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Master of Public Health

Associations Between Gastrointestinal Symptoms and COVID-19 Severity Outcomes, Based on a Propensity Score-Weighted Analysis of a Nationwide Cohort

AUTHORS

Shah SC , Canakis A , Halvorson AE , Dorn C , Wilson O , Denton J , Hauger R , Hunt C , Suzuki A , Matheny ME , Siew E , Hung A , Greevy RA , Roumie CL , . Gastro hep advances. 2022 8 7; ().

ABSTRACT

Background and Aims: Gastrointestinal (GI) symptoms are well-recognized manifestations of coronavirus disease 2019 (COVID-19). Our primary objective was to evaluate the association between GI symptoms and COVID-19 severity.

Methods: In this nationwide cohort of US veterans, we evaluated GI symptoms (nausea/vomiting/diarrhea) reported 30 days prior to and including the date of positive SARS-CoV-2 testing (March 1, 2020-February 20, 2021). All patients had >1 year of prior baseline data and >60 days follow-up relative to the test date. We used propensity score (PS)-weighting to balance covariates in patients with vs. without GI symptoms. The primary composite outcome was severe COVID-19, defined as hospital admission, intensive care unit (ICU) admission, mechanical ventilation, or death within 60-days of positive testing.

Results: Of 218,045 SARS-CoV-2 positive patients, 29,257 (13.4%) had GI symptoms. After PS-weighting, all covariates were balanced. In the PS-weighted cohort, patients with vs. without GI symptoms had severe COVID-19 more often (29.0% vs. 17.1%, P<0.001). When restricted to hospitalized patients (14.9%; n=32,430), patients with GI symptoms had similar frequencies of ICU admission and mechanical ventilation compared to patients without symptoms. There was a significant age interaction; among hospitalized patients >70 years old, lower COVID-19 associated mortality was observed in patients with vs. without GI symptoms, even after accounting for COVID-19-specific medical treatments.

Conclusion: In the largest integrated US healthcare system, SARS-CoV-2 positive patients with GI symptoms experienced severe COVID-19 outcomes more often than those without symptoms. Additional research on COVID-19 associated GI symptoms may inform preventive efforts and interventions to reduce severe COVID-19.

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