Outcomes and implications of diarrhea in patients with SARS-CoV-2 infection

Abstract

Background and aims

Diarrhea was not uncommon in patients with coronavirus disease 2019 (COVID-19), but the significance remains undetermined.

Methods

This retrospective study included 157 diarrhea cases form 564 hospitalized COVID-19 patients who were admitted to Wuhan Union Hospital from January 20 to February 29, 2020. Clinical characteristics, the course and the outcome of patients with diarrhea were analyzed. The correlation between diarrhea and fecal presence of coronavirus was also determined.

Results

The overall morbidity of diarrhea was 27.8% (157/564) in COVID-19 patients. Among them, 38 cases presented only with diarrhea, and 119 cases in both diarrhea and respiratory symptoms. Patients with diarrhea and respiratory symptoms had higher levels of inflammatory activity, longer hospital stay (27.5 vs. 23.0 vs. 22.0 days, p = .029) and higher odds ratio of mortality (3.2 times and 2.2 times, respectively) than those with diarrhea only or respiratory symptoms only. However, patients with diarrhea had longer time from onset to admission (14.5 days vs. 11.0 days, p = .04), higher positive viral RNA in stool (80.0% vs. 52.4%, p = .016) than those with both diarrhea and respiratory symptoms.

Conclusions

Diarrhea caused by high enteric viral burden may lead to long course and poor outcome in COVID-19 patients. The patients with diarrhea and respiratory symptoms were prone to serious condition, and had worse outcomes. However, the patients with diarrhea alone showed mild illness but delayed health-seeking.

Keywords:

• Coronavirus disease 2019
• severe acute respiratory syndrome coronavirus 2
• digestive system
• diarrhea
• fecal–oral transmission

Acknowledgements

The authors thank the patients and their families for their contribution to this study.

Ethics approval and consent to participate

The study was approved by the institutional review board prior to data collection. All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008. Informed consent was waived due to retrospective study.

Author contributions

H. Shang and T. Bai contributed equally to this study. H. Shang collected medical records data, analyzed the data and drafted the manuscript; T. Bai helped for data collection and data analysis; Y. Chen and C. Huang helped for data collection; S. Zhang and P. Yang supported for data entry and sorting; X. Hou and L. Zhang designed and supervised the study and revised the manuscript.

Disclosure statement

The authors declare that they have no conflict of interest.

Data availability statement

The raw data generated and analyzed in the current study are not publicly available due to appropriate protection of patient personal information but are available from the corresponding author on reasonable request.

Additional information

Funding

This work was supported by grants from the Science and Technology Department of Hubei Province, China [2020FCA014] and National Natural Science Foundation of China (NSFC), China [No. 81720108006].