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Epidemiological, clinical and virological characteristics of 74 cases of coronavirus-infected disease 2019 (COVID-19) with gastrointestinal symptoms
  1. Xi Jin1,
  2. Jiang-Shan Lian2,
  3. Jian-Hua Hu2,
  4. Jianguo Gao1,
  5. Lin Zheng2,
  6. Yi-Min Zhang2,
  7. Shao-Rui Hao2,
  8. Hong-Yu Jia2,
  9. Huan Cai2,
  10. Xiao-Li Zhang2,
  11. Guo-Dong Yu2,
  12. Kai-Jin Xu2,
  13. Xiao-Yan Wang2,
  14. Jue-Qing Gu2,
  15. Shan-Yan Zhang2,
  16. Chan-Yuan Ye2,
  17. Ci-Liang Jin2,
  18. Ying-Feng Lu2,
  19. Xia Yu2,
  20. Xiao-Peng Yu2,
  21. Jian-Rong Huang2,
  22. Kang-Li Xu3,
  23. Qin Ni2,
  24. Cheng-Bo Yu2,
  25. Biao Zhu2,
  26. Yong-Tao Li2,
  27. Jun Liu2,
  28. Hong Zhao2,
  29. Xuan Zhang2,
  30. Liang Yu2,
  31. Yong-Zheng Guo2,
  32. Jun-Wei Su2,
  33. Jing-Jing Tao2,
  34. Guan-Jing Lang2,
  35. Xiao-Xin Wu2,
  36. Wen-Rui Wu2,
  37. Ting-Ting Qv2,
  38. Dai-Rong Xiang2,
  39. Ping Yi2,
  40. Ding Shi2,
  41. Yanfei Chen2,
  42. Yue Ren1,
  43. Yun-Qing Qiu2,
  44. Lan-Juan Li2,
  45. Jifang Sheng2,
  46. Yida Yang2
  1. 1 Department of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
  2. 2 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Department of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
  3. 3 Department of Neurosurgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
  1. Correspondence to Dr Yida Yang, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Department of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China; yangyida65{at}163.com

Abstract

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
  • diarrhoea
http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • 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.

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