Worse COVID-19 Outcomes With Liver Injury at Presentation

By Will Boggs MD

May 16, 2020

NEW YORK (Reuters Health) - Gastrointestinal and hepatic manifestations of COVID-19 are common, but only liver injury at presentation is associated with an increased risk of death or ICU admission, according to a new study from New York.

"Don't ignore GI manifestations; they may be the only symptoms," Dr. Reem Sharaiha from Weill Cornell Medicine, New York-Presbyterian Hospital, New York told Reuters Health by email.

Several recent reports have shown a high prevalence of gastrointestinal and hepatic manifestations in patients with COVID-19, especially in Western populations.

Dr. Sharaiha and colleagues of Weill Cornell Medicine, New York-Presbyterian Hospital, examined outcomes in 1,059 adult patients (mean age, 61 years) diagnosed with COVID-19.

At presentation, 22% of these patients had diarrhea, 7% had abdominal pain, 16% had nausea, 9% had vomiting and 62% had biochemical evidence of liver injury (i.e., at least one of their liver enzymes was elevated).

Overall, a third of the patients had at least one gastrointestinal manifestation, the authors report in Gastroenterology.

Female patients and patients with chronic liver disease were significantly more likely to present with gastrointestinal symptoms, and older age was associated with a slightly but significantly higher rate of liver-test abnormalities at presentation.

Admission rates were significantly higher among patients with gastrointestinal manifestations (78% vs. 70%) and among those with liver injury (87% vs. 76%, respectively).

Independent predictors of the composite outcome of death or ICU admission included liver injury at presentation (odds ratio, 2.53), older age (OR, 1.03), comorbidities (OR, 1.19), tachypnea (OR, 1.73) and severe hypoxia (OR, 1.47). Overall, gastrointestinal manifestations were not significantly associated with this outcome.

"Some GI manifestations, namely diarrhea, led to better outcomes," Dr. Sharaiha said. "This may mean that there are different strains or there is some reason people get different manifestations and different severities of disease."

"(It's) important to keep publishing on this topic, more so on clinical experience," he said.

"These results provide clarification of the diagnosis of patients with COVID-19 and can be considered in risk stratification," the authors conclude.

Dr. Sherief Musa of Cairo University, who recently reviewed the characteristics of hepatic and gastrointestinal involvement in COVID-19, told Reuters Health by email, "These findings should alert primary-care physicians or gastroenterologists to raise their index of suspicion during the current pandemic when patients present with digestive symptoms, rather than waiting for respiratory symptoms to emerge. This may help with earlier identification of COVID-19 with earlier treatment and isolation."

"Also, liver abnormalities should be taken seriously and considered in risk stratification of patients in addition to other comorbidities," said Dr. Musa, who was not involved in the study.

SOURCE: https://bit.ly/2WVFuUP Gastroenterology, online May 7, 2020.