Diarrhea in Patients with Coronavirus Disease 2019: Clinical Characteristics, Outcomes and Implications

Background: Coronavirus disease 2019(COVID-19)is an emerged infection raised wide concerns for the pneumonia and respiratory manifestations. Also, diarrhea and other gastrointestinal symptoms are frequently observed in COVID-19 patients but the significance remains undetermined.Methods: This retrospective study included 157 diarrhea cases form 564 hospitalized COVID-19 patients who admitted to the 3 designated medical units of Wuhan Union Hospital from Jan 20 to Feb 29, 2020. Clinical characteristics, course and outcome of diarrhea patients, especially those without respiratory symptoms, were analyzed. The relations of diarrhea and fecal presence of coronavirus were also preliminary explored.Findings: The overall morbidity of diarrhea was 27.8% in COVID-19 patients. In 157 diarrhea suffers, 38 cases (24.2%) developed diarrhea without respiratory symptoms, and 12 cases (7.6%) with only diarrhea in the absence of fever and respiratory symptoms. Diarrhea was occurred 6.1±4.4 days after onset of symptoms, 48 cases (30.6%) developed diarrhea in the first 3 days. Patients with diarrhea showed higher levels of inflammatory activity with longer disease course and hospital stay, and potentially poorer outcome than those without diarrhea. In simple diarrhea patients, diarrhea appeared earlier with mild illness, less mortality and shorter total course of illness but longer time from onset to admission relative diarrhea patients with respiratory symptoms. Moreover, fecal coronavirus was related with longer disease course and hospital stay in diarrhea patients, and showed sustained positive enteric virus after negative conversion in respiratory specimen in some cease.Interpretation: Diarrhea was specially presented in COVID-19 patients and related with the longer course and poorer outcome of the disease due to potential higher viral burden, which may not be overlooked particular in a subgroup of patients with diarrhea as the initial or major symptom. Herein, it should take seriously the role of fecal coronavirus in the criteria of diagnosis and clinical cure.Funding Statement: This study was supported by grants of a novel coronavirus pneumonia emergency science and technology projects from the Science and Technology Department of Hubei Province, China (2020FCA014), and the projects of international cooperation and exchanges from the National Natural Science Foundation of China (NSFC), China (No. 81720108006).Declaration of Interests: The authors declare that they have no competing interests.Ethics Approval Statement: This study was approved by the Medical Ethical Review Committee, Union Hospital of Huazhong University of Science and Technology, China ([2020] No.0033).