Muhammed Bahaddin DURAK, Çağdaş ERDOĞAN, İbrahim Ethem GÜVEN, İlhami YÜKSEL

Hastanede Yatan Covid-19 Enfeksiyonlu Hastalarda Gastrointestinal Semptomların Klinik Önemi

Amaç: Bu çalışmamızda hastanede yatan hafif Covid-19 enfeksiyonu olan hastalarda gastrointestinal (GI) semptomların klinik önemini belirlemeyi amaçladık. Materyal ve Metod: Bu çalışma, doğrulanmış bir Covid-19 enfeksiyonu teşhisi ile hastaneye yatırılan yetişkin hastaları içermektedir. Demografik özellikler, semptomlar, klinik tablolar, tıbbi öykü, ilaçlar ve klinik ilerleme ve sonuçlar klinisyenler tarafından veri toplama formu kullanılarak not edildi. Hafif Covid-19 enfeksiyonu olan hastalarda GI semptomlarının klinik sonuçlara etkisi istatistiksel olarak değerlendirildi. Bulgular: 307 hasta çalışmaya dahil edildi. Hastaların 159'unda (%51,7) en az bir GI semptomu vardı. Hastaların %18.2'si sadece GI semptomları, %21,2'si ise sadece GI dışı semptomlar gösterdi. Hastaların %27'si başvuru sırasında asemptomatikti. En sık görülen GI semptom hastaların %16.9'unda görülen iştahsızlıktı. En sık görülen ikinci ve üçüncü GI semptomları sırasıyla %15 hastada ishal, %14 hastada bulantı ve tat kaybıydı. GI ve GI olmayan semptom grupları arasında laboratuvar parametrelerinde anlamlı bir fark yoktu. GI ve GI olmayan semptom grupları olan hastaların yaş, cinsiyet, sigara içme durumu ve komorbiditeleri karşılaştırıldığında, ortalama yaş, cinsiyet, sigara içenler ve komorbiditeler açısından fark yoktu. Ayrıca hastanede kalış süresi (p=0,377), tam iyileşme (p=0,372) ve mortalite (p=0,351) GI ve GI olmayan semptom gruplarında sırasıyla benzerdi. Sonuç: GI semptomlarıyla kendini gösteren Covid-19 enfeksiyonunun erken teşhisi, enfeksiyonun yayılmasını önlemeye yardımcı olabilir. Hastalarda saptanan GI semptomların çoğu hafif olup bunların varlığı daha kötü klinik sonuçlarla ilişkili saptanmamıştır.

Anahtar Kelimeler:

covid, gastrointestinal semptom, iştahsızlık, bulantı, diyare

Clinical Significance of Gastrointestinal Symptoms in Hospitalized Patients With Covid-19 Infection

Objective: To determine the clinical significance of gastrointestinal (GI) symptoms in mild hospitalized patients with Covid-19 infection. Material and Methods: This study included adult patients who were hospitalized with a confirmed diagnosis of Covid-19 infection. The demographical features, symptoms, clinical presentations, medical history, medications and clinical progress and outcomes were noted using data collection form by the clinicians. The effect of GI symptoms on clinical outcomes in patients with mild Covid-19 infection was statistically evaluated. Results: 307 patients were included to the study. 159 of patients (51.7%) had an at least one GI symptoms, 18.2% of those presented only GI symptoms while 21.2% only non-GI symptoms. 27% were asymptomatic at admission. The most common GI symptom was loss of appetite that presenting 16.9% patients. The second and third most common GI symptoms were diarrhea in 15% patients, nausea and loss of taste in 14% patients, respectively. There was no significant difference in laboratory parameters between GI and non-GI symptoms groups. When age, gender, smoking status, and comorbidities of patients with GI and non-GI symptoms groups were compared, there was no difference in mean age, gender, smokers, and comorbidities. In addition, the length of hospital stay (p=0.377), complete healing (p=0.372) and mortality (p=0.351) was similar in patients with GI and non-GI symptoms groups respectively. Conclusion: Early diagnosis of Covid-19 infection presenting with GI symptoms can help prevent infection spread. The majority of these symptoms were mild, and their presence was not associated with worse clinical outcomes.

Keywords:

Covid-19, gastrointestinal symptoms, loss of appetite, nausea, diarrhea,

PDF

___

1. Cao Y, Cai K, Xiong L. Coronavirus disease 2019: A new severe acute respiratory syndrome from Wuhan in China. Acta Virol. 2020;64(2):245-50.
2. who.int. Weekly operational update on COVID-19 - 23 August 2021 who.int2021 [updated 23 August 2021. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports.
3. Liu J, Huang J, Xiang D. Large SARS-CoV-2 Outbreak Caused by Asymptomatic Traveler, China. Emerg Infect Dis. 2020;26(9).
4. Lin L, Jiang X, Zhang Z, et al. Gastrointestinal symptoms of 95 cases with SARS-CoV-2 infection. Gut. 2020;69(6):997-1001.
5. Ziegler CGK, Allon SJ, Nyquist SK, et al. SARS-CoV-2 Receptor ACE2 Is an Interferon-Stimulated Gene in Human Airway Epithelial Cells and Is Detected in Specific Cell Subsets across Tissues. Cell. 2020;181(5):1016-35 e19.
6. Xiao F, Tang M, Zheng X, et al. Evidence for Gastrointestinal Infection of SARS-CoV-2. Gastroenterology. 2020;158(6):1831-3 e3.
7. Lee IC, Huo TI, Huang YH. Gastrointestinal and liver manifestations in patients with COVID-19. J Chin Med Assoc. 2020;83(6):521-3.
8. He X, Lau EHY, Wu P, et al. Temporal dynamics in viral shedding and transmissibility of COVID-19. Nat Med. 2020;26(5):672-5.
9. Liu Y, Yan LM, Wan L, et al. Viral dynamics in mild and severe cases of COVID-19. Lancet Infect Dis. 2020;20(6):656-7.
10. Azkur AK, Akdis M, Azkur D, et al. Immune response to SARS-CoV-2 and mechanisms of immunopathological changes in COVID-19. Allergy. 2020;75(7):1564-81.
11. Sokolowska M, Lukasik ZM, Agache I, et al. Immunology of COVID-19: Mechanisms, clinical outcome, diagnostics, and perspectives-A report of the European Academy of Allergy and Clinical Immunology (EAACI). Allergy. 2020;75(10):2445-76.
12. Kwo PY, Cohen SM, Lim JK. ACG Clinical Guideline: Evaluation of Abnormal Liver Chemistries. Am J Gastroenterol. 2017;112(1):18-35.
13. Elmunzer BJ, Spitzer RL, Foster LD, et al. Digestive Manifestations in Patients Hospitalized With Coronavirus Disease 2019. Clin Gastroenterol Hepatol. 2021;19(7):1355-65 e4.
14. Mao R, Qiu Y, He JS, et al. Manifestations and prognosis of gastrointestinal and liver involvement in patients with COVID-19: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2020;5(7):667-78.
15. Bilbul M, Paparone P, Kim AM, et al. Psychopharmacology of COVID-19. Psychosomatics. 2020;61(5):411-27.
16. Tariq R, Saha S, Furqan F, et al. Prevalence and Mortality of COVID-19 Patients With Gastrointestinal Symptoms: A Systematic Review and Meta-analysis. Mayo Clin Proc. 2020;95(8):1632-48.
17. Guan WJ, Ni ZY, Hu Y, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020;382(18):1708-20.
18. Mizumoto K, Kagaya K, Zarebski A, et al. Estimating the asymptomatic proportion of coronavirus disease 2019 (COVID-19) cases on board the Diamond Princess cruise ship, Yokohama, Japan, 2020. Euro Surveill. 2020;25(10).
19. Kim GU, Kim MJ, Ra SH, et al. Clinical characteristics of asymptomatic and symptomatic patients with mild COVID-19. Clin Microbiol Infect. 2020;26(7):948 e1- e3.