Epidemiological, clinical and virological characteristics of 74 cases of coronavirus-infected disease 2019 (COVID-19) with gastrointestinal symptoms

• Published in: Gut Vol. 69; no. 6; pp. 1002 - 1009
• Main Authors: Jin, Xi, Lian, Jiang-Shan, Hu, Jian-Hua, Gao, Jianguo, Zheng, Lin, Zhang, Yi-Min, Hao, Shao-Rui, Jia, Hong-Yu, Cai, Huan, Zhang, Xiao-Li, Yu, Guo-Dong, Xu, Kai-Jin, Wang, Xiao-Yan, Gu, Jue-Qing, Zhang, Shan-Yan, Ye, Chan-Yuan, Jin, Ci-Liang, Lu, Ying-Feng, Yu, Xia, Yu, Xiao-Peng, Huang, Jian-Rong, Xu, Kang-Li, Ni, Qin, Yu, Cheng-Bo, Zhu, Biao, Li, Yong-Tao, Liu, Jun, Zhao, Hong, Zhang, Xuan, Yu, Liang, Guo, Yong-Zheng, Su, Jun-Wei, Tao, Jing-Jing, Lang, Guan-Jing, Wu, Xiao-Xin, Wu, Wen-Rui, Qv, Ting-Ting, Xiang, Dai-Rong, Yi, Ping, Shi, Ding, Chen, Yanfei, Ren, Yue, Qiu, Yun-Qing, Li, Lan-Juan, Sheng, Jifang, Yang, Yida
• Format: Journal Article Web Resource
• Language: English
• Published: England BMJ Publishing Group LTD 01.06.2020; BMJ Publishing Group
• Subjects: ACE2; Adult; Angiotensin-converting enzyme 2; Antibiotics; Betacoronavirus; Bioinformatics; China; Clinical Laboratory Techniques; Clinical outcomes; Coronavirus Infections - diagnosis; Coronavirus Infections - epidemiology; Coronavirus Infections - physiopathology; Coronavirus Infections - virology; Coronaviruses; COVID-19; COVID-19 Testing; Diarrhea; Disease control; Disease transmission; Epidemiology; Female; Fever; Gastrointestinal Tract - physiopathology; Gastrointestinal Tract - virology; Glucocorticoids; Headache; Hospitals; Humans; Influenza; Intensive care; L-Lactate dehydrogenase; Laboratories; Lactic acid; Liver diseases; Male; Methylation; Middle Aged; Multivariate analysis; Mutation; N6-methyladenosine; Nausea; Pandemics; Patients; Physicians; Pneumonia; Pneumonia, Viral - diagnosis; Pneumonia, Viral - epidemiology; Pneumonia, Viral - physiopathology; Pneumonia, Viral - virology; Proteins; Public health; Radiography; Risk Factors; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Sputum; Ventilators; Virulence; Viruses; Vomiting; China; diarrhoea; infectious disease
• ISSN: 0017-5749; 1468-3288
• DOI: 10.1136/gutjnl-2020-320926

ObjectiveThe SARS-CoV-2-infected disease (COVID-19) outbreak is a major threat to human beings. Previous studies mainly focused on Wuhan and typical symptoms. We analysed 74 confirmed COVID-19 cases with GI symptoms in the Zhejiang province to determine epidemiological, clinical and virological characteristics.DesignCOVID-19 hospital patients were admitted in the Zhejiang province from 17 January 2020 to 8 February 2020. Epidemiological, demographic, clinical, laboratory, management and outcome data of patients with GI symptoms were analysed using multivariate analysis for risk of severe/critical type. Bioinformatics were used to analyse features of SARS-CoV-2 from Zhejiang province.ResultsAmong enrolled 651 patients, 74 (11.4%) presented with at least one GI symptom (nausea, vomiting or diarrhoea), average age of 46.14 years, 4-day incubation period and 10.8% had pre-existing liver disease. Of patients with COVID-19 with GI symptoms, 17 (22.97%) and 23 (31.08%) had severe/critical types and family clustering, respectively, significantly higher than those without GI symptoms, 47 (8.14%) and 118 (20.45%). Of patients with COVID-19 with GI symptoms, 29 (39.19%), 23 (31.08%), 8 (10.81%) and 16 (21.62%) had significantly higher rates of fever >38.5°C, fatigue, shortness of breath and headache, respectively. Low-dose glucocorticoids and antibiotics were administered to 14.86% and 41.89% of patients, respectively. Sputum production and increased lactate dehydrogenase/glucose levels were risk factors for severe/critical type. Bioinformatics showed sequence mutation of SARS-CoV-2 with m6A methylation and changed binding capacity with ACE2.ConclusionWe report COVID-19 cases with GI symptoms with novel features outside Wuhan. Attention to patients with COVID-19 with non-classic symptoms should increase to protect health providers.