Acute gastrointestinal injury in critically ill patients with COVID-19 in Wuhan, China

doi:10.3748/wjg.v26.i39.6087

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Oct 21, 2020 (publication date) through Apr 25, 2024

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Observational Study

World J Gastroenterol. Oct 21, 2020; 26(39): 6087-6097
Published online Oct 21, 2020. doi: 10.3748/wjg.v26.i39.6087

Table 1 Demographic data and clinical parameters

Variable	Value
Age (yr)	70 (60-79)
Sex (male: female)	59:24
Days from onset to admission	10 (7-15)
BMI (kg/m²)	23.8 (22.1-25.1)
APACHEII scores	14.0 (12.0-17.0)
SOFA scores	6.0 (4.0-7.0)
Initial symptoms or signs, n (%)
Fever	33 (39.8)
Cough	18 (21.7)
Chest tightness or pain	8 (9.6)
Dyspnea	7 (8.4)
Fatigue	6 (7.2)
Diarrhea	3 (3.6)
Nausea or vomiting	3 (3.6)
Pharyngalgia/myalgia	3 (3.6)
Abdominal pain	2 (2.4)
Laboratory parameters
CRP (mg/L)	85.9 (49.9-136.0)
WBC (10⁹/L)	10.30 (7.44-14.0)
Lymphocyte (10⁹/L)	0.60 (0.43-0.83)
PCT (ng/mL)	0.27 (0.14-0.50)
D-dimer (μg/mL)	8.29 (2.00-14.19)
Lactate (mmol/L)	2.22 (1.68-2.73)
Organ injury, n (%)
ARDS	77 (92.8)
Liver injury	15 (18.1)
AKI	30 (36.1)
Cardiac injury	37 (44.6)
MODS, n (%)	58 (69.9)
Septic shock, n (%)	16 (19.3)
Duration of MV (d)	9.0 (6.0-13.0)
Duration of CRRT (d)	0.0 (0.0-5.0)
Hospital stay (d)	18.0 (11.0-29.0)
Death, n (%)	40 (48.2)

BMI: Body mass index; APACHEII: Acute physiology and chronic health evaluation II; SOFA: Sequential organ failure assessment; CRP: C-reactive protein; WBC: White blood cell; PCT: Procalcitonin; ARDS: Acute respiratory distress syndrome; AKI: Acute kidney injury; MODS: Multiple organ dysfunction syndrome; MV: Mechanical ventilation; CRRT: Continuous renal replacement therapy.

Table 2 Acute gastrointestinal injury grades and clinical variables

Variables	No AGI (n = 11)	AGI I (n = 30)	AGI II (n = 35)	AGI III-IV (n = 7)	P value
BMI (kg/m²)	23.9 (22.5-24.9)	23.8 (21.5-26.1)	23.8 (22.1-24.9)	22.4 (21.6-23.1)	0.426
APACHEII scores	11.0 (9.0-12.0)	13.0 (10.0-14.3)	15.0 (13.0-18.0)	18.0 (16.0-21.0)	< 0.001
SOFA scores	3.0 (3.0-4.0)	5.0 (4.0-6.0)	6.0 (5.0-9.0)	10.0 (7.0-12.0)	< 0.001
CRP (mg/L)	82.7 (46.1-136.0)	72.3 (47.3-113.2)	99.8 (54.6-145.2)	130.4 (87.3-221.0)	0.155
WBC (10⁹/L)	7.9 (6.4-11.3)	8.7 (7.2-11.8)	11.9 (8.1-15.1)	16.6 (12.9-25.5)	0.001
Lymphocyte (10⁹/L)	0.85 (0.62-1.12)	0.66 (0.43-0.82)	0.51 (0.38-0.76)	0.59 (0.37-0.85)	0.044
PCT (ng/mL)	0.17 (0.08-0.49)	0.19 (0.13-0.41)	0.29 (0.16-0.50)	0.41 (0.31-0.97)	0.079
D-dimer (μg/mL)	2.65 (0.97-7.06)	4.60 (1.72-12.30)	11.90 (4.64-22.00)	15.51 (3.76-22.00)	0.001
Lactate (mmol/L)	1.17 (1.09-1.88)	2.09 (1.68-2.44)	2.25 (1.94-2.99)	2.55 (1.92-3.84)	0.038
MV days	6.0 (4.0-11.0)	7.0 (5.8-10.5)	10.0 (6.0-14.0)	14.0 (11.0-19.0)	0.029
CRRT days	0.0 (0.0-4.0)	0.0 (0.0-3.0)	0.0 (0.0-7.0)	6.0 (5.0-8.0)	0.045
Days from onset to admission	10.0 (7.0-15.0)	10.0 (6.0-14.3)	10.0 (7.0-15.0)	15.0 (10.0-21.0)	0.263
Hospital stay (d)	30.0 (28.0-34.0)	13.5 (9.0-24.0)	18.0 (11.0-31.0)	19.0 (13.0-28.0)	0.020
MODS, n (%)	6 (54.5)	18 (60.0)	27 (77.1)	7 (100.0)	0.089
Septic shock, n (%)	0 (0)	2 (6.7)	9 (25.7)	5 (71.4)	0.001
Death, n (%)	0 (0)	14 (46.7)	19 (54.3)	7 (100.0)	0.037

AGI: Acute gastrointestinal injury; BMI: Body mass index; APACHEII: Acute physiology and chronic health evaluation II; SOFA: Sequential organ failure assessment; CRP: C-reactive protein; WBC: White blood cell; PCT: Procalcitonin; ARDS: Acute respiratory distress syndrome; AKI: Acute kidney injury; MV: Mechanical ventilation; CRRT: Continuous renal replacement therapy; MODS: Multiple organ dysfunction syndrome.

Table 3 The incidence of different acute gastrointestinal injury grades in non-survivors and survivors, n (%)

AGI grades	Non-survivors (n = 40)	Survivors (n = 43)	P value
No AGI	0 (0)	11 (25.6)	< 0.001
AGI I	14 (35.0)	16 (37.2)	0.834
AGI II	19 (47.5)	16 (37.2)	0.343
AGI III-IV	7 (17.5)	0 (0)	0.004

AGI: Acute gastrointestinal injury.

Table 4 Independent factors associated with acute gastrointestinal injury grade II and above in multivariate logistic regression analysis

Variable	OR	95%CI	P value
SOFA scores	1.982	1.374-2.860	< 0.001
WBC counts	1.196	1.037-1.379	0.014
MV days	1.169	1.020-1.340	0.025

OR: Odds ratio; CI: Confidence interval; SOFA: Sequential organ failure assessment; WBC: White blood cell; MV: Mechanical ventilation.

Citation: Sun JK, Liu Y, Zou L, Zhang WH, Li JJ, Wang Y, Kan XH, Chen JD, Shi QK, Yuan ST. Acute gastrointestinal injury in critically ill patients with COVID-19 in Wuhan, China. World J Gastroenterol 2020; 26(39): 6087-6097
URL: https://www.wjgnet.com/1007-9327/full/v26/i39/6087.htm
DOI: https://dx.doi.org/10.3748/wjg.v26.i39.6087