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Anorexia Leads GI Complaints in Multicenter US Group With COVID-19
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Mark Mascolini
One third of a multicenter US group admitted to the hospital with COVID-19 had anorexia, the most frequent gastrointestinal (GI) problem reported [1]. Almost as many had diarrhea, and nearly two thirds had some GI problem [1]. Loss of taste independently raised odds of anorexia, and loss of smell independently predicted nausea.
Researchers at Boston’s Brigham and Women's Hospital noted that data remain sparse on GI implications of COVID-19 in US patients. They aimed to evaluate GI manifestations of SARS-CoV-2 infection in US adults and to evaluate GI-specific health outcomes.
The analysis included 318 consecutively admitted adults with PCR-confirmed SARS-CoV-2 at 2 tertiary care hospitals and 7 community hospitals in Massachusetts. Participants tended to be overweight or obese (average body mass index 30 kg/m2) and most had cardiovascular risk factors or other comorbidities.
Almost two thirds of the group (195 people, 61.3%) had at least one GI symptom. Despite the high average body mass index, the most frequent GI problem was anorexia (34.8%), followed by diarrhea (33.7%), nausea (26.4%), vomiting (15.4%), abdominal pain (14.5%), and weight loss (9.4%). One in 5 study participants had GI symptoms as the predominant presenting complaint with COVID-19.
Compared with COVID-19 inpatients without GI symptoms, those who had GI problems proved significantly more likely to report fatigue (65.1% versus 45.5%, P = 0.0006) or myalgia (49.2% versus 22.0%, P < 0.0001). Fatigue proved more prevalent in people with anorexia and diarrhea (P < 0.05) and myalgia in people with anorexia, diarrhea, and nausea (P < 0.05).
Among airway symptoms, people with versus without GI conditions had a lower frequency of dyspnea (54.9% versus 68.3%< P = 0.02) and a higher frequency of sore throat (21.5% versus 9.8%, P = 0.0064). Compared with people who had no GI symptoms, those with GI complaints had a significantly higher frequency of anosmia (loss of smell) (13.3% versus 4.9%, P = 0.0146) and ageusia (loss of taste) (10.9% versus 2.4%, P = 0.0057).
Multivariate regression analysis singled out loss of smell as an independent predictor of nausea, nearly tripling the odds of nausea (odds ratio [OR] 2.92, 95% confidence interval [CI] 1.28 to 6.68, P = 0.01). Two variables independently boosted odds or anorexia, loss of taste (OR 3.53, 95% CI 1.41 to 8.84, P = 0.007) and alcohol intake (OR 2.25, 95% CI 1.09 to 4.65, P = 0.03).
The researchers saw no significant differences between people with and without GI symptoms in clinical deterioration assessed as ICU admission, need for mechanical ventilation, or death. Among 202 people who completed hospitalization, 35 (17.3%) required an ICU stay, 26 (12.9%) needed mechanical ventilation, and 32 (15.8%) died in the hospital.
Diarrhea is frequently reported in patients with COVID-19, but a PubMed search (on April 26, 2020) turned up only 13 articles mentioning anorexia in the context of COVID-19. Yet two meta-analyses confirm the one-third prevalence of anorexia in the US multicenter study. Meta-analysis of 38 studies involving 3062 people with COVID-19 found anorexia in 38.8% [2]. Pooled prevalence of anorexia was 26.8% in a meta-analysis of GI symptoms in 18 studies [3].
References
1. Redd WD, Zhou JC, Hathorn KE, et al. Prevalence and characteristics of gastrointestinal symptoms in patients with SARS-CoV-2 infection in the United States: a multicenter cohort study. Gastroenterology. 2020 Apr 22. pii: S0016-5085(20)30564-3. doi: 10.1053/j.gastro.2020.04.045. https://www.gastrojournal.org/article/S0016-5085(20)30564-3/pdf
2. Zhu J, Ji P, Pang J, Zhong Z, Li H, He C, Zhang J, Zhao C. Clinical characteristics of 3,062 COVID-19 patients: a meta-analysis. J Med Virol. 2020 Apr 15. doi: 10.1002/jmv.25884.
3. Cheung KS, Hung IF, Chan PP, et al. Gastrointestinal manifestations of SARS-CoV-2 infection and virus load in fecal samples from the Hong Kong cohort and systematic review and meta-analysis. Gastroenterology. 2020 Apr 3. pii: S0016-5085(20)30448-0. doi: 10.1053/j.gastro.2020.03.065.
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