COVID-19'da gastrointestinal semptomlar ile hastalığın seyri ve prognozu arasında bir ilişki var mı? Tek merkezli pilot çalışma

Yıl 2020, Cilt: 19 Sayı: 3, 103 - 108, 30.12.2020

Enver Avcı İsa Ardahanlı , Erkin Öztaş Selçuk Dişibeyaz

https://doi.org/10.17941/agd.847338

Cited By: 4

Öz

Giriş ve Amaç: Pandemi yapan ve çok fazla ölüm nedeni olan COVID-19 genelde solunumsal semptomlarla prezente olsa da bazen bu semptomlara gastrointestinal semptomlar da eşlik etmektedir. Çalışmamızda COVID-19 hastalarında gastrointestinal semptomların sıklığını ve prognozla ilişkisini araştırmayı amaçladık. Gereç ve Yöntem: 11 Mart 2020-30 Nisan 2020 tarihleri arasında Bilecik Devlet Hastanesine başvuran ve real time polimeraz zincir reaksiyonu ile tanısı konulan 110 hastanın demografik, radyolojik, laboratuvar ve klinik açıdan analizi yapıldı. Bulgular: Hastaneye başvuru esnasında 13 (%11.8) hastada bir veya daha fazla gastrointestinal semptom vardı. Biyokimyasal parametrelerden D-dimer ve fibrinojen artışıyla gastrointestinal semptomlar arasında belirgin ilişki vardı (p <0.001). gastrointestinal semptom varlığı hastalık şiddeti ile ilişkiliydi (p=0.012) ve hastalık şiddetini öngörmede yüksek prediktif değere sahipti (Odds Ratio=7.2). Sonuç: COVID-19 nadiren sadece gastrointestinal semptomlarla prezente olabilmektedir. Pandemi döneminde gastrointestinal semptomu olan hastalarda COVID-19 akılda tutulmalı ve sağlık çalışanları bu konuda uyanık olmalıdır ve korunma adına gerekli tedbirlerini almalıdırlar. Ayrıca bu hastaların erken tespit edilmesi ile hastalığın daha fazla yayılması engellenebilecektir.

Anahtar Kelimeler

COVID-19, gastrointestinal semptomlar, hastalık şiddeti

Is there a relationship between gastrointestinal symptoms and disease course and prognosis in COVID-19? A single-center pilot study

Öz

Background and Aims: Although COVID-19 pandemic that causes many deaths is usually presented with respiratory symptoms, the symptoms are often accompanied by gastrointestinal symptoms. In our study, we aimed to investigate the frequency of gastrointestinal symptoms in COVID-19 patients and their relationship with prognosis. Materials and Methods: Demographic, radiological, laboratory, and clinical analyses were conducted on 110 patients who submitted to Bilecik State Hospital between 11 March 2020 and 30 April 2020. Furthermore, a real-time polymerase chain reaction was used to diagnose COVID-19. Results: During hospital admission, 13 (11.8%) patients had one or more gastrointestinal symptoms. There was an increase in the occurrence of gastrointestinal symptoms with age (p=0.062). In addition, there was a strong correlation between GI symptoms with D-dimer and fibrinogen increase from biochemical parameters (p<0.01). The occurrence of gastrointestinal symptoms was associated with disease severity (p = 0.012) and had a high predictive value when predicting disease severity (OR = 7.2). Conclusion: COVID-19 can rarely be presented with only gastrointestinal symptoms. Moreover, COVID-19 should be kept in mind in patients with gastrointestinal symptoms during the pandemic period, and health workers should be cautious and take appropriate precautions for protection. In addition, early identification of these patients will prevent further spread of the disease.

Anahtar Kelimeler

COVID-19, gastrointestinal symptoms, disease severity

Kaynakça

• 1. Wang L, Wang Y, Ye D, Liu Q. Review of the 2019 novel Coronavirus (SARS-CoV-2) based on current evidence. Int J Antimicrob Agents 2020;55:105948. Epub 2020 Mar 19.
• 2. Wu Z, McGoogan JM. Characteristics of and important lessons from the Coronavirus Disease 2019 (COVID-19) outbreak in China: summary of a Report of 72314 cases from the Chinese Center for Disease Control and Prevention. JAMA 2020;323:1239-42.
• 3. Xiao F, Tang M, Zheng X, et al. Evidence for gastrointestinal infection of SARS-CoV-2. Gastroenterology 2020;158:1831-3.e3. Epub 2020 Mar 3.
• 4. Gu J, Han B, Wang J. COVID-19: Gastrointestinal manifestations and potential fecal-oral transmission. Gastroenterology 2020;158:1518-9. Epub 2020 March 3.
• 5. Pan L, Mu M, Yang P, et al. Clinical characteristics of COVID-19 patients with digestive symptoms in Hubei, China: A descriptive, cross-sectional, multicenter study. Am J Gastroenterol 2020;115:766-73.
• 6. Holshue ML, DeBolt C, Lindquist S, et al. First case of 2019 novel coronavirus in the United States. N Engl J Med 2020;382:929-36.
• 7. Han C, Duan C, Zhang MD, et al. Digestive symptoms in COVID-19 patients with mild disease severity: Clinical presentation, stool viral RNA testing, and outcomes. Am J Gastroenterol 2020;115:916-23. Epub Apr 15.
• 8. Jin X, Lian JS, Hu JH, et al. Epidemiological, clinical and virological characteristics of 74 cases of coronavirus-infected disease 2019 (COVID-19) with gastrointestinal symptoms Gut 2020;69:1002-9. Epub 2020 Mar 24.
• 9. Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 2020;323:1061-9.
• 10. Redd WD, Zhou JC, Hathorn KE, et al. Prevalence and characteristics of gastrointestinal symptoms in patients with severe acute respiratory syndrome Coronavirus 2 infection in the United States: A multicenter cohort study. Gastroenterology 2020;159:765-7.e2. Epub 2020 Apr 22.
• 11. Ye Z, Zhang Y, Wang Y, Huang Z, Song B. Chest CT manifestations of new coronavirus disease 2019 (COVID-19): a pictorial review. Eur Radiol 2020;30:4381-9. Epub 2020 Mar 19.
• 12. Liu Y, Gayle AA, Wilder-Smith A, Rocklöv J. The reproductive number of COVID-19 is higher compared to SARS coronavirus. J Travel Med 2020;27:taaa021.
• 13. Lee N, Hui D, Wu A, et al. A major outbreak of severe acute respiratory syndrome in Hong Kong. N Engl J Med 2003;348:1986-94.
• 14. Leung WK, To KF, Chan PK, et al. Enteric involvement of severe acute respiratory syndrome-associated coronavirus infection. Gastroenterology 2003;125:1011-7.
• 15. Chan JF, Lau SK, Tos K, Cheng VC, Woo PC, Yuen KY. Middle East respiratory syndrome coronavirus: another zoonotic betacoronavirus causing SARS-like disease. Clin Microbiol Rev 2015;28:465-522.
• 16. Chan JF-W, Yuan S, Kok KH, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet 2020;395:514-23.
• 17. Zhang H, Kang ZJ, Gong HY, et al. The digestive system is a potential route of 2019-nCov infection: a bioinformatics analysis based on single-cell transcriptomes. Gut 2020;69:1010-8. Published online 2020 Apr 2.
• 18. Liang W, Feng Z, Rao S, et al. Diarrhoea may be underestimated: a missing link in 2019 novel coronavirus. Gut 2020;69:1141-3. Epub 2020 Feb 26.
• 19. Ong J, Young BE, Ong S. COVID-19 in gastroenterology: a clinical perspective. Gut 2020;69:1144-5. Epub 2020 Mar 20.