Hepatic and gastrointestinal disturbances in Egyptian patients infected with coronavirus disease 2019: A multicentre cohort study

Abstract

BACKGROUND Various liver and gastrointestinal involvements occur in patients with coronavirus disease 2019 (COVID-19) at variable prevalence. Most studies report mild liver function disturbances correlated with COVID-19 severity, though liver failure is unusual. AIM To study liver and gastrointestinal dysfunctions in Egyptian patients with COVID-19 and their relation to disease outcomes METHODS This multicentre cohort study was conducted on 547 Egyptian patients from April 15, 2020 to July 29, 2020. Consecutive polymerase chain reaction-confirmed COVID-19 cases were included from four quarantine hospitals affiliated to the Egyptian ministry of health. Demographic information, laboratory characteristics, treatments, fibrosis-4 (FIB-4) index, COVID-19 severity, and outcomes were recorded and compared according to the degree of liver enzyme elevation and the presence of gastrointestinal symptoms. Follow-ups were conducted until discharge or death. Regression analyses were performed to determine the independent factors affecting mortality. RESULTS This study included 547 patients, of whom 53 (9.68%) died during hospitalization and 1 was discharged upon his request. Patients’ mean age was 45.04 ± 17.61 years, and 21.98% had severe or critical COVID-19. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were available for 430 and 428 patients, respectively. In total, 26% and 32% of patients had elevated ALT and AST, respectively. Significant liver injury with ALT or AST elevation exceeding 3-fold was recorded in 21 (4.91%) and 16 (3.73%) patients, respectively. Male gender, smoking, hypertension, chronic hepatitis C, and lung involvement were associated with elevated AST or ALT. AST was elevated in 50% of patients over 60-years-old. FIB-4 was significantly higher in patients admitted to the intensive care unit (ICU), those with more severe COVID-19, and non-survivors. The independent variables affecting outcome were supplementary vitamin C intake (1 g daily capsules) [odds ratio (OR): 0.05, 95% confidence interval (CI): 0.008–0.337]; lung consolidation (OR: 4.540, 95%CI: 1.155–17.840); ICU admission (OR: 25.032, 95%CI: 7.110–88.128); and FIB-4 score > 3.25 (OR: 10.393, 95%CI: 2.459-43.925). Among 60 (13.98%) patients with gastrointestinal symptoms, 52 (86.67%) had diarrhoea. Patients with gastrointestinal symptoms were predominantly females with higher body mass index, and 50 (83.40%) patients had non-severe COVID-19. CONCLUSION Few Egyptian patients with COVID-19 developed a significant liver injury. The independent variables affecting mortality were supplementary vitamin C intake, lung consolidation, ICU admission, and FIB-4 score.

Impact of COVID-19 on digestive system: prevalence, clinical characteristics, outcome, and relation to the severity of COVID-19

“…Our study showed that the most common presentations of SARS-CoV-2 infection were fever (80%), cough (68.7%), and dyspnea (65%) which was consistent with previous studies [22][23][24]. Moreover, middle-aged, and elderly people were more susceptible to COVID-19, which may be contributed to the lower immunity in these populations.…”

“…Within our cohort, 104 (34.7%) patients presented with GI symptoms which is lower than the results reported by other studies conducted in the USA and China which were in the range of 50.5-61.3% [10,12]. In contrast, this prevalence was higher than other studies conducted in China, Italy, and Egypt [7,22,24,25].…”

Patterns of liver profile disturbance in patients with COVID-19

“…In another study by Sarin et al [ 36 ], including 185 noncirrhotic patients with CLD and 43 cirrhotic patients, higher rates of severe liver injury and mortality were shown following COVID-19 disease, especially in patients with more decompensated liver disease (Child–Pugh score ≥ 9). Furthermore, some patients with cirrhosis may develop either acute-on-chronic liver failure (ACLF) or acute decompensation[ 37 ].…”

Acute liver injury in COVID-19 patients hospitalized in the intensive care unit: Narrative review

“…In addition, Shousha et al [ 35 ] conducted a prospective cohort study in 547 Egyptian patients with COVID-19 in order to investigate the underlying prevalence and severity of liver and gastrointestinal disturbances, as well as their effect on disease outcomes[ 35 ]. Among patients who required ICU admission (122/547), 48.50% had elevated AST and 35.60% had elevated ALT.…”

“…In the multivariate analysis, FIB-4 score > 3.25 was a significant predictor of mortality. Unfortunately, no other specific ICU details could be extrapolated from this study, owing to the trial design and aim, which was not focused on ICU patients[ 35 ].…”