Gastrointestinal and liver manifestations in patients with COVID-19

Lee, I‐Cheng; Huo, Teh–Ia; Huang, Yi-Hsiang

doi:10.1097/jcma.0000000000000319

Cited by 210 publications

(211 citation statements)

References 32 publications

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“…In the present study, bloating was reported as one of the gastrointestinal symptoms which was in line with the ndings of Pan et al who reported the most common gastrointestinal symptoms as anorexia, diarrhea, vomiting, and abdominal pain, respectively (41). Also, patients with concomitant gastrointestinal ndings along with other symptoms may experience a more severe form of the disease increasing the risk of mortality (37,41). Therefore, clinical specialists should be vigilant about gastrointestinal symptoms such as diarrhea and anorexia, even in the absence of respiratory manifestations, as important symptoms of Covid-19 disease.…”

Section: Discussionsupporting

confidence: 90%

Clinical Manifestations of Covid-19 Disease; Exploring the Experiences of Infected Health-Care Providers.

Toulabi

Veiskramian

Azadi

et al. 2020

Preprint

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Background: Covid-19 is a novel disease with many unknown clinical and managemental dimensions. To effectively diagnose, control, and treat the disease, it is required to divulge its clinical symptoms and their qualities. On the other hand, no one can better interpret the clinical symptoms than the caregivers infected by the disease. So, the aim of this study was to exploring the experiences of infected health-care providers about clinical manifestations of Covid-19 disease.Methods: The present qualitative research was conducted using the conventional content analysis method in Iran from March to Jun 2020. Participants in this study included infected health care providers with Covid-19, who were selected based on purposeful sampling method. The data was collected by 18 phone call interviews and analyzed according Lundman and Graneheim approach.Results: Qualitative data analysis revealed 10 categories including respiratory disorders, fever and chills, body pain, fatigue, headache, skin disorders, gastrointestinal disorders, taste and olfactory disturbances, insomnia and also stress and anxiety.Conclusion: Patients with Covid-19 may experience specific or non-specific disorders. It is necessary to consider people with non-specific manifestations as suspicious cases and screen them with proper diagnostic tests. This can help to identify true positive patients and provide them with more effective health cares, and prevent further spread of the disease by isolating suspected individuals.Trial registration number: Not applicable

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Section: Discussionsupporting

confidence: 90%

Clinical Manifestations of Covid-19 Disease; Exploring the Experiences of Infected Health-Care Providers.

Toulabi

Veiskramian

Azadi

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…with pneumonia, (1,8) SARS-CoV-2 has been associated with multiple extrapulmonary effects, (1) including gastrointestinal and hepatic manifestations. (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) Previous studies have identified increased liver tests in 14%-78% of affected persons, primarily serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT). (16)(17)(18) Although the prevalence and severity of abnormal liver tests have been described, (19) their relationship to baseline liver tests preceding COVID-19 hospitalization remains poorly understood.…”

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confidence: 99%

Abnormal Liver Tests in COVID‐19: A Retrospective Observational Cohort Study of 1,827 Patients in a Major U.S. Hospital Network

et al. 2020

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BaCKgRoUND aND aIMS: The coronavirus-19 disease (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 virus, is associated with significant morbidity and mortality attributable to pneumonia, acute respiratory distress syndrome, and multiorgan failure. Liver injury has been reported as a nonpulmonary manifestation of COVID-19, but characterization of liver test abnormalities and their association with clinical outcomes is incomplete. appRoaCH aND ReSUltS: We conducted a retrospective cohort study of 1,827 patients with confirmed COVID-19 who were hospitalized within the Yale-New Haven Health System between March 14, 2020 and April 23, 2020. Clinical characteristics, liver tests (aspartate aminotransferase [AST], alanine aminotransferase [ALT], alkaline phosphatase [ALP], total bilirubin [TBIL], and albumin) at three time points (preinfection baseline, admission, and peak hospitalization), and hospitalization outcomes (severe COVID-19, intensive care unit [ICU] admission, mechanical ventilation, and death) were analyzed. Abnormal liver tests were commonly observed in hospitalized patients with COVID-19, both at admission (AST 66.9%, ALT 41.6%, ALP 13.5%, and TBIL 4.3%) and peak hospitalization (AST 83.4%, ALT 61.6%, ALP 22.7%, and TBIL 16.1%). Most patients with abnormal liver tests at admission had minimal elevations 1-2× the upper limit of normal (ULN; AST 63.7%, ALT 63.5%, ALP 80.0%, and TBIL 75.7%). A significant proportion of these patients had abnormal liver tests prehospitalization (AST 25.9%, ALT 38.0%, ALP 56.8%, and TBIL 44.4%). Multivariate analysis revealed an association between abnormal liver tests and severe COVID-19, including ICU admission, mechanical ventilation, and death; associations with age, male sex, body mass index, and diabetes mellitus were also observed. Medications used in COVID-19 treatment (lopinavir/ritonavir, hydroxychloroquine, remdesivir, and tocilizumab) were associated with peak hospitalization liver transaminase elevations >5× ULN. CoNClUSIoNS: Abnormal liver tests occur in most hospitalized patients with COVID-19 and may be associated with poorer clinical outcomes. (Hepatology 2020;72:1169-1176). C oronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first described in December 2019 in patients with severe pneumonia in Wuhan, China. (1) The World Health Organization declared COVID-19 a global pandemic in March 2020. (2) Although the initial burden of disease was predominantly found in China, (1,3,4,5,6) the United States has reported the most cases of COVID-19 and COVID-19-related death globally since March 26, 2020 and April 11, 2020, respectively. (7) This infection is estimated to have resulted in >11 million cases and 500,000 deaths globally, including 3 million cases and 130,000 deaths in the United States as of July 8, 2020. (7) Whereas patients with COVID-19 typically present with fever and respiratory symptoms consistent

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“…The other indicators concurrent with the progress of the disease were the increases of both CRP and ESR. The wife showed elevated bilirubin, which also occurred after taking iopinavir/ritonavir, and it has been reported that the administration of iopinavir/ritonavir is related to liver function damage 6 ,at the same time, the patient had obvious nausea and discomfort after taking iopinavir/ritonavir which gradually disappeared after the drug was discontinued, so the elevated bilirubin was likely to be associated with both iopinavir/ritonavir medication and viral infection which have been reported 18 .…”

Section: Discussionmentioning

confidence: 84%

A Couple with Different Symptoms after Simultaneously 2019-nCoV Infected

Zhang

Tang

et al. 2020

Preprint

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Background 2019-nCoV has posed a significant threat to human health since the epidemic began. So far, there is no definite safe and effective drug treatment. Proper management can help prevent mild patients from becoming severe. We report a couple with different symptoms after simultaneously infected by the same source of 2019-nCoV and analyze the changes in the diagnosis and treatment process. Case presentation We report a couple with different symptoms after simultaneously infected by the same source of 2019-nCoV in Shandong, China，describe their clinical course，characteristics and detection results in detail, and analyze the changes in the diagnosis and treatment process. The wife was mainly affected by respiratory system and had ever experienced high fever for several days. The husband's condition is lighter than his wife，mainly manifested as digestive tract symptoms，but it took longer than his wife for the nucleic acid of nasopharynx swab for 2019-nCoV to turn negative. Conclusions In the course of the disease both of the couple had hypokalemia which was easy to be corrected. CRP and ESR were consistent with the changes of the disease during the 2019-nCoV infection, which were good indicators to reflect the severity and development of the disease. Two months after discharge, both of them showed negative IgM antibody and positive IgG antibody.

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Gastrointestinal and liver manifestations in patients with COVID-19

Cited by 210 publications

References 32 publications

Clinical Manifestations of Covid-19 Disease; Exploring the Experiences of Infected Health-Care Providers.

Clinical Manifestations of Covid-19 Disease; Exploring the Experiences of Infected Health-Care Providers.

Abnormal Liver Tests in COVID‐19: A Retrospective Observational Cohort Study of 1,827 Patients in a Major U.S. Hospital Network

A Couple with Different Symptoms after Simultaneously 2019-nCoV Infected

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