Hepatic and gastrointestinal manifestations in patients with COVID-19 and relationship with disease severity: a single-centre experience

Background and aims: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), emerged in late 2019. While the infection is commonly perceived as a respiratory disease, gastrointestinal complaints have been described in a significant number of patients since the beginning of the pandemic. This study investigated the prevalence of hepatic and gastrointestinal manifestations among patients with COVID-19 in terms of symptoms and biochemical findings, and the relationship with disease severity and outcomes.

Methods: Patients admitted to a tertiary medical centre in Dubai, United Arab Emirates, between March and June 2020, with COVID-19 were analysed retrospectively. Patients were stratified into two main groups based on the presence or absence of hepatic and gastrointestinal manifestations.

Results: Among 521 eligible patients, 119 patients (22.8%) had gastrointestinal manifestations, and the majority of patients were middle-aged males (90%). The most common symptom was diarrhoea, followed by vomiting and abdominal pain. The most commonly observed biochemical abnormality was raised alanine transferase. No differences in the severity of COVID-19 pneumonia or overall mortality rate were found between the two groups. However, patients with COVID-19 pneumonia, even those without hepatic or gastrointestinal manifestations, had longer hospital stays (P<0.05) and other infection-related complications.

Conclusion: This paper adds to the literature on the extrapulmonary manifestations of SARS-CoV- 2 with a focus on the hepatic and gastrointestinal systems. The presence of hepatic and gastrointestinal manifestations in patients with COVID-19 at hospital admission was not associated with increased severity of COVID-19 pneumonia or overall mortality.