Associations Between Gastrointestinal Symptoms and COVID-19 Severity Outcomes Based on a Propensity Score–Weighted Analysis of a Nationwide Cohort
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...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2022-01-01
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| Series: | Gastro Hep Advances |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772572322001133 |
| _version_ | 1811221333285011456 |
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| author | Shailja C. Shah Andrew Canakis Alese E. Halvorson Chad Dorn Otis Wilson Jason Denton Richard Hauger Christine Hunt Ayako Suzuki Michael E. Matheny Edward Siew Adriana Hung Robert A. Greevy, Jr. Christianne L. Roumie |
| author_facet | Shailja C. Shah Andrew Canakis Alese E. Halvorson Chad Dorn Otis Wilson Jason Denton Richard Hauger Christine Hunt Ayako Suzuki Michael E. Matheny Edward Siew Adriana Hung Robert A. Greevy, Jr. Christianne L. Roumie |
| author_sort | Shailja C. Shah |
| collection | DOAJ |
| description | 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 before and including the date of positive SARS-CoV-2 testing (March 1, 2020, to 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 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 < .001). When restricted to hospitalized patients (14.9%; n=32,430), patients with GI symptoms had similar frequencies of intensive care unit admission and mechanical ventilation compared with patients without symptoms. There was a significant age interaction; among hospitalized patients aged ≥70 years, 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 health care 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. |
| first_indexed | 2024-04-12T07:57:32Z |
| format | Article |
| id | doaj.art-70197cf5fecd4414a45013d5f016b3c0 |
| institution | Directory Open Access Journal |
| issn | 2772-5723 |
| language | English |
| last_indexed | 2024-04-12T07:57:32Z |
| publishDate | 2022-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Gastro Hep Advances |
| spelling | doaj.art-70197cf5fecd4414a45013d5f016b3c02022-12-22T03:41:26ZengElsevierGastro Hep Advances2772-57232022-01-0116977984Associations Between Gastrointestinal Symptoms and COVID-19 Severity Outcomes Based on a Propensity Score–Weighted Analysis of a Nationwide CohortShailja C. Shah0Andrew Canakis1Alese E. Halvorson2Chad Dorn3Otis Wilson4Jason Denton5Richard Hauger6Christine Hunt7Ayako Suzuki8Michael E. Matheny9Edward Siew10Adriana Hung11Robert A. Greevy, Jr.12Christianne L. Roumie13Gastroenterology Section, VA San Diego, San Diego, California; Division of Gastroenterology, University of California, San Diego, San Diego, California; Correspondence: Address correspondence to: Shailja C. Shah, MD, MPH, GI Section, VA San Diego Healthcare System, 3350 La Jolla Village Drive, Mail Code: 111D, La Jolla, California 92161.Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, MarylandDepartment of Biostatistics, Vanderbilt University Medical Center, Nashville, TennesseeDepartment of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TennesseeDepartment of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TennesseeDepartment of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TennesseeDepartment of Psychiatry, University of California San Diego, La Jolla, California; Center of Excellence for Stress and Mental Health, San Diego, CaliforniaDivision of Gastroenterology, Duke University Medical Center, Durham, North Carolina; Gastroenterology Section, Durham VA Health Care System, Durham, North CarolinaDivision of Gastroenterology, Duke University Medical Center, Durham, North Carolina; Gastroenterology Section, Durham VA Health Care System, Durham, North CarolinaDepartment of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee; VA Tennessee Valley Healthcare System, Health Services Research and Development, Nashville, Tennessee; Department of Medicine, Vanderbilt University Medical Center, Nashville, TennesseeVA Tennessee Valley Healthcare System, Health Services Research and Development, Nashville, Tennessee; Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TennesseeVA Tennessee Valley Healthcare System, Health Services Research and Development, Nashville, Tennessee; Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TennesseeDepartment of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee; VA Tennessee Valley Healthcare System, Clinical Services Research and Development, Nashville, TennesseeDepartment of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; VA Tennessee Valley Healthcare System, Clinical Services Research and Development, Nashville, Tennessee; VA Geriatrics Research Education and Clinical Center (GRECC), VA Tennessee Valley Health System, Nashville, TennesseeBackground 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 before and including the date of positive SARS-CoV-2 testing (March 1, 2020, to 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 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 < .001). When restricted to hospitalized patients (14.9%; n=32,430), patients with GI symptoms had similar frequencies of intensive care unit admission and mechanical ventilation compared with patients without symptoms. There was a significant age interaction; among hospitalized patients aged ≥70 years, 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 health care 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.http://www.sciencedirect.com/science/article/pii/S2772572322001133COVID-19EpidemiologyInfectious diseasesOutcomesSARS-CoV-2 |
| spellingShingle | Shailja C. Shah Andrew Canakis Alese E. Halvorson Chad Dorn Otis Wilson Jason Denton Richard Hauger Christine Hunt Ayako Suzuki Michael E. Matheny Edward Siew Adriana Hung Robert A. Greevy, Jr. Christianne L. Roumie Associations Between Gastrointestinal Symptoms and COVID-19 Severity Outcomes Based on a Propensity Score–Weighted Analysis of a Nationwide Cohort Gastro Hep Advances COVID-19 Epidemiology Infectious diseases Outcomes SARS-CoV-2 |
| title | Associations Between Gastrointestinal Symptoms and COVID-19 Severity Outcomes Based on a Propensity Score–Weighted Analysis of a Nationwide Cohort |
| title_full | Associations Between Gastrointestinal Symptoms and COVID-19 Severity Outcomes Based on a Propensity Score–Weighted Analysis of a Nationwide Cohort |
| title_fullStr | Associations Between Gastrointestinal Symptoms and COVID-19 Severity Outcomes Based on a Propensity Score–Weighted Analysis of a Nationwide Cohort |
| title_full_unstemmed | Associations Between Gastrointestinal Symptoms and COVID-19 Severity Outcomes Based on a Propensity Score–Weighted Analysis of a Nationwide Cohort |
| title_short | Associations Between Gastrointestinal Symptoms and COVID-19 Severity Outcomes Based on a Propensity Score–Weighted Analysis of a Nationwide Cohort |
| title_sort | associations between gastrointestinal symptoms and covid 19 severity outcomes based on a propensity score weighted analysis of a nationwide cohort |
| topic | COVID-19 Epidemiology Infectious diseases Outcomes SARS-CoV-2 |
| url | http://www.sciencedirect.com/science/article/pii/S2772572322001133 |
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