Biochemical elevation of liver function and gastrointestinal (GI) symptoms were common in patients with COVID-19 at the time of hospital admission. Patients with elevated liver function had a poorer prognosis while patients with GI distress did not. These observations were reported in a research paper published in Clinical Gastroenterology and Hepatology.

Between February and March, 2020, 325 patients with SARS-CoV-2 were admitted to the Humanitas Hospital in Milan, Italy. Researchers confirmed infection with real-time polymerase chain reaction (RT-PCR). In total, 33 of these patients were admitted to the intensive care unit (ICU) or died within 24 hours and were subsequently removed from the analysis. Researchers collected clinical and laboratory information from the electronic medical records of the remaining 292 patients.

The majority of patients were male (68.2%) and older (mean age 65.0 ± 14.1 years). The researchers reported diarrhea within a week of hospital admittance in 27.1% of the patients.

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At the study conclusion, a minority of patients (44.2%) had been discharged. The majority were still either hospitalized (36.6%) or were experiencing clinical deterioration (28.1%), including 56 individuals who had died.

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The researchers observed that GI symptoms such as diarrhea or vomiting, alkaline phosphatase, direct bilirubin, total bilirubin, and lipase levels were significantly associated with death or admission the ICU. After adjusting for age and sex, GI symptoms associated with death or ICU transfer had an adjusted hazard ratio (aHR) of 0.47 (95% CI, 0.23-0.97; P =.041), alkaline phosphatase levels per a 100 U/L increase had an aHR of 1.14 (95% CI; 1.05-1.23; P =.001), and high lipase levels had an aHR of 2.02 (95% CI, 1.08-3.80; P =.028).

The researchers concluded that both GI distress and biochemical stimulation of liver function were common in patients admitted to the hospital with COVID-19 infection. Patients with elevated liver function had a poorer prognosis while those with GI symptoms were more likely to be discharged.

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Aghemo A, Piovani D, Parigi T L, et al. Covid-19 digestive system involvement and clinical outcomes in a large academic hospital in Milan, Italy [available online May 11, 2020]. Clin Gastroenterol Hepatol. doi:10.1016/j.cgh.2020.05.011