Gastrointestinal Manifestations and Liver Injury: Correlation with Mortality and Clinical Outcomes in Patients with COVID-19

Abstract

Background and aims: Reports indicate that patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection present with gastrointestinal (GI) manifestations and abnormal liver function; however, the impact on clinical findings is unclear. The aim of this study is to report the impact of gastrointestinal and liver injury (LI) associated with coronavirus disease (COVID-19). Material and methods: The authors retrospectively evaluated patients who presented to the emergency department and were diagnosed with COVID-19 by PCR nasopharyngeal swab. Primary outcomes were the impact of GI findings and LI on in-hospital mortality. Secondary outcomes were length of stay in hospital and need for intensive care unit (ICU) level care. Results: Of the entire cohort, 64.0% had LI during hospitalisation. LI was present in 88.7% of those who died. In multivariate analysis, GI manifestations were associated with decreased risk of mortality (odds ratio [OR]: 0.46; 95% confidence interval [CI]: 0.24–0.90; p=0.002). GI symptoms did not impact length of stay, 5.06 days for patients with GI symptoms versus 4.74 in patients without (OR: 1.01; 95% CI: 0.96–1.07; p=0.43), or need for ICU (OR: 0.97; 95% CI: 0.60–1.58; p=0.9076) (Table 1). In multivariate analysis, LI was associated with increased mortality (OR: 8.60; 95% CI: 3.49–21.15; p<0.0001), need for ICU (OR: 10.94; 95% CI: 4.07–29.45; p<0.0001), and length of stay 5.87 days versus 3.01 days (OR: 1.23; 95% CI: 1.14–1.32; p<0.0001). Conclusion: The results of the data analysis show that GI symptoms may inversely correlate with mortality, while LI is associated with increased mortality, length of stay, and ICU admission.

T-Cell Immune Responses and Immunological Factors Associated with Coronavirus Disease 2019 Progression as Predictors for the Severity of the Disease in Hospitalized Patients

“…We observed similar results: the levels of ALT, AST, and ALP were higher in the critical group compared to the severe subject and these enzymes were elevated in both hospitalized groups in comparison to the healthy subject which were the signs of liver injury. The possible mechanisms of this damage to the liver might be the direct viral invasion of hepatocytes through ACE2r that expresses on the healthy hepatocytes, immune-mediated injury caused by cytokine storm, or underlying liver conditions like alcohol-related liver disease [ 19 , 20 ].…”

A Systematic Review of SARS-CoV-2-Associated Hepatic Dysfunction and the Impact on the Clinical Outcome of COVID-19

“…Makar et al demonstrated a substantial relationship between liver damage and a higher risk of death, the requirement for ICU, and length of stay. The global mortality in this study was 18% (97/539), and among deceased individuals, 88.7% had liver damage [ 37 ]. In line with the previous study, 45.2% of 1611 COVID-19 patients presented with altered LFTs on admission in a large multicentric cohort from South America.…”