Background and Aims Coronavirus disease 2019 (COVID‐19) has been associated with acute liver injury (ALI) manifested by increased liver enzymes in reports worldwide. Prevalence of liver injury and associated clinical characteristics are not well defined. We aim to identify the prevalence of and risk factors for development of COVID‐19‐associated ALI in a large cohort in the United States. Approach and Results In this retrospective cohort study, all patients who underwent SARS‐CoV‐2 testing at three hospitals in the NewYork‐Presbyterian network were assessed. Of 3,381 patients, 2,273 tested positive and had higher initial and peak alanine aminotransferase (ALT) than those who tested negative. ALI was categorized as mild if ALT was greater than the upper limit of normal (ULN) but <2 times ULN, moderate if ALT was between 2 and 5 times the ULN, and severe if ALT was >5 times the ULN. Among patients who tested positive, 45% had mild, 21% moderate, and 6.4% severe liver injury (SLI). In multivariable analysis, severe ALI was significantly associated with elevated inflammatory markers, including ferritin (odds ratio [OR], 2.40; P < 0.001) and interleukin‐6 (OR, 1.45; P = 0.009). Patients with SLI had a more severe clinical course, including higher rates of intensive care unit admission (69%), intubation (65%), renal replacement therapy (RRT; 33%), and mortality (42%). In multivariable analysis, peak ALT was significantly associated with death or discharge to hospice (OR, 1.14; P = 0.044), controlling for age, body mass index, diabetes, hypertension, intubation, and RRT. Conclusions ALI is common in patients who test positive for SARS‐CoV‐2, but is most often mild. However, among the 6.4% of patients with SLI, a severe disease course should be anticipated.

C oronavirus disease 2019 (COVID-19) is a pandemic characterized by a high fatality rate. 1 The incidence of COVID-19 has risen dramatically in the United States since March 2020, with the highest number of cases in the country present in New York City. 2 As health care systems rise to the challenge of unprecedented demands, there is an urgent need to characterize the spectrum of clinical presentations of this disease to allow early identification, isolation, and triage of affected patients.Although fever, cough, and shortness of breath are among the most common presenting symptoms, gastrointestinal symptoms are increasingly recognized among patients with COVID-19. [3][4][5][6][7] This case-control study aimed to describe gastrointestinal symptomatology-including diarrhea and nausea/vomiting-in US patients with COVID-19 compared to patients presenting under similar circumstances who tested negative for COVID-19. The secondary aims were to characterize the associations of gastrointestinal symptoms with total illness duration and early clinical outcomes. MethodsThis was a retrospective case-control study. Adults 18 years of age were considered for the study if they underwent nasopharyngeal swab testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) between March 10, 2020, and March 21, 2020, at outpatient settings, including clinics or the emergency departments, of New York-Presbyterian-Columbia or the medical center's affiliates in New York. Indications for testing during this period were respiratory symptoms (cough, fever, shortness of breath) with intent to hospitalize or the same symptoms in essential personnel. Patients were excluded if insufficient data were available in the electronic medical record or if testing was performed during a preexisting inpatient admission. This study was approved by the Columbia University Irving Medical Center institutional review board.Manual chart review of randomly selected patients was performed by 3 investigators (YRN, MP, DEF) blinded to SARS-CoV-2 test result. The primary exposure was presence of gastrointestinal symptoms, including diarrhea or nausea/

Alterations to the saliva microbiome based on SARS-CoV-2 viral load indicate potential biologically relevant bacterial-viral relationships which may affect clinical outcomes in COVID-19 disease.

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