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Critically ill patients with COVID-19 can develop a myriad of gastrointestinal issues. Are such sequelae primary manifestations of COVID-19 or simply complications of critical illness? Investigators at one Boston hospital evaluated 242 patients with acute respiratory distress syndrome (ARDS) and COVID-19 who were admitted from March to May 2020 and compared them with 244 patients with non-COVID ARDS who were admitted in 2018 or 2019. Patients with COVID-19 were more likely to have preexisting diabetes, whereas those with non-COVID ARDS were more likely to have chronic heart and lung disease. Administered medications were not reported.
In a propensity-matched subset of patients, those with COVID-19 were significantly more likely to have gastrointestinal complications (74% vs. 37%), including transaminitis, severe ileus, and bowel ischemia. In three patients who required surgery for bowel ischemia, fibrin thrombi were found in the microvasculature.
El Moheb M et al. Gastrointestinal complications in critically ill patients with and without COVID-19. JAMA 2020 Sep 24; [e-pub]. (https://doi.org/10.1001/jama.2020.19400)
Comment
Without medication data, determining the etiology of these findings is difficult. Mechanically ventilated patients with COVID-19 seem to receive more sedation than is typically seen for those with ARDS, and this greater use of opioids could contribute to severe ileus. In addition, some experimental therapies have been associated with transaminitis. Although it remains unclear how much of the difference is a direct result of COVID-19 infection, these findings should spur greater vigilance and a lower threshold to assess for complications such as bowel ischemia.