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

• Karina Cárdenas-Jaén ^[4] ; Sergio A. Sánchez-Luna ^[1] ; Alicia Vaillo-Rocamora ^[4] ; Micaela Riat Castro-Zocchi ^[5] ; Laura Guberna-Blanco ^[5] ; Daniel Useros-Brañas ^[6] ; José M. Remes-Troche ^[7] ; Close Antonio Ramos-De la Medina ^[7] ; Bryan A. Priego-Parra ^[7] ; José A. Velarde-Ruiz Velasco ^[8] ; Pedro Martínez-Ayala ^[8] ; Álvaro Urzúa ^[2] ; Dannette Guiñez-Francois ^[2] ; Katarzyna M. Pawlak ^[9] ; Katarzyna Kozłowska-Petriczko ^[10] ; Irati Gorroño-Zamalloa ^[11] ; Clara Urteaga-Casares ^[11] ; Inmaculada Ortiz-Polo ^[12] ; Adolfo del Val Antoñana ^[12] ; Edgard E. Lozada-Hernández ^[13] ; Enrique Obregón-Moreno ^[13] ; Guillermo García-Rayado ^[14] ; María José Domper-Arnal ^[14] ; Diego Casas-Deza ^[15] ; Elena I. Esteban-Cabello ^[16] ; Luis A. Díaz ^[3] ; Arnoldo Riquelme ^[3] ; Helena Martínez-Lozano ^[17] ; Francisco Navarro-Romero ^[18] ; Ignasi Olivas ^[19] ; Guillem Iborra-Muñoz ^[20] ; Alicia Calero-Amaro ^[21] ; Ibán Caravaca-García ^[21] ; Francisco J. Lacueva-Gómez ^[21] ; Rubén Pastor-Mateu ^[22] ; Berta Lapeña-Muñoz ^[23] ; Violeta Sastre-Lozano ^[24] ; Nazaret M. Pizarro-Vega ^[25] ; Luigi Melcarne ^[26] ; Marc Pedrosa-Aragón ^[27] ; José J. Mira ^[28] ; Aurora Mula MStat ^[28] ; Irene Carrillo ^[29] ; Enrique de-Madaria ^[4]
  1. [1] University of Alabama at Birmingham

     University of Alabama at Birmingham

     Estados Unidos

     
  2. [2] Universidad de Chile

     Universidad de Chile

     Santiago, Chile

     
  3. [3] Pontificia Universidad Católica de Chile

     Pontificia Universidad Católica de Chile

     Santiago, Chile

     
  4. [4] Gastroenterology Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
  5. [5] Gastroenterology Department, La Princesa University Hospital and IIS-Princesa & Biomedical Research Center on Liver and Digestive Diseases Network (CIBEREHD), Madrid, Spain
  6. [6] Internal Medicine Department, La Princesa University Hospital & IIS-Princesa, Madrid, Spain
  7. [7] Gastroenterology Department, Spanish Hospital of Veracruz & Medical Biological Research Institute, Veracruz University, Veracruz, Mexico
  8. [8] Gastroenterology Department, Civil Hospital of Guadalajara Fray Antonio Alcalde, Guadalajara, Mexico
  9. [9] Gastroenterology Department, Endoscopy Unit, Hospital of the Ministry of Interior and Administration, Szczecin, Poland
  10. [10] Gastroenterology and Internal Medicine Department, SPWSZ Hospital, Szczecin, Poland
  11. [11] Gastroenterology Department, University Hospital of Arava, Vitoria-Gasteiz, Spain
  12. [12] Gastroenterology Unit, Digestive Diseases Department, La Fe University and Polytechnic Hospital, Valencia, Spain
  13. [13] General Surgery Service, Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajio, León-Guanajuato, Mexico
  14. [14] Gastroenterology Department, Lozano Blesa University Clinical Hospital & Aragón Health Research Institute (IIS Aragón), Zaragoza, Spain
  15. [15] Gastroenterology and Hepatology Department, Miguel Servet University Hospital & Health Research Institute of Aragón (IIS Aragón), Zaragoza, Spain
  16. [16] Internal Medicine Department, Miguel Servet University Hospital, Zaragoza, Spain
  17. [17] Gastroenterology Department, Gregorio Marañón General University Hospital & Gregorio Marañón Institute of Health Research, Madrid, Spain
  18. [18] Internal Medicine Department, Costa del Sol Hospital, Marbella, Spain
  19. [19] Gastroenterology Department, Hospital Clinic of Barcelona & Centre for Biomedical Research Network on Liver and Digestive Diseases (CIBEReHD) & August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
  20. [20] Gastroenterology Department, Mataró Hospital, Mataró, Spain
  21. [21] Surgery Department, Elche General University Hospital, Elche, Spain
  22. [22] Gastroenterology Department, Valencia General University Hospital Consortium, Valencia, Spain
  23. [23] Gastroenterology Department, San Pedro Hospital, Logroño, Spain
  24. [24] Gastroenterology Department, Santa Lucía University Hospital, Cartagena, Spain
  25. [25] astroenterology Department, Fuenlabrada University Hospital, Fuenlabrada, Spain
  26. [26] Gastroenterology Department, Parc Taulí University Hospital, Sabadell, Spain
  27. [27] Infectious Diseases Department, Parc Taulí University Hospital, Sabadell, Spain
  28. [28] ATENEA Research, The Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), Alicante, Spain
  29. [29] Health Psychology Department, Miguel Hernandez University, Elche, Spain

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• Localización: Gastroenterología y hepatología, ISSN 0210-5705, Vol. 46, Nº. 6, 2023, págs. 425-438
• Idioma: inglés
• Títulos paralelos:
  • Síntomas y complicaciones gastrointestinales en pacientes hospitalizados por COVID-19, estudio internacional, multicéntrico, de cohorte, prospectivo (proyecto TIVURON)
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• Resumen
  • 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.