Gastrointestinal Manifestations and Liver Abnormalities in COVID-19: A Real-World Experience and a Novel COVID-19 Prognostic Index

Abstract

Introduction: Gastrointestinal (GI) manifestations and liver function abnormalities have been reported in Coronavirus Disease-2019 (COVID-19). However, data is variable and lacking from the Indian Population. Moreover, the prognostic implication of these manifestations has not been well-defined Aim: To determine the impact of COVID-19, on the gastrointestinal tract and Liver Function Test (LFT) and develop a prognostic model for mortality Materials and Methods: An observational descriptive study was conducted in the Department of Internal Medicine at a temporary dedicated COVID-19 centre in a Tertiary Care Cardiothoracic Centre, Western Maharashtra, India. The hospital records of all the patients admitted from July 2020 to September 2020 were analysed. Clinical details and laboratory details were obtained from 589 Reverse Transcription– Polymerase Chain Reaction (RT-PCR) confirmed patients. The data was analysed and a prognostic scoring system was developed. Patients with positive Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) RT-PCR on nasopharyngeal or oropharyngeal swabs. The data was entered in Microsoft Excel 2010 worksheet and t-test or Mann-Whitney test was also applied to compare the mean of variables being studied by separation of living and deceased patients based on the normality of the quantitative data. Results: The mean age±SD of the study participants was 44.74±19.61 years. The majority {127/589 (21.56 %)} of the patients were in the age group of 51-60 years. A total of 5 (0.84%) out of 589 patients had diarrhoea, and 3 (0.51%) had vomiting at the time of admission. Elevated Aspartate Aminotransferase (AST), Alanine Transaminase (AST), Alkaline Phosphatase (ALP), Gamma-glutamyl Transferase (GGT), Lactate Dehydrogenase (LDH), Creatine Kinase Myocardial Band (CK-MB) was reported in non survivors in 45 (90%), 39 (78%), 15 (30%), 28 (56%), 48 (96%) and 49 (98%) out of 50 cases, respectively. The prognostic scoring system was developed with the following variables: age, Diabetes Mellitus (DM), symptomatic, breathlessness, albumin, AST, ALP, LDH, Prothrombin Time (PT), D-Dimer. The area under the curve, came out to be 0.91 and a cut-off value of three in the scoring system was able to predict death at a sensitivity of 85.5% and specificity of 79.6%. Conclusion: Gastrointestinal manifestations and abnormalities in LFTs are important extrapulmonary manifestations of COVID19. Patients with abnormal liver tests had higher risks of progressing to severe disease. Hence, LFT should be monitored and evaluated frequently during hospitalisation for COVID-19.

Keywords

• aspartate aminotransferase
• coronavirus disease-2019
• liver function tests
• lactate dehydrogenase
• severe acute respiratory syndrome coronavirus 2