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The overall rate of severe gastrointestinal (GI) complications in COVID-19 patients admitted to the intensive care unit (ICU) was only 5.1%, investigators from the North American Alliance for the Study of Digestive Manifestation of COVID-19 found. Severe complications, however, were associated with a death rate of 55.6%.

The majority of complications related to liver enzyme elevation, followed by GI bleeding and Clostridioides difficile (C. diff) infection, according to Emad Qayed, MD, MPH, of Emory University in Atlanta, and colleagues.

"Despite a high prevalence of GI symptoms in patients with COVID-19, this study found that the frequency of severe GI complications is low in COVID-19 patients admitted to the ICU," Qayed told 番茄社区app, noting that the study therefore does not support a link between COVID-19 and bowel ischemia, severe ileus, or other severe GI and hepatic consequences. "Physicians should continue to treat the underlying pulmonary disease and follow existing guidelines on the care of critically ill patients with COVID-19," he said.

In particular, the phenomenon of intestinal ischemia may not be as problematic as initially believed, the investigators wrote in the study online in . Reported in another as in excess of 4%, the rate of intestinal ischemia in the study by Qayed and co-authors was only 0.2%.

Patients hospitalized with COVID-19 are known to often have including diarrhea, nausea, vomiting, and abdominal pain, and it is recommended that these be part of the differential diagnosis of coronavirus infection.

But the overall rate of serious manifestations has been unknown, despite reports earlier this year from Massachusetts General Hospital in Boston suggesting a of these infection consequences.

Study Details

For the new study, which was conducted at 36 U.S. and Canadian medical centers, Qayed and co-investigators enrolled the first 50 to 100 consecutive adults with a confirmed diagnosis of COVID-19 at each center. In total, data were collected for 1,992 hospitalized patients.

The 878 participants admitted to the ICU had a mean age of 61.9, and 61.8% were male; 52.2% were obese with a mean body mass index (BMI) of 32.2.

The most common comorbidities were hypertension (67.7% of patients), diabetes mellitus (40.8%), pulmonary disease (31%), and cardiac disease (25.2%). Previous GI or liver disease was reported by 9.1%, and 73.4% reported no current or previous alcoholism.

Overall, 634 ICU patients (72.2%) required mechanical ventilation, and 534 (60.8%) needed vasopressor support.

The hepatic complication of interest in the study was severe liver enzyme elevation with an alanine aminotransferase (ALT) over 1,000 IU/L. GI complications included any significant luminal and pancreaticobiliary medical or surgical disorder such as acute pancreatitis, acute cholecystitis, acute mesenteric ischemia, intestinal obstruction, and GI infections, as well as GI bleeding requiring endoscopic evaluation or intervention.

With a median hospital stay of 16 days -- 9 in the ICU and 299 deaths -- GI outcomes in the ICU cohort were as follows:

• Any severe complications (mainly ALT over 1,000 IU/L): 5.1% (45 patients)

• Luminal and pancreaticobiliary complications: 2.7% (24 patients)

• Severe GI bleeding: 1.1% (10 patients)

• C. diff infection: 0.7% (six patients)

• Acute cholecystitis, or mesenteric ischemia: 0.2% (two patients each)

• Acute pancreatitis or small bowel obstruction: 0.1% (one patient each)

• Death rate in those with severe GI complications: 55.6% (25 patients)

Notwithstanding the observed low incidence of intestinal ischemia, "it is increasingly apparent that COVID-19 represents a hypercoagulable disorder that is associated with a higher incidence of venous thromboembolism," Qayed and co-authors wrote. "Additionally, since [SARS-CoV-2] has been found to infect the endothelial cells of different vascular beds in the heart, small bowel, and lungs ... it is postulated that endotheliitis caused by COVID-19 leads to microthrombus formation and organ ischemia."

The virus's infection route via the angiotensin-converting enzyme (ACE) 2 receptors, which abound in endothelial cells across a range of organ systems, is thought to play a role, the team noted. Accordingly, some researchers believe there is a rationale for while tackling viral replication. particularly with anti-inflammatory anti-cytokine drugs, ACE inhibitors, and statins.

"The current study was long overdue as it gives us the most up-to-date and comprehensive depiction of severe gastrointestinal complications associated with COVID-19 infection," Salmaan A. Jawaid, MD, of Baylor College of Medicine in Houston, who was not involved with the study, told 番茄社区app. While the data are reassuring, "I would be cautious about their interpretation, specifically in the incidence of gastrointestinal bleeding."

Given the hypercoagulable state induced by COVID-19, infected patients are often placed on anticoagulation, which increases the risk of GI bleeding, Jawaid continued. "Consequently, I wonder how many patients in the current data set were or were not on anticoagulation, as this can affect the true incidence of gastrointestinal bleeding in this patient population."

He also pointed to the important finding that of those with severe complications, more than half died. "Thus, having a severe gastrointestinal complication in the setting of a COVID-19 infection may portend increased mortality," he said, calling for further research to look at this association.

Study limitations, Qayed and co-authors said, included that age over 89 was not documented and that BMI data was missing for 52 patients.

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