Clinical Characteristics of COVID-19 Patients With Digestive Symptoms in Hubei, China: A Descriptive, Cross-Sectional, Multicenter Study
Clinical Characteristics of COVID-19 Patients With Digestive Symptoms in Hubei, China: A Descriptive, Cross-Sectional, Multicenter Study
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中国湖北省出现消化系统症状的 COVID-19 患者的临床特征：一项描述性、横断面、多中心研究。
DOI：
10.14309/ajg.0000000000000620
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发表时间：
2020-05-01
影响因子：
9.8
通讯作者：
Tu, Lei
中科院分区：
文献类型：
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作者：
Pan, Lei;Mu, Mi;Tu, Lei
目的：自2019年12月2019冠状病毒病（COVID-19）暴发以来，感染该病毒的患者频繁报告各种消化系统症状。在这项研究中，我们旨在进一步调查COVID-19患者的患病率和消化症状的结局。方法：在这项描述性、横断面、多中心研究中，我们纳入了2020年1月18日至2020年2月28日在3家医院就诊的COVID-19确诊患者。所有患者均通过实时聚合酶链反应确诊，并分析临床特征、实验室数据和治疗情况。数据被跟踪到2020年3月18日。结果：本研究分析了204例COVID-19患者及完整的实验室、影像学和历史资料。平均年龄52.9岁（SD +/- 16），其中男性107人，女性97人。虽然大多数患者以发热或呼吸道症状就诊，但我们发现103例（50.5%）患者报告了消化系统症状，包括食欲不振（81例[78.6%]）、腹泻（35例[34%]）、呕吐（4例[3.9%]）和腹痛（2例[1.9%]）。如果将食欲不振排除在分析之外（因为它对胃肠道的特异性较低），则总共有38例（18.6%）患者表现为胃肠道特异性症状，包括腹泻、呕吐或腹痛。有消化系统症状的患者从发病到入院的时间明显长于无消化系统症状的患者（9.0天vs 7.3天）。6例有消化道症状，无呼吸道症状。随着病情的加重，消化系统症状变得更加明显。与无消化症状的患者相比，有消化症状的患者平均肝酶水平较高，单核细胞计数较低，凝血酶原时间较长，接受的抗菌药物治疗较多。讨论：我们发现消化系统症状在COVID-19患者中很常见。此外，这些患者从发病到入院时间较长，凝血时间较长，肝酶水平较高。临床医生应认识到，腹泻等消化系统症状是COVID-19的常见表现之一，对于出现消化系统症状的高危患者，可能需要更早地提高怀疑指数。然而，需要进一步的大样本研究来证实这些发现。
OBJECTIVE: Since the outbreak of Coronavirus Disease 2019 (COVID-19) in December 2019, various digestive symptoms have been frequently reported in patients infected with the virus. In this study, we aimed to further investigate the prevalence and outcomes of COVID-19 patients with digestive symptoms. METHODS: In this descriptive, cross-sectional, multicenter study, we enrolled confirmed patients with COVID-19 who presented to 3 hospitals from January 18, 2020, to February 28, 2020. All patients were confirmed by real-time polymerase chain reaction and were analyzed for clinical characteristics, laboratory data, and treatment. Data were followed up until March 18, 2020. RESULTS: In the present study, 204 patients with COVID-19 and full laboratory, imaging, and historical data were analyzed. The average age was 52.9 years (SD +/- 16), including 107 men and 97 women. Although most patients presented to the hospital with fever or respiratory symptoms, we found that 103 patients (50.5%) reported a digestive symptom, including lack of appetite (81 [78.6%] cases), diarrhea (35 [34%] cases), vomiting (4 [3.9%] cases), and abdominal pain (2 [1.9%] cases). If lack of appetite is excluded from the analysis (because it is less specific for the gastrointestinal tract), there were 38 total cases (18.6%) where patients presented with a gastrointestinal-specific symptom, including diarrhea, vomiting, or abdominal pain. Patients with digestive symptoms had a significantly longer time from onset to admission than patients without digestive symptoms (9.0 days vs 7.3 days). In 6 cases, there were digestive symptoms, but no respiratory symptoms. As the severity of the disease increased, digestive symptoms became more pronounced. Patients with digestive symptoms had higher mean liver enzyme levels, lower monocyte count, longer prothrombin time, and received more antimicrobial treatment than those without digestive symptoms. DISCUSSION: We found that digestive symptoms are common in patients with COVID-19. Moreover, these patients have a longer time from onset to admission, evidence of longer coagulation, and higher liver enzyme levels. Clinicians should recognize that digestive symptoms, such as diarrhea, are commonly among the presenting features of COVID-19 and that the index of suspicion may need to be raised earlier in at-risk patients presenting with digestive symptoms. However, further large sample studies are needed to confirm these findings.