Objective The SARS-CoV-2-infected disease (COVID-19) outbreak is a major threat to human beings. Previous studies mainly focused on Wuhan and typical symptoms. We analysed 74 confirmed COVID-19 cases with GI symptoms in the Zhejiang province to determine epidemiological, clinical and virological characteristics.
Design COVID-19 hospital patients were admitted in the Zhejiang province from 17 January 2020 to 8 February 2020. Epidemiological, demographic, clinical, laboratory, management and outcome data of patients with GI symptoms were analysed using multivariate analysis for risk of severe/critical type. Bioinformatics were used to analyse features of SARS-CoV-2 from Zhejiang province.
Results Among enrolled 651 patients, 74 (11.4%) presented with at least one GI symptom (nausea, vomiting or diarrhoea), average age of 46.14 years, 4-day incubation period and 10.8% had pre-existing liver disease. Of patients with COVID-19 with GI symptoms, 17 (22.97%) and 23 (31.08%) had severe/critical types and family clustering, respectively, significantly higher than those without GI symptoms, 47 (8.14%) and 118 (20.45%). Of patients with COVID-19 with GI symptoms, 29 (39.19%), 23 (31.08%), 8 (10.81%) and 16 (21.62%) had significantly higher rates of fever >38.5°C, fatigue, shortness of breath and headache, respectively. Low-dose glucocorticoids and antibiotics were administered to 14.86% and 41.89% of patients, respectively. Sputum production and increased lactate dehydrogenase/glucose levels were risk factors for severe/critical type. Bioinformatics showed sequence mutation of SARS-CoV-2 with m6A methylation and changed binding capacity with ACE2.
Conclusion We report COVID-19 cases with GI symptoms with novel features outside Wuhan. Attention to patients with COVID-19 with non-classic symptoms should increase to protect health providers.
- infectious disease
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XJ, J-SL, J-HH, JG, LZ, Y-MZ, S-RH and H-YJ are joint first authors.
Contributors XJ, J-SL, J-HH, J-GG, LZ, Y-MZ, S-RH, H-YJ designed the study, analysed the data and wrote the paper. HC, X-LZ, G-DY, K-JX, X-YW, J-QG, S-YZ, C-YY, C-LJ, Y-FL, XY, X-PY, J-RH, K-LX, QN, C-BY, BZ, Y-TL, JL, HZ, XZ, LY, Y-ZG, J-WS, J-JT, G-JL, X-XW, W-RW, T-TQ, D-RX, PY, DS, Y-FC and YR collected data and performed study. Y-QQ, L-JL, J-FS and Y-DY designed the study, supervised the whole study process and critically revised the manuscript.
Funding National Major Science and Technology Research Projects for the Control and Prevention of Major Infectious Diseases in China (2017Z×10202202). National Science Funding of China (81770574).
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.
Patient consent for publication Not required.
Ethics approval The study was approved by the Clinical Research Ethics Committee of the First Affiliated Hospital, College of Medicine, Zhejiang University (No. IIT20200005C).
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. All data were included in the article and its associated supplementary materials and open to public.