Characteristic of hospitalized COVID 19 patients with gastrointestinal manifestation and liver injury
DOI:
https://doi.org/10.36216/jpd.v7i2.225Keywords:
COVID 19, gastrointestinal symptoms, liver injuryAbstract
Background: COVID-19 is known to affect the digestive and liver systems. These can occur during the disease, and the prevalence was varied widely.
Objective: This study aimed to investigate the prevalence and characteristics of hospitalized COVID-19 patients with gastrointestinal symptoms and liver injury.
Methods: The data collected from the first 3 months of COVID-19 hospitalized patients (April – June 2020). We analyzed patients with gastrointestinal symptoms (nausea or vomiting, abdominal discomfort or pain, diarrhea, and anorexia) and patients with liver injury (alanine aminotransferase (ALT) (> 45 U/L for men and > 34 U/L for women) or aspartate aminotransferase (AST) level (> 35 U/L for men and > 31 U/L for women) at admission), then compared their clinical features with those who did not show gastrointestinal symptoms and liver injury.
Results: A total of 232 hospitalized COVID-19 patients were included. Gastrointestinal symptoms were found in 16.4% of patients. The symptoms were diarrhea (3.01%), anorexia (1.72%), nausea or vomiting (12.06%), and abdominal pain or discomfort (1.72%). The patients with gastrointestinal symptoms were more likely than those without to be admitted to the intensive ward (13.15% vs. 2.5%; p= 0.012). The elevation of liver aminotransferase levels on admission was found in 40.9% of patients. Longer hospitalization (15 days vs 11 days; p= 0.007) more likely to have liver injury.
Conclusion: Patients with liver injury had a longer hospital stay than patients without liver injury, while gastrointestinal symptoms have no significance on the duration of hospitalization.
Downloads
References
Shereen MA, Khan S, Kazmi A, et al. COVID-19 infection: Origin, transmission, and characteristics of human coronaviruses. J Adv Res 2020;24:91–8.
WHO Coronavirus Disease (COVID-19) Dashboard [Internet]. [cited 2023 June 12]. Available from: https://covid19.who.int/
Sohrabi C, Alsafi Z, O'Neill N, et al. World Health Organization declares global emergency: A review of the 2019 novel coronavirus (COVID-19). Int J Surg. 2020;76:71-6.
World Health Organization. Clinical Management of COVID 19 [Internet]. 2020. Available from: https://www.who.int/publications/i/item/clinical-management-of-covid-19
Hamming I, Timens W, Bulthuis MLC, et al. Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step in understanding SARS pathogenesis. J Pathol. 2004;203(2):631–7.
Hao SR, Zhang SY, Lian JS, et al. Liver Enzyme Elevation in Coronavirus Disease 2019: A Multicenter, Retrospective, Cross-Sectional Study. Am J Gastroenterol. 2020;115(7):1075-83.
Cipriano M, Ruberti E, Giacalone A. Gastrointestinal infection could be new focus for coronavirus diagnosis. Cureus. 2020;12(3).
Lee IC, Huo TI, Huang YH. Gastrointestinal and liver manifestations in patients with COVID-19. J Chin Med Assoc. 2020;83(6):521–3.
Pan L, Mu M, Yang P, et al. Clinical characteristics of COVID-19 patients with digestive symptoms in Hubei, China: A descriptive, cross-sectional, multicenter study. Am J Gastroenterol. 2020;115(5):766–73.
Alqahtani SA, Schattenberg JM. Liver injury in COVID-19: The current evidence. United Eur Gastroenterol J. 2020;8(5):509–19.
Wong GL-H, Wong VW-S, Thompson A, et al. Management of patients with liver derangement during the COVID-19 pandemic: an Asia-Pacific position statement. Lancet Gastroenterol Hepatol. 2020;5(8):776–87.
Andrade RJ, Aithal GP, Björnsson ES, et al. EASL Clinical Practice Guidelines: Drug-induced liver injury. J Hepatol. 2019;70(6):1222–61.
Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497–506.
Sun P, Qie S, Liu Z, et al. Clinical characteristics of hospitalized patients with SARS-CoV-2 infection: A single arm meta-analysis. J Med Virol. 2020;92(6):612-7.
Huang R, Zhu L, Wang J, et al. Clinical features of patients with COVID-19 with nonalcoholic fatty liver disease. Hepatol Commun. 2020;4(12):1758-68.
Fan Z, Chen L, Li J, et al. Clinical features of COVID-19-related liver functional abnormality. Clin Gastroenterol Hepatol. 2020;18:1561–6.
CDC’s role in helping cruise ship travelers during the COVID-19 pandemic | CDC [Internet]. [cited 2020 Oct 3]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/travelers/cruise-ship/what-cdc-is-doing.html
Jin X, Lian JS, Hu JH, et al. Epidemiological, clinical and virological characteristics of 74 cases of coronavirus-infected disease 2019 (COVID-19) with gastrointestinal symptoms. Gut. 2020;69(6):1002–9.
Cheung KS, Hung IF, Chan PP, et al. Gastrointestinal manifestations of SARS-CoV-2 infection and virus load in fecal samples from the Hong Kong cohort and systematic review and meta-analysis. Gastroenterology. 2020;159(1):81-95.
Guan W, Ni Z, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382(18):1708–20.
Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA - J Am Med Assoc. 2020;323(11):1061–9.
Zhang JJ, Dong X, Cao YY, et al. Clinical characteristics of 140 patients infected with SARS-CoV-2 in Wuhan, China. Allergy. 2020;75(7):1730-41.
Jin X, Lian JS, Hu JH, et al. Epidemiological, clinical and virological characteristics of 74 cases of coronavirus-infected disease 2019 (COVID-19) with gastrointestinal symptoms. Gut. 2020;69(6):1002–9.
Paliwal D, Rajput S, Rana S. COVID-19: Gut and liver. J Med Evid. 2020;1(1):21.
Hoffmann M, Kleine-Weber H, Schroeder S, et al. SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor. Cell. 2020;181(2):271-0.e8.
D'Amico F, Baumgart DC, Danese S, et al. Diarrhea during COVID-19 infection: Pathogenesis, epidemiology, prevention, and management. Clin Gastroenterol Hepatol. 2020;18(8):1663-72.
Effenberger M, Grander C, Grabherr F, et al. Systemic inflammation as fuel for acute liver injury in COVID-19. Dig Liver Dis. 2021;53(2):158-65.
Li Q, Guan X, Wu P, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N Engl J Med. 2020;382(13):1199–207.
Ali N, Hossain K. Liver injury in severe COVID-19 infection: current insights and challenges. Expert Rev Gastroenterol Hepatol. 2020;14(10):879–84.
Metawea MI, Yousif WI, Moheb I. COVID 19 and liver: An A-Z literature review. Dig Liver Dis. 2021;53(2):146-52.
Wang Y, Liu S, Liu H, et al. SARS-CoV-2 infection of the liver directly contributes to hepatic impairment in patients with COVID-19. J Hepatol. 2020;73(4):807-16.
Li J, Fan J-G. Characteristics and mechanism of liver injury in 2019 coronavirus disease. J Clin Transl Hepatol. 2020;8(1):13–7.
Downloads
Published
Issue
Section
License
Copyright (c) 2023 Jurnal Penyakit Dalam Udayana
This work is licensed under a Creative Commons Attribution 4.0 International License.