Gastrointestinal Consequences of Discharged COVID-19 Patients: A Multicenter Cohort Study

Background: The majority of COVID-19 patients presented persisting symptoms after discharge. We aimed to determine the long-term enteric consequences of SARS-CoV-2 infection, and to identify the risk and the protective factors for gastrointestinal sequelae. Methods: A retrospective cohort of 117 SARS-CoV-2 nucleic acid positive patients hospitalized in 12 hospitals from January 16 to March 7, 2020 were included in this study. Clinical data collected during hospitalization, from return visits and from telephone interviews in 3 months after discharge were reviewed. Multivariable logistic regression was performed to identify the risk and the protective factors for any and individual gastrointestinal sequelae. Findings: In three months after discharge, 53 patients (45%) presented at least one gastrointestinal sequelae. Common gastrointestinal sequelae included loss of appetite (28 patients, 24%), nausea (21 patients, 18%), acid reflux (21 patients, 18%), and diarrhea (17 patients, 15%). Decreased blood oxygen saturation and PPI treatment were risk factors, while enteral nutrition was a protective factor for gastrointestinal sequelae in general. For individual gastrointestinal sequelae, the decreased blood oxygen saturation was a risk factor, while male sex was a protective factor for loss of appetite after discharge. For nausea after discharge, PPI treatment was a risk factor while parenteral nutrition was a protective factor. Decreased blood oxygen saturation, BMI >25, and PPI treatment were risk factors for acid reflux after discharge. And finally, male sex was a risk factor for diarrhea after discharge. Interpretation: At three months after discharge, gastrointestinal sequelae were still common in recovering COVID-19 patients. Decreased blood oxygen saturation, PPI treatment, BMI >25, and male sex are risk factors, while nutritional support and male sex are protective factors, for gastrointestinal sequelae. Our data highlight the importance of gastrointestinal care and nutritional support for discharged COVID-19 patients. Funding: Guangdong Province “Pearl River Talent Plan” Innovation and Entrepreneurship Team Project, National Natural Science Foundation of China, and the National Key Clinical Discipline of China. Declaration of Interests: All authors declare no competing interests. Ethics Approval Statement: This study was approved by the Institutional Review Boards of Sun Yat-sen University and the participating hospitals.