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Coronavirus (COVID-19)

Gastrointestinal Complications in Critically Ill Patients With and Without COVID-19

Educational Objective
To understand the gastrointestinal complications in critically ill patients with and without COVID-19

1 Credit CME

JAMA

Published Online: September 24, 2020

Research Letter

Article Information and Disclosures

Mohamad El Moheb, MD¹;

Leon Naar, MD¹;

Mathias A. Christensen, BSc¹;

Carolijn Kapoen, BSc¹;

Lydia R. Maurer, MD¹;

Maha Farhat, MD, MSc²;

Haytham M. A. Kaafarani, MD, MPH¹

Author Affiliations

¹Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Boston
²Division of Pulmonary and Critical Care, Massachusetts General Hospital, Boston

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Coronavirus disease 2019 (COVID-19) appears to have significant extrapulmonary complications affecting multiple organ systems.¹^- 3 Critically ill patients with COVID-19 often develop gastrointestinal complications during their hospital stay, including bowel ischemia, transaminitis, gastrointestinal bleeding, pancreatitis, Ogilvie syndrome, and severe ileus.³ Whether the high incidence of gastrointestinal complications is a manifestation of critical illness in general or is specific to COVID-19 remains unclear. We compared the incidence of gastrointestinal complications of critically ill patients with COVID-19–induced acute respiratory distress syndrome (ARDS) vs comparably ill patients with non–COVID-19 ARDS using propensity score analysis.

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Article Information

Corresponding Author: Haytham M. A. Kaafarani, MD, MPH, Harvard Medical School, Division of Trauma, Emergency Surgery, and Surgical Critical Care, 165 Cambridge St, Ste 810, Boston, MA 02114 (hkaafarani@mgh.harvard.edu).

Accepted for Publication: September 14, 2020.

Published Online: September 24, 2020. doi:10.1001/jama.2020.19400

Correction: This article was corrected on March 16, 2021, to fix the median (interquartile range) days on opioid drip reported in the Table for patients with acute respiratory distress syndrome with and without COVID-19.

Author Contributions: Dr Kaafarani had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: El Moheb, Naar, Christensen, Maurer, Kaafarani.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: El Moheb, Farhat, Kaafarani.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: El Moheb, Naar, Christensen, Maurer, Farhat, Kaafarani.

Administrative, technical, or material support: Kaafarani.

Supervision: Maurer, Farhat, Kaafarani.

Conflict of Interest Disclosures: None reported.

Additional Contributions: We thank George Velmahos, MD, PhD, Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Boston, for his clinical expertise and advice. Dr Velmahos was not compensated for his contributions.

References

Hirsch JS , Ng JH , Ross DW , et al; Northwell COVID-19 Research Consortium; Northwell Nephrology COVID-19 Research Consortium. Acute kidney injury in patients hospitalized with COVID-19. Kidney Int. 2020;98(1):209-218. doi:10.1016/j.kint.2020.05.006 PubMed Google Scholar Crossref

Levi M , Thachil J , Iba T , Levy JH . Coagulation abnormalities and thrombosis in patients with COVID-19. Lancet Haematol. 2020;7(6):e438-e440. doi:10.1016/S2352-3026(20)30145-9 PubMed Google Scholar Crossref

Kaafarani HMA , El Moheb M , Hwabejire JO , et al. Gastrointestinal complications in critically ill patients with COVID-19. Ann Surg. 2020;272(2):e61-e62. doi:10.1097/SLA.0000000000004004 PubMed Google Scholar Crossref

Ranieri VM , Rubenfeld GD , Thompson BT , et al; ARDS Definition Task Force. Acute respiratory distress syndrome: the Berlin Definition. JAMA. 2012;307(23):2526-2533.PubMed Google Scholar

Qi F , Qian S , Zhang S , Zhang Z . Single cell RNA sequencing of 13 human tissues identify cell types and receptors of human coronaviruses. Biochem Biophys Res Commun. 2020;526(1):135-140. doi:10.1016/j.bbrc.2020.03.044 PubMed Google Scholar Crossref

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.