Clinical Characteristics of SARS-CoV-2 Infected Pneumonia with Diarrhea

BACKGROUND: The pneumonia associated with the novel coronavirus (Severe Acute Respiratory Syndrome Coronavirus 2, SARS-CoV-2) is breaking out in Wuhan, China. We aimed to clarify the differences of clinical, laboratory, radiological, and outcome characteristics between SARS-CoV-2 infective pneumonia (Corona Virus Disease 2019, COVID-19) patients with diarrhea and those without. METHODS: In this retrospective, single-center study, we included 84 confirmed patients of SARS-CoV-2 pneumonia in Wuhan Union Hospital from Jan 19 to Feb 7. Patients were confirmed by Real-Time Reverse-Transcriptase–Polymerase-Chain-Reaction Testing in pharyngeal swab. The clinical manifestations, laboratory examinations, imaging manifestations and outcomes of patients with diarrhea and those without diarrhea were compared. FINDINGS: Of 84 patients with SARS-CoV-2 pneumonia, diarrhea occurred in 26 (31%) patients. Patients with diarrhea, compared to those without diarrhea, were more likely to have headache (57.7% vs 22.4%, p = 0.003), myalgia or fatigue (94.4% vs 50.0%,p = 0.010), cough(84.6% vs 44.8%, p < 0.001), sputum production(53.8% vs 20.7%, p = 0.0004), nausea(38.5% vs 10.3, p < 0.005) and vomiting(19.2% vs 1.7%, p = 0.010). The duration of fever and dyspnea in patients with diarrhea was significantly longer than those without diarrhea (10.5±4.7 vs 7.6±3.4(day), p = 0.005; 8.1±3.2 vs 4.7±2.3(day), p = 0.002; respectively). There are no differences in most of the laboratory findings between these two groups, including lymphocyte count, creatinine, lactate dehydrogenase and D-Dimer. The positive rate of testing SARS-CoV-2 from stool of COVID-19 patients with diarrhea was much higher than that of patients without (69.2% vs 17.2%, p < 0.001). As of Feb 19, the negative rate in retesting SARS-CoV-2 from throat swab of diarrhea group was significantly lower, as compared with non-diarrhea group (76.9% vs 96.6%, p = 0.010). Of 76 COVID-19 patients whose throat swab test have turn to be negative for SARS-CoV-2, the positive rate in retesting SARS-CoV-2 from stool was significantly higher in diarrhea group, as compared to non-diarrhea group (45.0% vs 19.6%, p = 0.039). INTERPRETATION: COVID-19 patients with diarrhea suffered discomfort longer, as compared with COVID-19 pneumonia patients without diarrhea. The elimination of SARS-CoV-2 from digestive system took much more time than that from respiratory system, in some COVID-19 patients with diarrhea.