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
ARTICLE HIGHLIGHTS
Research background

Hepatic and gastrointestinal (GI) disturbances have been reported in patients with coronavirus disease 2019 (COVID-19) with variable prevalence according to disease severity and population characteristics. This could be due to direct severe acute respiratory syndrome coronavirus 2 invasion through the angiotensin-converting enzyme 2 receptors or indirect effects such as an uncontrolled immune response, drug-induced injury, or sepsis.

Research motivation

Comprehensive researches on hepatic and GI derangements in patients with COVID-19 are still lacking, and they are needed for better understanding of the underlying factors, clinical presentations, and disease outcome

Research objectives

We aimed to study the prevalence and severity of liver and GI derangements in Egyptian patients with COVID-19 infection and their relation to disease outcomes.

Research methods

This multicentre cohort study was conducted on 547 COVID-19 cases from four quarantine hospitals during the period from April 15, 2020 to July 29, 2020. Clinical, laboratory features, fibrosis-4 (FIB-4) index, COVID-19 severity, and outcomes were recorded. Follow-ups were conducted until discharge or death.

Research results

Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were elevated in 26% and 32% of patients while elevations above 3 fold were recorded in 4.91% and 3.73% patients, respectively. Male gender, smoking, hypertension, chronic hepatitis C, and lung involvement were associated with elevated AST or ALT. 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, lung consolidation, ICU admission, and FIB-4 score > 3.25. GI symptoms were present in 60 (13.98%) patients. They were predominantly females with higher body mass index, and 50 (83.40%) patients had non-severe COVID-19.

Research conclusions

Significant liver injury was uncommon among Egyptian patients with COVID-19. The independent variables affecting mortality were supplementary vitamin C intake, lung consolidation, ICU admission, and FIB-4 score.

Research perspectives

Variables independently affecting mortality were supplementary vitamin C intake, FIB-4 score > 3.25, lung consolidation, and ICU admission. GI symptoms occurred in patients with non-severe COVID-19.