Clinical features of patients with COVİD-19 that refer to emergency department with abdominal pain

According to World Health Organization (WHO) data, approximately 450 million people worldwide are affected by pneumonia each year, with nearly 3 million of these cases resulting in death. Throughout human history, viral pneumonias have emerged as the most common cause of mortality. The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), first identified in December 2019 and later named Coronavirus disease-19 (COVID-19) by the WHO on February 11 2020, can present asymptomatically but also lead to fatal clinical outcomes. While the characteristic symptoms of COVID-19 are primarily respiratory, gastrointestinal symptoms have also been observed in patients. Various studies report that between 11.4% to 61.1% of patients exhibit gastrointestinal symptoms, with some research indicating a strong association between abdominal pain and high mortality. In our study conducted at the Pamukkale University Hospital Emergency Department, a tertiary referral center, we examined the clinical characteristics of patients presenting with abdominal pain who were diagnosed with COVID-19 between March 2020 and March 2023. The aim of our study was to elucidate the clinical features of abdominal pain, a relatively lesser-known manifestation of COVID-19. The average age of patients in our study was 59.12 years, with 46.6% being over 65 years old. We found that 45.2% of patients in our study experienced respiratory symptoms, a significantly lower percentage compared to existing literature. Additional gastrointestinal symptoms alongside abdominal pain were present in 34.2% of patients, while 19.2% exhibited no additional symptoms alongside abdominal pain. The most common type of pain observed was diffuse abdominal pain, occurring in 27.4% of cases. The 7-day mortality rate was 16.4%, the 30-day mortality rate was 27.4%, and the intensive care unit (ICU) admission rate was 26%. Among those admitted to the ICU, the 7-day and 30-day mortality rates were 52.9% and 89.5%, respectively, highlighting advanced age as a significant risk factor and indicator of poor prognosis. Our findings revealed statistically significant associations between high mortality and high rates of service and ICU admissions with levels of Neutrophil-to-Lymphocyte Ratio (NLR), bilirubin, D-dimer, creatinine, urea, and counts of leukocytes and lymphocytes. While biochemical markers such as AST, ALT, GGT, ALP, INR, and CRP were higher in patients with poor prognosis, this difference was not statistically significant. In conclusion, at the time of emergency department presentation, levels of NLR, bilirubin, D-dimer, creatinine, urea, and counts of leukocytes and lymphocytes are strong predictors of poor prognosis. Advanced age remains a significant risk factor associated with poor outcomes. Our data suggests a correlation between pathological findings in hepatobiliary enzymes and liver function tests with poor COVID-19 prognosis. The high mortality rate in our study underscores the severe prognosis of abdominal pain in patients diagnosed with COVID-19.