Digestive Symptoms in COVID-19 Patients With Mild Disease Severity: Clinical Presentation, Stool Viral RNA Testing, and Outcomes
Digestive Symptoms in COVID-19 Patients With Mild Disease Severity: Clinical Presentation, Stool Viral RNA Testing, and Outcomes
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轻度疾病严重程度的 COVID-19 患者的消化道症状：临床表现、粪便病毒 RNA 检测和结果
DOI：
10.14309/ajg.0000000000000664
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发表时间：
2020-06-01
影响因子：
9.8
通讯作者：
Hou, Xiaohua
中科院分区：
文献类型：
--
作者：
Han, Chaoqun;Duan, Caihan;Hou, Xiaohua
目的：2019冠状病毒病（COVID-19）最常见的呼吸道症状包括咳嗽，呼吸急促和喉咙痛。然而，COVID-19患者也会出现消化道症状，并且通常在病情不太严重的门诊患者中描述。在这项研究中，我们试图描述具有消化道症状和轻度疾病严重程度的COVID-19患者的临床特征。方法：我们确定了患有轻度疾病和一种或多种消化道症状（腹泻，恶心和呕吐）的COVID-19患者，有或没有呼吸道症状，并将他们与仅出现呼吸道症状的一组进行了比较。我们对患者进行了临床随访，直到他们在至少2份间隔≥24小时的连续呼吸道标本上检测出COVID-19呈阴性。然后比较消化道症状和呼吸道症状患者的临床特征。研究结果：有206名低严重程度的COVID-19患者，其中48名仅出现消化道症状，69名同时出现消化道和呼吸道症状，89名仅出现呼吸道症状。在有消化道症状的两组患者中，67人表现为腹泻，其中19.4%的患者在病程中以腹泻为首发症状。腹泻持续1 ~ 14 d，平均5.4 ± 3.1d，排便次数4.3 ± 2.2次/d。62.4%的消化道症状患者同时出现发热。有消化道症状的患者比有呼吸道症状的患者就诊时间晚（16.0 ± 7.7vs11.6 ± 5.1d，P < 0.001）。然而，有消化道症状的患者从症状发作到病毒清除的时间较长（P < 0.001），粪便病毒阳性的可能性更高（73.3%比14.3%，P = 0.033）。讨论：我们描述了一个独特的COVID-19患者亚组，其疾病严重程度较轻，以消化道症状的存在为标志。这些患者更有可能在粪便中检测出病毒RNA阳性，在病毒清除之前有更长的延迟，并且与仅有呼吸道症状的患者相比，诊断延迟。
OBJECTIVES: Coronavirus disease 2019 (COVID-19) most commonly presents with respiratory symptoms, including cough, shortness of breath, and sore throat. However, digestive symptoms also occur in patients with COVID-19 and are often described in outpatients with less severe disease. In this study, we sought to describe the clinical characteristics of COVID-19 patients with digestive symptoms and mild disease severity. METHODS: We identified COVID-19 patients with mild disease and one or more digestive symptoms (diarrhea, nausea, and vomiting), with or without respiratory symptoms, and compared them with a group presenting solely with respiratory symptoms. We followed up patients clinically until they tested negative for COVID-19 on at least 2 sequential respiratory tract specimens collected ≥24 hours apart. We then compared the clinical features between those with digestive symptoms and those with respiratory symptoms. RESULTS: There were 206 patients with low severity COVID-19, including 48 presenting with a digestive symptom alone, 69 with both digestive and respiratory symptoms, and 89 with respiratory symptoms alone. Between the 2 groups with digestive symptoms, 67 presented with diarrhea, of whom 19.4% experienced diarrhea as the first symptom in their illness course. The diarrhea lasted from 1 to 14 days, with an average duration of 5.4 ± 3.1 days and a frequency of 4.3 ± 2.2 bowel movements per day. Concurrent fever was found in 62.4% of patients with a digestive symptom. Patients with digestive symptoms presented for care later than those with respiratory symptoms (16.0 ± 7.7 vs 11.6 ± 5.1 days, P < 0.001). Nevertheless, patients with digestive symptoms had a longer duration between symptom onset and viral clearance (P < 0.001) and were more likely to be fecal virus positive (73.3% vs 14.3%, P = 0.033) than those with respiratory symptoms. DISCUSSION: We describe a unique subgroup of COVID-19 patients with mild disease severity marked by the presence of digestive symptoms. These patients are more likely to test positive for viral RNA in stool, to have a longer delay before viral clearance, and to experience delayed diagnosis compared with patients with only respiratory symptoms.