key: cord-1034761-dgjdhf5g authors: Díaz, Luis Antonio; García-Salum, Tamara; Fuentes-López, Eduardo; Ferrés, Marcela; Medina, Rafael A.; Riquelme, Arnoldo; Levican, Jorge; Almonacid, Leonardo I.; Serrano, Eileen; Chahuan, Javier; Cofré, Colomba; Álvarez, Manuel; Labarca, Jaime; Valderrama, Sebastián; Salinas, Erick; Toro, Adriana; Ortega, Marcos; García, Patricia; Pizarro, Margarita title: Symptom profiles and risk factors for hospitalization in patients with SARS-CoV-2 and COVID-19: A Large Cohort from South America date: 2020-05-08 journal: Gastroenterology DOI: 10.1053/j.gastro.2020.05.014 sha: 84c8c9d153adf366e90b13a7e82364f681f96de0 doc_id: 1034761 cord_uid: dgjdhf5g nan San Carlos for their support to this project related to recruitment process. 5 The pandemic caused by a novel Severe Acute Respiratory Syndrome coronavirus (SARS-CoV-2) can cause several gastrointestinal (GI) symptoms. A recent systematic review showed a prevalence of GI symptoms in 17.6%. The most frequent manifestations were anorexia (26.8%), diarrhea (12.5%), nausea/vomiting (10.2%), and abdominal pain (9.2%) 1 , and recent reports showed the detection of viral RNA in stools for prolonged periods (70.3%) 1 . We established the frequency and impact of GI symptoms, and viral presence in stools among Chilean patients infected with SARS-CoV-2. We used information available from the Chilean Ministry of Health. SARS-CoV-2 infection was confirmed by a quantitative real-time reverse transcription-polymerase chain reaction In Chile, there were 82,271 tests performed to detect SARS-CoV-2, and 7,213 (8.8%) were positive by April 11 th 2020, accounting for an incidence of 37.1 cases per 100,000 6 inhabitants. We included 7,016 in the analysis (97.3% of patients confirmed nationally). The median age was 40 years old, and 50% were females. The most common symptoms were cough (53.4%), myalgia (56.4%), and fever (43.9%) (Figure) . Diarrhea was reported in 7.3%, and 3.7% had abdominal pain. A total of 1,155 patients were hospitalized (16.5%): 716 (62%) were in a general ward, 439 (38%) were in an intensive care unit, and 328 (28.4%) required mechanical ventilation. At the end of this study, 80 deaths had occurred (mortality rate 1.1%). The presence of diarrhea was associated with a higher risk of hospitalization, with a relative risk (RR) of 1.31 (CI-95% 1.1-1.57; p-value <0.01), but abdominal pain was not (RR 1.25, CI-95% 0.98-1.60; p-value <0.076). In the convenience cohort (N=28), the median age was 43.6 years-old [23-83]; 11 (39.3%) were females, and 12 (42.9%) were hospitalized. None of our patients died at the end of this study. Twelve (42.9%) patients referred to GI symptoms, including diarrhea (32.1%), nausea (14.3%), abdominal pain (3.6%), and vomiting (3.6%). Viral RNA was detected in 23 patients (83.1%) with respiratory secretions, and 6 (50%) patients with stool samples available were positive. Of these, 4 (66.7%) presented GI symptoms (Figure) In Chile, 7.3% of SARS-CoV-2 patients reported diarrhea and 3.7% abdominal pain. A significant percentage of our population required hospitalization, reaching a low mortality rate of 1.1%. The presence of diarrhea was associated with a higher risk of hospitalization, increasing the risk by 31%. Instead, abdominal pain was not associated with a higher risk of hospitalization. In our CC, we determined that 50% of patients had detectable stool viral RNA during illnesses, and patients with diarrhea had higher stool RNA positivity than those without diarrhea. The overall frequency of GI symptoms was similar to other populations 1-3 . Recent publications showed that the frequency of GI symptoms is higher in severe patients, becoming more pronounced with an increase disease severity 1, 2 . However, the specific symptoms associated with higher risk had not been characterized. In this study, diarrhea and nausea were the most prevalent symptoms, highlighting and confirming the diverse clinical manifestations 1, 3-5 . The mean C T value was similar between patients with and without GI manifestations. We could only obtain stool samples from a subset of our recruited patients; hence, further studies are warranted to accurately assess the proportion of individuals with viral shedding in stools. It has been widely proposed that SARS-CoV-2 could enter cells using the Angiotensinconverting-Enzyme-2 (ACE2) as a receptor 6 . ACE2 modulates intestinal inflammation, and 8 recent evidence showed that intestinal epithelium also supports SARS-CoV-2 replication, suggesting that the fecal-oral route could provide a source of potential transmission 7, 8 . In conclusion, the presence of diarrhea was associated with a higher risk of hospitalization in Chilean patients diagnosed with SARS-CoV-2. The frequency of GI manifestations in our population is similar to previous reports. Fifty percent of patients have detectable SARS-CoV-2 RNA in stools. The fecal-oral route might be an underestimated mechanism of transmission. Preventive measures focused on this pathway could potentially decrease transmission. Gastrointestinal Manifestations of SARS-CoV-2 Infection and Virus Load in Fecal Samples from the Hong Kong Cohort and Systematic Review and Meta-analysis Clinical Characteristics of COVID-19 Patients With Digestive Symptoms in Hubei, China: A Descriptive, Cross-Sectional, Multicenter Study COVID-19 patients' clinical characteristics, discharge rate, and fatality rate of meta-analysis Imaging and Clinical Features of Patients With Novel Coronavirus SARS-CoV-2: A systematic review and meta-analysis Panic of Buying Toilet Papers: A Historical Memory or a Horrible Truth? 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