March 18 (UPI) -- Fever, cough and shortness of breath have been widely acclaimed as the hallmark symptoms of COVID-19, the disease caused by the new coronavirus, but a new analysis suggests diarrhea may be common as well.
While most patients with the virus present with respiratory symptoms and signs, early experience in China reveals that as many as one in four patients experiences digestive symptoms as their chief complain.
The finding comes from a descriptive, cross-sectional multicenter study in China by investigators at the Wuhan Medical Treatment Expert Group for COVID-19, published Wednesday in The American Journal of Gastroenterology.
"In this study, COVID-19 patients with digestive symptoms have a worse clinical outcome and higher risk of mortality compared to those without digestive symptoms, emphasizing the importance of including symptoms like diarrhea to suspect COVID-19 early in the disease course before respiratory symptoms develop," Dr. Brennan M.R. Spiegel, co-editor-in-chief of the journal, said in a press release. "This may lead to earlier diagnosis of COVID-19, which can lead to earlier treatment and more expeditious quarantine to minimize transmission from people who otherwise remain undiagnosed."
The findings are based on data from 204 patients with COVID-19 who were admitted to three hospitals in Hubei province between Jan. 18, 2020, and Feb. 28, 2020. Disease diagnosis was confirmed by real-time RT-PCR, the standard test used for COVID-19.
Although the U.S. Centers for Disease Control and Prevention includes diarrhea and vomiting on its list of symptoms for COVID-19, fever, cough and shortness of breath -- or the catch-all phrase "flu-like symptoms" -- are mentioned far more. A case report published earlier this month by the journal Gut, though, listed diarrhea is a key symptom in patients with COVID-19.
However, of the 204 patients included in the AJG study published Wednesday, 99 reported gastrointestinal symptoms as their chief complaint. Of these, 83 experienced anorexia -- or weight loss -- while 29 had diarrhea, eight had vomiting and four reported abdominal pain.
Notably, seven patients in the analysis with COVID-19 presented with digestive symptoms but no respiratory symptoms.
In general, as the disease progressed in severity, digestive symptoms became more pronounced. The authors found that those without digestive symptoms were nearly twice as likely to be cured and discharged than patients with digestive symptoms -- 60 percent versus 34.3 percent.
For the study population overall, the average time from symptom onset to hospital admission was 8.1 days, but patients with digestive symptoms had a significantly longer time from onset to admission than patients without digestive symptoms -- nine versus 7.3 days. The authors believe this indicates that those with digestive symptoms sought care later because they did not yet suspect COVID-19 due to the fact that they did not have respiratory symptoms.
"Clinicians must bear in mind that digestive symptoms, such as diarrhea, may be a presenting feature of COVID-19, and that the index of suspicion may need to be raised earlier in these cases rather than waiting for respiratory symptoms to emerge," the researchers wrote in the study.
"If clinicians solely monitor for respiratory symptoms to establish case definitions for COVID-19, they may miss cases initially presenting with extra-pulmonary symptoms, or the disease may not be diagnosed later until respiratory symptoms emerge," researchers said.