
These results enhance our knowledge of the prevalence of gastrointestinal symptoms and laboratory abnormalities in Canadian patients and offer important baseline data for longitudinal studies in these patients
Our findings increase our knowledge of the epidemiology of COVID-19 in Canada and allow future comparison with international data

SciScore for 10.1101/2021.10.28.21265610: (What is this?)

Please note, not all rigor criteria are appropriate for all manuscripts.

Table 1: Rigor

Ethics	IRB: This study was approved by the Hamilton Integrated Research Ethics Board (Project #: 12862-C) and Howard University Office of Regulatory Research Compliance (IRB-12-CMED-76).
Sex as a biological variable	Patient demographics (age, sex, nursing home, known exposure, hospital admission, duration of symptoms, length of stay), symptoms (fever, dyspnea, cough, fatigue, myalgia, loss of taste, loss of appetite, abdominal pain, nausea, vomiting, diarrhea, dysphagia, gastrointestinal bleeding, pancreatitis, cholecystitis), underlying comorbidities (hypertension, cardiac disease, diabetes, obesity, smoking, alcohol intake, history of luminal gastrointestinal disease, liver disease, alcohol abuse, inflammatory bowel syndrome, gastrointestinal cancer, pancreatitis, gastroesophageal reflux disease or peptic ulcer disease), and laboratory data measured at baseline: international normalized ratio (INR) (0.8 - 1.2); total bilirubin (<21); direct bilirubin (<5); creatinine (male 60-110, female 49-90); C-reactive protein (<10.0); lactate dehydrogenase (120-250); fibrinogen (1.6-4.2); alanine aminotransferase (ALT) (male <50, female <35); albumin (42-50); platelets (130-400), creatine phosphokinase (CPK) (male less than 60 years old 45-250, male greater than 60 years old 40-200, female all ages 30-150); WBC (4.8-10.8); aspartate transaminase (AST) (male 18-54, female 18-34); alkaline phosphatase (ALP) (38-126).
Randomization	not detected.
Blinding	not detected.
Power Analysis	not detected.

Table 2: Resources

Software and Algorithms
Sentences	Resources
SPSS version 26 (SPSS Inc., Chicago, IL, USA) was used for these analyses.	SPSS suggested: (SPSS, RRID:SCR_002865)

Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

Results from LimitationRecognizer: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.

Results from TrialIdentifier: No clinical trial numbers were referenced.

Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

Results from JetFighter: We did not find any issues relating to colormaps.

Results from rtransparent:

Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
No protocol registration statement was detected.

Results from scite Reference Check: We found no unreliable references.

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