Resumen de Gastrointestinal symptoms and complications in patients hospitalized due to COVID-19, an international multicentre prospective cohort study (TIVURON project)

Karina Cárdenas Jaén, Sergio A. Sánchez Luna, Alicia Vaillo Rocamora, Micaela Riat Castro Zocchi, Laura Guberna Blanco, Daniel Useros Brañas, José María Remes Troche, Antonio Ramos de La Medina, Bryan Priego Parra, José Antonio Velarde Ruiz Velasco, Pedro Martínez Ayala, Álvaro Urzúa, Dannette Guiñez Francois, Katarzyna M. Pawlak, Katarzyna Kozłowska Petriczko, Irati Gorroño Zamalloa, Clara Urteaga Casares, Inmaculada Ortiz Polo, Adolfo del Val Antoñana, Edgard E. Lozada Hernández, Enrique Obregón Moreno, G. García Rayado, María José Domper Arnal, Diego Casas Deza, Elena I. Esteban Cabello, Luis A. Díaz, Arnoldo Riquelme, Helena Martínez Lozano, Francisco Navarro Romero, Ignasi Olivas, Guillem Iborra Muñoz, Alicia Calero Amaro, Ibán Caravaca García, Francisco Javier Lacueva Gómez, Rubén Pastor Mateu, Berta Lapeña Muñoz, Violeta María Sastre Lozano, Nazaret M. Pizarro Vega, Luigi Melcarne, Marc Pedrosa Aragón, José J. Mira, Aurora Mula MStat, Irene Carrillo, Enrique de Madaria Pascual

• español

  Antecedentes Estudios retrospectivos evidencian que la enfermedad por coronavirus (COVID-19) conlleva síntomas y complicaciones gastrointestinales (GI). Nuestro objetivo fue evaluar prospectivamente las manifestaciones GI de pacientes hospitalizados por COVID-19.

  Métodos Estudio internacional, multicéntrico, de cohorte, prospectivo, que seleccionó a pacientes con COVID-19 en 31 centros de España, México, Chile y Polonia, entre mayo-septiembre de 2020. Los pacientes fueron seguidos hasta 15 días tras el alta y completaron cuestionarios que evaluaban los síntomas y complicaciones GI. Se realizó un análisis descriptivo, bivariante y multivariante de los resultados. Se consideró significativa p < 0,05.

  Resultados Se incluyeron 829 pacientes; 129 (15,6%) presentaron COVID-19 grave, 113 (13,7%) requirieron ingreso en UCI y 43 (5,2%) fallecieron. Al ingreso, los síntomas GI más prevalentes fueron anorexia (n = 413; 49,8%), diarrea (n = 327; 39,4%), náuseas/vómitos (n = 227; 27,4%) y dolor abdominal (n = 172; 20,7%), que resultaron de intensidad leve/moderada y se resolvieron durante el seguimiento. Un tercio de los pacientes presentaron daño hepático. La COVID-19 no grave se asoció con la presencia de ≥2 síntomas GI al ingreso (OR 0,679; IC 95%: 0,464-0,995; p = 0,046) y/o diarrea durante la hospitalización (OR 0,531; IC 95%: 0,328-0,860; p = 0,009). El análisis multivariante reveló que los peores resultados hospitalarios no se asociaron de forma independiente con el daño hepático o los síntomas GI.

  Conclusión Los síntomas GI fueron más frecuentes de lo que se había documentado, resultaron leves, se resolvieron rápidamente y no se asociaron de forma independiente con COVID-19 grave. El daño hepático fue una complicación frecuente en los pacientes hospitalizados que no se asoció de forma independiente con COVID-19 grave.

• English

  Background Retrospective studies suggest that coronavirus disease (COVID-19) commonly involves gastrointestinal (GI) symptoms and complications. Our aim was to prospectively evaluate GI manifestations in patients hospitalized for COVID-19.

  Methods This international multicentre prospective cohort study recruited COVID-19 patients hospitalized at 31 centres in Spain, Mexico, Chile, and Poland, between May and September 2020. Patients were followed-up until 15 days post-discharge and completed comprehensive questionnaires assessing GI symptoms and complications. A descriptive analysis as well as a bivariate and multivariate analysis were performer using binary logistic regression. p < 0.05 was considered significant.

  Results Eight hundred twenty-nine patients were enrolled; 129 (15.6%) had severe COVID-19, 113 (13.7%) required ICU admission, and 43 (5.2%) died. Upon admission, the most prevalent GI symptoms were anorexia (n = 413; 49.8%), diarrhoea (n = 327; 39.4%), nausea/vomiting (n = 227; 27.4%), and abdominal pain (n = 172; 20.7%), which were mild/moderate throughout the disease and resolved during follow-up. One-third of patients exhibited liver injury. Non-severe COVID-19 was associated with ≥2 GI symptoms upon admission (OR 0.679; 95% CI 0.464–0.995; p = 0.046) or diarrhoea during hospitalization (OR 0.531; 95% CI 0.328–0.860; p = 0.009). Multivariate analysis revealed that worse hospital outcomes were not independently associated with liver injury or GI symptoms.

  Conclusion GI symptoms were more common than previously documented, and were mild, rapidly resolved, and not independently associated with COVID-19 severity. Liver injury was a frequent complication in hospitalized patients not independently associated with COVID-19 severity.