Gastrointestinal Symptoms Are Associated with Increased Risk of Progression from Non- severe to Severe Illness in COVID-19 Patients

Background: The involvement of gastrointestinal (GI) symptoms in the progression of illness in COVID-19 patients has not been illustrated, with the association between GI symptoms and illness severity remaining controversial. The present study aimed to evaluate the association between GI symptoms and the illness progression, severity, and prognosis in COVID-19 patients. Methods: This study retrospectively recruited consecutive patients with laboratory-confirmed COVID-19 from three hospitals in Wuhan. The severity of illness was classified as non-severe and severe for analyses. The primary outcome was the association between GI symptoms and progression from non-severe to severe illness (PNTS) in COVID-19 patients. Results: Of the 934 COVID-19 patients (mean age 59.3 years; 43.7% males), the prevalence of overall and specific GI symptoms at/prior to admission were 59.9% and 13.0%, respectively. Patients with GI symptoms were associated with increased risk of fever (56.1% vs. 48.1%; P=0.02), increased IL-6 (18.2% vs. 11.7%; P=0.04), ground-glass opacity (56.8% vs. 43.1%; P<0.001), bilateral pneumonia (80.4% vs. 72.3%; P=0.005), secondary infections (12.6% vs. 6.5%;, P=0.003), and hypoalbuminemia (26.2% vs. 18.4%; P=0.01). Patients with GI symptoms had a higher risk for PNTS (2.9% vs. 0.6%; P=0.02), even after full adjustments (OR, 6.50; (95%CI:1.34-31.6); P=0.02), but comparable risk for severe illness or deaths. GI symptoms and the specific GI symptoms were identified as the independent risk factors for PNTS. Conclusions: The occurrence of GI symptoms is proved to be an independent risk factor for PNTS, which might be a predicting indicator in the prevention of illness deterioration at an early stage.