Observational Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 28, 2021; 27(40): 6951-6966
Published online Oct 28, 2021. doi: 10.3748/wjg.v27.i40.6951
Hepatic and gastrointestinal disturbances in Egyptian patients infected with coronavirus disease 2019: A multicentre cohort study
Hend Ibrahim Shousha, Shimaa Afify, Rabab Maher, Noha Asem, Eman Fouad, Ehab F Mostafa, Mohammed A Medhat, Amr Abdalazeem, Hazem Elmorsy, Miriam M Aziz, Rateba S Mohammed, Mohamed Ibrahem, Hassan Elgarem, Dalia Omran, Mohamed Hassany, Bassem Elsayed, Ahmed Y Abdelaziz, Mohamed El Kassas
Hend Ibrahim Shousha, Endemic Medicine, Faculty of Medicine, Cairo University, Cairo 11562, Egypt
Shimaa Afify, Mohamed Hassany, Bassem Elsayed, Gastroenterology Department, National Hepatology & Tropical Medicine Research Institute, Cairo 11563, Egypt
Rabab Maher, Hepatology Department, Students Hospital, Cairo University, Giza 12566, Egypt
Noha Asem, Eman Fouad, The Public Health Department, Faculty of Medicine, Cairo University, Cairo 11562, Egypt
Noha Asem, Mohamed Hassany, Egyptian, Ministry of Health and Population, Cairo 11567, Egypt
Ehab F Mostafa, Mohammed A Medhat, Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Assiut University, Assiut 15655, Egypt
Amr Abdalazeem, Mohamed El Kassas, Endemic Medicine Department, Faculty of Medicine, Helwan University, Cairo 13544, Egypt
Hazem Elmorsy, Internal Medicine, 15 Mayo Smart Hospital, Ministry of Health and Population, Cairo 13488, Egypt
Miriam M Aziz, Pediatrics Department, Faculty of Medicine, Cairo University, Cairo 11562, Egypt
Rateba S Mohammed, Occupational and Environmental Medicine Department, Faculty of Medicine, Cairo University, Cairo 11562, Egypt
Mohamed Ibrahem, Clinical Biochemistry Department, Faculty of medicine, Cairo University, Cairo 11562, Egypt
Hassan Elgarem, Dalia Omran, Endemic Medicine Department, Faculty of Medicine, Cairo University, Cairo 11562, Egypt
Ahmed Y Abdelaziz, Urology Department, Cairo University, Cairo 11562, Egypt
Author contributions: Shousha HI was the guarantor and designed the study; Afify S, Maher R, Mostafa EF, Medhat MA, Abdelazeem A, Elmorsy H, Mohammed RS, Ibrahem M, Hassany M, Elsayed B, and El Kassas M participated in the acquisition of the data; Asem N and Fouad E participated in the analysis and interpretation of the data; Shousha HI and El Kassas M drafted the initial manuscript; Afify S, Aziz MM, Maher R, Mostafa EF, Medhat MA, Elgarem H, Omran D, Hassan M, Abdelaziz AY, and Elsayed B critically revised the article for important intellectual content.
Institutional review board statement: This study was approved by the research ethics committee of the Faculty of Medicine at Cairo University (No. N-37-2020, May 14, 2020) and the research ethics committee of the Egyptian Ministry of Health and Population (No. 17-2020/8, June 21, 2020).
Informed consent statement: All study subjects gave written informed consent before study inclusion.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hend Ibrahim Shousha, MD, MSc, Associate Professor, Endemic Medicine, Faculty of Medicine, Cairo University, Kasr Alainy Street, Cairo 11562, Egypt. hendshousha@kasralainy.edu.eg
Received: February 4, 2021
Peer-review started: February 4, 2021
First decision: March 6, 2021
Revised: March 17, 2021
Accepted: August 25, 2021
Article in press: August 25, 2021
Published online: October 28, 2021
Abstract
BACKGROUND

Various liver and gastrointestinal involvements occur in patients with coronavirus disease 2019 (COVID-19) at variable prevalence. Most studies report mild liver function disturbances correlated with COVID-19 severity, though liver failure is unusual.

AIM

To study liver and gastrointestinal dysfunctions in Egyptian patients with COVID-19 and their relation to disease outcomes

METHODS

This multicentre cohort study was conducted on 547 Egyptian patients from April 15, 2020 to July 29, 2020. Consecutive polymerase chain reaction-confirmed COVID-19 cases were included from four quarantine hospitals affiliated to the Egyptian ministry of health. Demographic information, laboratory characteristics, treatments, fibrosis-4 (FIB-4) index, COVID-19 severity, and outcomes were recorded and compared according to the degree of liver enzyme elevation and the presence of gastrointestinal symptoms. Follow-ups were conducted until discharge or death. Regression analyses were performed to determine the independent factors affecting mortality.

RESULTS

This study included 547 patients, of whom 53 (9.68%) died during hospitalization and 1 was discharged upon his request. Patients’ mean age was 45.04 ± 17.61 years, and 21.98% had severe or critical COVID-19. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were available for 430 and 428 patients, respectively. In total, 26% and 32% of patients had elevated ALT and AST, respectively. Significant liver injury with ALT or AST elevation exceeding 3-fold was recorded in 21 (4.91%) and 16 (3.73%) patients, respectively. Male gender, smoking, hypertension, chronic hepatitis C, and lung involvement were associated with elevated AST or ALT. AST was elevated in 50% of patients over 60-years-old. FIB-4 was significantly higher in patients admitted to the intensive care unit (ICU), those with more severe COVID-19, and non-survivors. The independent variables affecting outcome were supplementary vitamin C intake (1 g daily capsules) [odds ratio (OR): 0.05, 95% confidence interval (CI): 0.008–0.337]; lung consolidation (OR: 4.540, 95%CI: 1.155–17.840); ICU admission (OR: 25.032, 95%CI: 7.110–88.128); and FIB-4 score > 3.25 (OR: 10.393, 95%CI: 2.459-43.925). Among 60 (13.98%) patients with gastrointestinal symptoms, 52 (86.67%) had diarrhoea. Patients with gastrointestinal symptoms were predominantly females with higher body mass index, and 50 (83.40%) patients had non-severe COVID-19.

CONCLUSION

Few Egyptian patients with COVID-19 developed a significant liver injury. The independent variables affecting mortality were supplementary vitamin C intake, lung consolidation, ICU admission, and FIB-4 score.

Keywords: COVID-19, Egypt, Liver injury, Gastrointestinal symptoms, Fibrosis-4, Liver enzymes

Core Tip: The prevalence and severity of liver and gastrointestinal dysfunction in patients with coronavirus disease 2019 (COVID-19) vary among populations with different underlying characteristics and disease outcomes. This is the first report from Egypt specifically exploring hepatic and gastrointestinal involvement in Egyptian patients with COVID-19. In this study, we analyzed multicentre data of patients with polymerase chain reaction-confirmed COVID-19 from April 15, 2020 to July 29, 2020. Based on these data, we assessed the degree of liver injury and presence of gastrointestinal symptoms concerning COVID-19 disease severity, intensive care unit admission, and outcome.