Clinical characteristics of gastrointestinal symptoms and liver function injury in patients with coronavirus disease 2019

Objective To analyze the clinical characteristics of gastrointestinal symptoms and liver function injury in patients with coronavirus disease 2019 (COVID-19). Methods From January 23, 2020 to February 29, 2020, medical records of 251 patients with COVID-19 admitted to the West Campus of the Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, were collected. The proportion of the patients with gastrointestinal symptoms including anorexia, nausea and vomit, diarrhea and abdominal pain were analyzed respectively. The patients were divided into common type (76 cases), severe type (65 cases) and critical type (110 cases). The incidence of liver function injury and index of liver function such as total bilirubin (TBil), direct bilirubin (DBil), alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), γ-glutamyl transpeptidase (GGT), lactate dehydrogenase (LDH) and albumin of the patients with different clinical types and with or without gastrointestinal symptoms were analyzed. Student t test, Chi square test and Fisher's exact test were performed for statistical analysis. Results The main gastrointestinal symptoms of patients with COVID-19 were anorexia (33.9%, 85/251), diarrhea (12.0%, 30/251), nausea and vomit (7.6%, 19/251) and abdominal pain (1.2%, 3/251). 143 patients (57.0%) had liver function injury, the rate of liver function injury in critical type patients was 75.5% (83/110), which was higher than that of common type (40.8%, 31/76) and severe type patients (44.6%, 29/65), and the differences were statistically significant (χ2=22.765 and 16.865, both P 0.05). The proportion of liver function injury of patients with gastrointestinal symptoms was 57.8% (67/116), compared with that of liver function injury of patients without gastrointestinal symptoms (56.3%, 76/135), the difference was not statistically significant (P>0.05). The median value of TBil, DBil, ALT, AST, ALP, GGT, LDH and globulin level of critical type patients was 13.5 μmol/L, 4.9 μmol/L, 44.5 U/L and 50.0 U/L, 64.0 U/L, 41.0 U/L, 527.0 U/L and 33.6 g/L respectively. The proportion of critical type patients with TBil level > 34.2 μmol, DBil >13.6 μmol, ALT> 80 U/L and AST> 80 U/L was 7.3% (8/110), 7.3% (8/110), 17.3% (19/110) and 17.3% (19/110), respectively. These results were all higher than those of common type patients (9.5 μmol/L, 2.9 μmol/L, 28.5 U/L, 28.5 U/L, 54.0 U/L, 25.5 U/L, 225.5 U/L and 30.1 g/L, 0, 0, 6.6% (5/76), 2.6% (2/76) ) and severe type patients (10.4 μmol/L, 3.4 μmol/L, 30.0 U/L, 31.0 U/L, 49.0 U/L, 25.0 U/L, 284.0 U/L and 30.7 g/L, 0, 0, 6.2% (4/65), 1.5% (1/65) ), and the differences were statistically significant (Z=-4.264, -5.507,-4.000, -6.558, -3.112, -4.333, -4.858, -3.873, Fisher's exact test, Fisher's exact test, χ2=4.574, 9.620; Z=-3.060, -3.850, -3.923, -5.005, -9.495, -7.651, -3.853, -2.725, Fisher's exact test, Fisher's exact test, χ2=4.425, 10.169; all P 20.0 to 34.2 μmol/L of patients with diarrhea was higher than that of patients without diarrhea (70.0%, 21/30 vs. 10.9%, 24/221), and the differences were statistically significant (Z = -2.182, P = 0.029; χ2 = 62.788, P <0.01). Conclusions Anorexia is the most common digestive symptom in COVID-19 patients, the incidence of diarrhea, nausea and vomit and abdominal pain is low. The incidence of liver function injury of critical type patients is high. There is no significant correlation between gastrointestinal symptoms and liver function injury. Albumin level of patients with diarrhea is lower. Key words: COVID-2019; Diarrhea; Gastrointestinal symptoms; Liver function; Albumin