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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

Coronavirus disease 2019 (COVID-19) appears to have significant extrapulmonary complications affecting multiple organ systems.13 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

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
1.
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.2020.05.006PubMedGoogle ScholarCrossref
2.
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)30145-9PubMedGoogle ScholarCrossref
3.
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.0000000000004004PubMedGoogle ScholarCrossref
4.
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.PubMedGoogle Scholar
5.
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.2020.03.044PubMedGoogle ScholarCrossref
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