Does COVID-19 Contribute to Gastrointestinal Complications in Critically Ill?

COVID-19 is a complicated virus and subsequent infection due, in part, to the multiple ways in which it can impact the body. In fact, it seems to cause extrapulmonary complications that can negatively affect multiple organ systems.

One of the systems often affected is the digestive system, and many patients experience gastrointestinal complications when hospitalized for COVID-19. These complications vary and may include bowel ischemia, gastrointestinal bleeding, Ogilvie syndrome, pancreatitis, severe ileus, and transaminitis.

Despite this apparent correlation between COVID-19 and gastrointestinal complications, it is unclear whether the issues are caused by generalized critical illness or by COVID-19 specifically. To gain a clearer understanding of this possible link, a recent study compared critically ill patients with acute respiratory distress syndrome (ARDS), some with COVID-19 and some without.

The Study

Between March 13, 2020, and May 7, 2020, COVID-19 patients admitted to the intensive care units of Massachusetts General Hospital with ARDS were included in the study. They were then compared to a cohort of patients with ARDS admitted between 2018 and 2019.

All protocols remained unchanged for treating ARDS, and propensity score matching was used to adjust for demographics, comorbidities, and the severity of the illness at the time of ICU admission. Both groups were assessed for gastrointestinal complications, including ileus, mesenteric ischemia, Ogilvie syndrome, and transaminitis.

Measures were taken to ensure that any differences that may contribute to increased incidence ratios were accounted for.

Findings

244 non-COVID patients with ARDS qualified for the comparison, while 242 COVID-19 patients met the criteria. Of these, 92 of each were propensity score matched for comparison.

It was found that COVID-19 patients with ARDS were significantly more likely to experience gastrointestinal complications than their non-COVID counterparts. In fact, they were two times as likely to develop such issues (74% versus 37%).

4% of COVID-19 patients included in the comparison developed bowel ischemia, 48% developed severe ileus, and 55% developed transaminitis. When compared to the non-COVID patients’ numbers (0%, 22%, and 27%, respectively), the significant increase in gastrointestinal complications is clear.

What it Means

Critically ill patients with COVID-19 suffered from gastrointestinal complications at a much higher rate than their non-COVID counterparts. There are a handful of factors that may contribute to this outcome, including the effects of COVID-19 itself and the increased demand for opioids in patients with COVID-19.

It is important to keep in mind that this study was conducted at a single center and no inflammatory markers were used for comparison matching. So, while certain lessons can be gleaned from this study, more research must be conducted before a clear picture can come into focus.