COVID-19 Patients’ Symptoms: Gastrointestinal presentations, comorbidities and outcomes in a Canadian hospital setting

As of January 14th, 2021, Canada has confirmed 681,000 positive coronavirus disease 2019 (COVID-19) cases and more than 17,000 associated deaths. We sought to determine the gastrointestinal (GI) symptoms in patients with a positive nasopharyngeal swab who were admitted to a hospital in Hamilton, Ontario.

We collected data from 192 patients presenting with COVID-19 across our city-wide hospital network from March 2020 to October 2020. Statistical and correlative analysis of symptoms, comorbidities and mortality were performed. The retrospective chart review was approved by HiREB (12862). This was a multi-center study with Howard University in Washington, DC.

Of the 192 patients that met our inclusion criteria, 52 reported having GI symptoms. Diarrhea was the most prevalent (14.5%) GI symptom. Nausea and vomiting were reported in 5.7% and 6.2% cases, respectively. Loss of appetite was seen in 10.9% (21 patients) of patients. Of those with GI symptoms, 67.4% (35 patients) had GI symptoms before admission. There was higher mortality among patients who were older, male, and living in a nursing home. Those with elevated liver enzymes and elevated creatinine when admitted to the hospital were also more likely to have a poor outcome.

Prevalence of GI symptoms in our cohort of 192 patients

The presence of GI symptoms demonstrates that the effects of COVID-19 are not limited to respiratory symptoms but spread multi-systemically with a wide array of presentations. GI symptoms, such as diarrhea, should be evaluated alongside respiratory symptoms. This study highlights the need to conduct further investigations into infection’s systemic effects, specifically in the gastrointestinal system.

In the future, this data will be included in a sample that incorporates data collected in the United States, Bangladesh and Venezuela in the future. Currently, all of the indicated centers are conducting individual analyses in their respective locations, using the same data collection form. We also plan to combine our data with other centers across Canada.