Patients with COVID-19 who presented with diarrhea had better disease outcomes, including reduced need for mechanical ventilation, shorter hospital stay, and decreased mortality, compared with patients who did not have gastrointestinal (GI) symptoms, according to study findings published in the Indian Journal of Medical Microbiology.
GI symptoms are commonly documented in patients with COVID-19. However, the clinical effect of these symptoms on COVID-19 outcome is mixed due to most data coming from retrospective studies. The objective of the current study was to assess the effect of GI symptoms on COVID-19 outcome in patients admitted to the hospital for COVID-19.
The prospective, single-center study in India included 203 admitted patients diagnosed with COVID-19 who did not have any pre-existing GI conditions. Patients were categorized as having only respiratory symptoms, respiratory and GI symptoms, or only GI symptoms. A detailed history of symptoms, disease course, and disease outcomes were recorded for each participant.
Patients most commonly presented with both respiratory and GI symptoms, followed by respiratory symptoms alone, and GI symptoms alone, at 57.6%, 24.1%, and 9.9%, respectively. Of the patients with GI symptoms, only 23% had GI symptoms at presentation, while the remainder of patients developed GI symptoms throughout the disease course. Nearly 60% of patients had more than 1 GI symptom, with diarrhea being the most common at 30%.
Patients with vs without diarrhea had no mortality (0.0% vs 7.7%), no need for mechanical ventilation (0% vs 10.6%), and had a shorter hospital length of stay (12.46±4.2 vs 14.94±5.8 days). After adjusting for multiple confounders, the presence of GI symptoms was a statistically significant negative predictor of moderate or severe disease (P =.004).
Study limitations included the lack of objective measurements like cytokine levels. Larger studies are also necessary to confirm the current study findings.
“GI symptoms are frequent in patients with SARS-CoV-2 infection, and the commonest is diarrhea,” the study authors noted. “Diarrhea is a harbinger of better outcome with lower mortality among COVID-19 positive patients.”
Singh S, Samanta J, Suri V, et al. Presence of diarrhea associated with better outcomes in patients with COVID-19 – a prospective evaluation. Indian J Med Microbiol. Published online April 26, 2022. doi:10.1016/j.ijmmb.2022.04.002