Digestive Manifestations in Patients Hospitalized With Coronavirus Disease 2019.
Digestive Manifestations in Patients Hospitalized With Coronavirus Disease 2019.
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DOI：
10.1016/j.cgh.2020.09.041
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发表时间：
2021-07
期刊：
影响因子：
--
通讯作者：
North American Alliance for the Study of Digestive Manifestations of COVID-19
中科院分区：
文献类型：
--
作者：
Elmunzer BJ;Spitzer RL;Foster LD;Merchant AA;Howard EF;Patel VA;West MK;Qayed E;Nustas R;Zakaria A;Piper MS;Taylor JR;Jaza L;Forbes N;Chau M;Lara LF;Papachristou GI;Volk ML;Hilson LG;Zhou S;Kushnir VM;Lenyo AM;McLeod CG;Amin S;Kuftinec GN;Yadav D;Fox C;Kolb JM;Pawa S;Pawa R;Canakis A;Huang C;Jamil LH;Aneese AM;Glamour BK;Smith ZL;Hanley KA;Wood J;Patel HK;Shah JN;Agarunov E;Sethi A;Fogel EL;McNulty G;Haseeb A;Trieu JA;Dixon RE;Yang JY;Mendelsohn RB;Calo D;Aroniadis OC;LaComb JF;Scheiman JM;Sauer BG;Dang DT;Piraka CR;Shah ED;Pohl H;Tierney WM;Mitchell S;Condon A;Lenhart A;Dua KS;Kanagala VS;Kamal A;Singh VK;Pinto-Sanchez MI;Hutchinson JM;Kwon RS;Korsnes SJ;Singh H;Solati Z;Willingham FF;Yachimski PS;Conwell DL;Mosier E;Azab M;Patel A;Buxbaum J;Wani S;Chak A;Hosmer AE;Keswani RN;DiMaio CJ;Bronze MS;Muthusamy R;Canto MI;Gjeorgjievski VM;Imam Z;Odish F;Edhi AI;Orosey M;Tiwari A;Patwardhan S;Brown NG;Patel AA;Ordiah CO;Sloan IP;Cruz L;Koza CL;Okafor U;Hollander T;Furey N;Reykhart O;Zbib NH;Damianos JA;Esteban J;Hajidiacos N;Saul M;Mays M;Anderson G;Wood K;Mathews L;Diakova G;Caisse M;Wakefield L;Nitchie H;Waljee AK;Tang W;Zhang Y;Zhu J;Deshpande AR;Rockey DC;Alford TB;Durkalski V;North American Alliance for the Study of Digestive Manifestations of COVID-19
2019冠状病毒病（COVID-19）中消化系统表现的患病率和重要性仍不确定。我们的目的是评估因COVID-19住院的患者中消化系统表现的患病率、谱、严重程度和意义。在北美地理位置多样化的医疗中心联盟中发现了因COVID-19住院的并发症患者。从电子健康记录中手动提取与基线特征、消化系统学、实验室评估、影像学和从症状发作至出院或死亡的内镜检查结果相关的数据，以表征消化系统表现的患病率、谱和严重程度。进行回归分析，以评估消化系统表现与COVID-19相关严重结局之间的关联。36家中心共有1992例患者符合合格标准并被纳入。总体而言，53%的患者在患病期间的任何时间至少出现1种胃肠道症状，最常见的是腹泻（34%）、恶心（27%）、呕吐（16%）和腹痛（11%）。在74%的病例中，胃肠道症状被判定为轻度。总的来说，35%的患者出现丙氨酸氨基转移酶或总胆红素水平异常; 77%的病例中这些水平升高至正常上限的5倍以下。调整潜在混杂因素后，任何时间出现胃肠道症状（比值比，0.93; 95%CI，0.76-1.15）或入院时肝脏检查异常（比值比，1.31; 95%CI，0.80-2.12）与机械通气或死亡无关。在因COVID-19住院的患者中，胃肠道症状和肝功能检查异常很常见，但大多数是轻度的，它们的存在与更严重的临床病程无关。
The prevalence and significance of digestive manifestations in coronavirus disease 2019 (COVID-19) remain uncertain. We aimed to assess the prevalence, spectrum, severity, and significance of digestive manifestations in patients hospitalized with COVID-19. Consecutive patients hospitalized with COVID-19 were identified across a geographically diverse alliance of medical centers in North America. Data pertaining to baseline characteristics, symptomatology, laboratory assessment, imaging, and endoscopic findings from the time of symptom onset until discharge or death were abstracted manually from electronic health records to characterize the prevalence, spectrum, and severity of digestive manifestations. Regression analyses were performed to evaluate the association between digestive manifestations and severe outcomes related to COVID-19. A total of 1992 patients across 36 centers met eligibility criteria and were included. Overall, 53% of patients experienced at least 1 gastrointestinal symptom at any time during their illness, most commonly diarrhea (34%), nausea (27%), vomiting (16%), and abdominal pain (11%). In 74% of cases, gastrointestinal symptoms were judged to be mild. In total, 35% of patients developed an abnormal alanine aminotransferase or total bilirubin level; these were increased to less than 5 times the upper limit of normal in 77% of cases. After adjusting for potential confounders, the presence of gastrointestinal symptoms at any time (odds ratio, 0.93; 95% CI, 0.76–1.15) or liver test abnormalities on admission (odds ratio, 1.31; 95% CI, 0.80–2.12) were not associated independently with mechanical ventilation or death. Among patients hospitalized with COVID-19, gastrointestinal symptoms and liver test abnormalities were common, but the majority were mild and their presence was not associated with a more severe clinical course.
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