Gastrointestinal Symptoms and Liver Damage in Patients with COVID-19

Introduction: Gastrointestinal and hepatic symptoms may be seen before respiratory symptoms in Coronavirus disease 2019 (COVID19). The purpose of the present study was to evaluate the relationship between liver damage and observed symptoms and laboratory parameters. Materials and Methods: Patients followed-up with diagnoses of COVID-19 between March and August 2020 were included in the study. Clinical characteristics and laboratory parameters were compared according to liver damage status. Results: Four hundred and thirteen COVID-19 cases were included. The prevalence of gastrointestinal symptoms was 19.8%, the most common being nausea/vomiting, abdominal pain, and diarrhea (10.4%, 6.1%, and 2.9%, respectively). CT-confirmed pneumonia, intensive care requirement, and mean length of hospitalization differed significantly depending on liver damage status (p< 0.001, p= 0.006, p= 0.002, respectively). Significant differences were determined between the groups with and without liver damage in terms of all the laboratory parameters examined, apart from white blood cell, neutrophil, lymphocyte, neutrophil:lymphocyte ratio (NLR), total bilirubin, and partial thromboplastin time (PTT) (p< 0.05). Significant associations were present between alanine aminotransferase levels and all other laboratory parameters apart from NLR and PTT (p< 0.001). Aspartate aminotransferase (OR: 1.22, CI: 1.16-1.28) and albumin (OR: 2.28, CI: 1.12-4.63) were identified as significant independent risk factors for liver damage in patients with COVID-19. Conclusion: Gastrointestinal symptoms are not uncommon in COVID-19 patients. Liver damage may be associated with progression to intensive care and systemic inflammation.