Gastrointestinal (GI) and hepatic manifestations among patients hospitalized with COVID-19 were found not to be associated with increased pneumonia severity or overall mortality, according to study results in IJID Regions.

Researchers sought to determine whether hepatic and GI manifestations, specifically symptoms and biochemical findings, at time of hospital admission were associated with disease severity and outcomes among patients hospitalized with COVID-19.

The cross-sectional study included 521 patients with COVID-19 infection who were admitted to a hospital in the United Arab Emirates from March to June 2020. The patients were categorized into 2 main groups according to the presence or absence of GI symptoms at initial assessment and hospital admission.


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Among the participants, 90.0% were men and the mean age was 45.35±11.21 years. Of the cohort, 119 (22.8%) patients had GI symptoms, and 402 patients (77.2%) had no GI symptoms upon hospital admission. COVID-19 pneumonia (89.3%) was the predominant diagnosis upon admission, followed by upper respiratory tract infection (8.3%) and surgical diagnosis, such as pancreatitis and appendicitis (1.2%).

Diarrhea was the most common GI symptom (10.9%), followed by vomiting (9.2%), abdominal pain (6.3%), anorexia (5.8%), and nausea (4.8%). GI symptoms occurred an average of 4.27±2.68 days.

Regarding biochemical abnormalities, 46.6% of patients had a mild increase in serum alanine transferase (ALT) level, and 2 patients had a moderate increase in ALT.

Among patients without GI symptoms, 71.6% had mild to moderate pneumonia and 17.2% had severe pneumonia. In patients with GI symptoms, 76.5% had mild to moderate pneumonia and 13.4% had severe pneumonia.

Procalcitonin and C-reactive protein were significantly associated with GI symptoms (P <.05).

Hospital length of stay was significantly associated with pneumonia on the chest radiograph and isolated respiratory symptoms (P <.05) but was not associated with abnormal liver function tests or combined GI and respiratory symptoms (P >.05). The overall mortality rate was 9.5% in participants without GI symptoms and 11.8% in those with GI symptoms.

None of the comorbidities was significantly related to GI involvement with and without adjustment for covariates, with nearly all P values greater than .05. Regarding hepatic involvement, male sex and dyslipidemia were associated with a statistically significant risk.

Study limitations included the retrospective, single-center design and small sample size, which could introduce selection bias and limit the reliability and generalizability of the findings.

“Managing physicians from different specialties involved in the care of COVID-19 patients need to be familiar with GI manifestations and that patients with COVID-19 diarrhea can transmit the virus,” the researchers wrote. “The hepatobiliary system can also be involved during the course of COVID-19 infection secondary to several factors and can be linked to disease severity.”

Reference

Kaiyasah H, Fardan H, Bashir O, Hussein M, Alsubbah H, Al Dabal L. Hepatic and gastrointestinal manifestations in COVID-19 patients and its relation to disease severity, single-center experience. IJID Regions. 2022;3:143-149. doi:10.1016/j.ijregi.2022.03.025