Hepatic and Gastrointestinal Manifestations of COVID-19

Abstract

Background: Coronavirus disease (COVID-19) is a global challenge affecting more than 45 million people with a significant mortality. Objective: To determine the frequency of hepatic and gastrointestinal manifestations in patients of COVID-19. Methodology: This was a cross sectional study conducted at King Edward Medical University (KEMU), Mayo Hospital, Lahore for three months. After ethical approval of the study, 230 COVID-19 positive cases of ages 15 to 80 years were included in the study. Complete history & examination regarding hepatic & gastrointestinal symptoms were noted. Liver function tests & prothrombin time (PT) were sent to pathology laboratory at the time of presentation & results were noted. Data was analyzed using SPSS version 26. Descriptive continuous variables like age, bilirubin, Aminotransferases & PT were taken as mean ± standard deviation. Categorical variables like gender, hepatic & GI symptoms were taken as frequency and percentages. Results: In 230 patients, the most common gastrointestinal symptom at presentation was diarrhea 34 (14.8%), anosmia 10 (4.3%), nausea & vomiting, abdominal pain 8 (3.5%) each, dysgeusia & right hypochondrial pain 4(1.7%) & Hiccup malaise, anorexia 2 (0.9%). No patient presented with jaundice. Among hepatic manifestations, 8.7% patients had elevated bilirubin levels while Aspartate aminotransferase (AST) was raised in 40% of cases, Alanine aminotransferase (ALT) in 11.3%, Alkaline phosphatase in 1.7%, Gamma-glutamyl transferase (GGT) in 54.8% of cases. 8 (3.5%) cases showed decrease albumin levels and 6.1% cases had prolonged Prothrombin Time (PT). Conclusion: Hepatic & gastrointestinal symptoms were present as the main presenting symptoms of COVID-19 in many patients. So, careful history must be taken for these extra-pulmonary symptoms to avoid any delay in treatment & progression of disease with complications.