Characteristic of hospitalized COVID 19 patients with gastrointestinal manifestation and liver injury

Cokorde Istri Yuliandari Krisnawardani Kumbara; Cokorda Agung Wahyu Purnamasidhi; I Ketut Mariadi; Gde Somayana; I Dewa Nyoman Wibawa; Putu Gita Indraswari

doi:10.36216/jpd.v7i2.225

Authors

Cokorde Istri Yuliandari Krisnawardani Kumbara Department of Internal Medicine, Faculty of Medicine of Udayana University / Udayana University Hospital, Badung, Bali, Indonesia
Cokorda Agung Wahyu Purnamasidhi Department of Internal Medicine, Faculty of Medicine of Udayana University / Udayana University Hospital, Badung, Bali, Indonesia
I Ketut Mariadi Gastroenterohepatology Division, Department of Internal Medicine, Faculty of Medicine of Udayana University / Prof. Dr. I.G.N.G Ngoerah Hospital, Denpasar, Bali, Indonesia
Gde Somayana Gastroenterohepatology Division, Department of Internal Medicine, Faculty of Medicine of Udayana University / Prof. Dr. I.G.N.G Ngoerah Hospital, Denpasar, Bali, Indonesia
I Dewa Nyoman Wibawa Gastroenterohepatology Division, Department of Internal Medicine, Faculty of Medicine of Udayana University / Prof. Dr. I.G.N.G Ngoerah Hospital, Denpasar, Bali, Indonesia
Putu Gita Indraswari Medical Faculty of Udayana University, Denpasar, Bali, Indonesia

DOI:

https://doi.org/10.36216/jpd.v7i2.225

Keywords:

COVID 19, gastrointestinal symptoms, liver injury

Abstract

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

Download data is not yet available.

Author Biographies

Cokorda Agung Wahyu Purnamasidhi, Department of Internal Medicine, Faculty of Medicine of Udayana University / Udayana University Hospital, Badung, Bali, Indonesia

Department of Internal Medicine, Faculty of Medicine of Udayana University / Udayana University Hospital, Badung, Bali, Indonesia
I Ketut Mariadi, Gastroenterohepatology Division, Department of Internal Medicine, Faculty of Medicine of Udayana University / Prof. Dr. I.G.N.G Ngoerah Hospital, Denpasar, Bali, Indonesia

Gastroenterohepatology Division, Department of Internal Medicine, Faculty of Medicine of Udayana University / Prof. Dr. I.G.N.G Ngoerah Hospital, Denpasar, Bali, Indonesia
Gde Somayana, Gastroenterohepatology Division, Department of Internal Medicine, Faculty of Medicine of Udayana University / Prof. Dr. I.G.N.G Ngoerah Hospital, Denpasar, Bali, Indonesia

Gastroenterohepatology Division, Department of Internal Medicine, Faculty of Medicine of Udayana University / Prof. Dr. I.G.N.G Ngoerah Hospital, Denpasar, Bali, Indonesia
I Dewa Nyoman Wibawa, Gastroenterohepatology Division, Department of Internal Medicine, Faculty of Medicine of Udayana University / Prof. Dr. I.G.N.G Ngoerah Hospital, Denpasar, Bali, Indonesia

Gastroenterohepatology Division, Department of Internal Medicine, Faculty of Medicine of Udayana University / Prof. Dr. I.G.N.G Ngoerah Hospital, Denpasar, Bali, Indonesia
Putu Gita Indraswari, Medical Faculty of Udayana University, Denpasar, Bali, Indonesia

Medical Faculty of Udayana University, Denpasar, Bali, Indonesia

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.