Background As the COVID-19 epidemic is wreaking havoc with a staggering number of infections and fatalities worldwide, digestive symptoms are increasingly coming to the limelight. However, the data on the extent of gut and liver involvement has been variable and somewhat conflicting.
Methods We identified 711 adults who had tested positive for COVID-19 at Richmond University Medical Center in New York between March 13 and May 13, 2020. We analyzed their clinical and laboratory data from electronic medical records.
Results The average age of the patients was 60.5 years; 55% were men. 27.1% reported a gastrointestinal (GI) symptom and 56.9% had at least one abnormal liver enzyme. The most common was diarrhea with a frequency of 17.3% followed by nausea 16.2% and vomiting/anorexia 13.7%. Abdominal pain 5.6%, dysgeusia 3.2%, and GI bleeding 2.2% was the least common. Symptoms were mostly mild and lasted 3-5 days. The liver function was deranged in more than half of the patients. AST alone was elevated in 16.6%, both AST/ALT 15.7%, alkaline phosphatase 23%, and bilirubin 10%. Potential confounders were rare but included preexisting liver disease and hepatotoxic medications. Prothrombin time (PT) was mildly elevated in 13.4%. The lipase was elevated in 2.4% without upper abdominal pain. In 75%-90% of cases, liver test abnormalities were mild (1.5-3 x normal). Overall, 86.6% of patients were admitted primarily with respiratory failure and 28.5% died of their illness.
Conclusions 27% of COVID-19 patients experienced a digestive disturbance and >55% showed a predominantly mild degree of liver dysfunction and cholestasis.