Retrospective analysis of digestive system manifestations in patients with coronavirus disease 2019

Abstract

BACKGROUND Coronavirus disease 2019 (COVID-19) is spreading around the world, presenting mainly as respiratory symptoms. Some patients have obvious digestive system symptoms, or even present with only digestive system symptoms. Therefore, it is of great significance to clarify the digestive system manifestations in COVID-19 patients. AIM To explore the digestive system manifestations of 350 patients with COVID-19 hospitalized at our hospital, to provide reference for the diagnosis and treatment of COVID-19. METHODS The data of 350 COVID-19 inpatients at our hospital, such as general conditions, initial symptoms, disease severity, digestive system symptoms, and liver function, were retrospectively analyzed. The digestive system symptoms and liver function indexes were compared between non-critically ill patients and critically ill patients. Statistical methods involved independent sample median test, continuity correction chi-square test, and one-way analysis of variance. RESULTS All the 350 patients were definitely diagnosed with COVID-19, including 176 (50.3%) males and 174 (49.7%) females. They ranged in age from 17 to 94 years, with a median age of 59 years. There were 254 (72.6%) non-critically ill patients and 96 (27.4%) critically ill patients. The initial symptoms were mainly fever, dry cough, fatigue, and chest tightness; 262 (74.9%) cases showed fever, 189 (54.0%) showed dry cough, 237 (67.7%) showed fatigue, and 195 (55.7%) showed chest tightness. Seventy-nine (22.6%) cases showed digestive system symptoms, mainly diarrhea, vomiting, and abdominal pain; 42 (12.0%) cases showed diarrhea, 48 (13.7%) showed vomiting, and 3 (0.9%) showed abdominal pain. Five (1.4%) cases presented with digestive system symptoms as the initial symptoms. One hundred and fifty (42.9%) cases had abnormal liver function indexes (increase in at least one of ALT, AST, TBIL, and DBIL), of which 73 (20.9%) had elevated ALT, 98 (28.0%) had elevated AST, 60 (17.1%) had elevated DBIL, and 27 (7.7%) had elevated TBIL. Serum albumin (ALB) was reduced in 275 (78.6%) patients. The percentage of non-critically ill patients with digestive system symptoms (52/254, 20.5%) was not statistically significant from that of critically ill patients (52/254 [20.5%] vs 27/96 [28.1%],χ 2 = 2.334, P > 0.05). The abnormal rate of liver function indexes (87/254, 34.3%) was significantly lower in non-critically ill patients than in critically ill patients (87/254 [34.3%] vs 63/96 [65.6%], χ 2 = 28, P < 0.05). The percentage of patients with ALB decline was significantly lower in non-critically ill patients than in critically ill patients (182/254 [71.7%] vs 93/96 [96.9%],χ 2 = 26.322, P < 0.05). In both non-critically ill and critically ill patients, the increase in liver function indexes was mostly not more than 2 × upper limit of normal, and ALB was mostly in the range of 30-40 g/ L. Compared with the non-diarrhea group (236/308, 76.6%), the percentage of patients with ALB reduction in the diarrhea group (39/42, 92.9%) was statistically lower (χ 2 = 5.785, P < 0.05). There was no statistically significant difference in duration of onset between groups with different albumin concentrations (P > 0.05). CONCLUSION Hospitalized COVID-19 patients may show some digestive system symptoms, with diarrhea and vomiting being most common. A few patients present with digestive system symptoms as the initial manifestation, which is more likely to cause misdiagnosis. Some patients with COVID-19 show liver injury, although most of cases are mild, and no liver failure occurs. Compared with non-critically ill patients, the incidence of digestive system symptoms is generally similar to that of non-critically ill patients, but the incidence and degree of abnormal liver function indexes are higher in critically ill patients. Most patients with COVID-19 may have decreased serum albumin, and patients with diarrhea are more likely to have serum albumin decline. The above conclusions may help increase the awareness of COVID-19 among clinicians and improve their treatment skills.