Gastrointestinal Complications in Critically Ill COVID-19 Patients

Author: Dr. Asma Burney (MBBS) | Reviewer: Muhammad Rehan Mian (MSPH) | October 5, 2020

A research letter published by JAMA draws attention to Gastro-Intestinal (GI) complications in critically ill COVID-19 patients. The researchers used propensity score analysis to compare the incidence of GI complications in critically ill patients with COVID-19–induced Acute Respiratory Distress Syndrome (ARDS) with comparably ill patients with non–COVID-19 ARDS.

Data was collected from COVID patients admitted in the Massachusetts General Hospital ICUs and compared to a cohort of ARDS patients admitted between 2018 and 2019. GI complications like transaminitis, ileus, Ogilvie syndrome, and mesenteric ischemia were examined in both groups and statistical analysis was carried out.

The results found that patients with COVID-19 were more likely to develop GI complications compared to those without COVID-19. Specifically, patients with COVID-19 developed more transaminitis, severe ileus, and bowel ischemia.

The authors suggest that the high expression of Angiotensinogen Converting Enzyme ACE-2 receptors along the epithelial lining of the gut that act as host-cell receptors for SARS-CoV-2 could explain the GI involvement. Higher opioid requirements and COVID-19–induced coagulopathy may also explain the disproportionately high rate of ileus and ischemic bowel disease.

Limitations of the study include the single center and the unavailability of inflammatory markers. Further studies are needed to examine the pathophysiology of these findings.

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