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In this large retrospective cohort study of persons admitted to two hospitals in New York City with SARS-CoV-2 infection in March, one-third of patients presented with at least one gastrointestinal symptom and nearly two-thirds presented with evidence of liver injury as measured by elevated aminotransferase levels.

Women and patients with chronic liver disease had an increased odds of presenting with gastrointestinal symptoms. Diarrhea was the most common gastrointestinal symptom experienced. Patients with gastrointestinal symptoms were more frequently admitted to the hospital; however, they had a lower risk of composite death and ICU admission. Individuals with liver injury were also more likely to require admission to the hospital, and liver injury at presentation was strongly associated with an increased odds of the composite endpoint of death or ICU admission in a multivariable adjusted model.

As data continue to emerge on the COVID-19 manifestations, it is important to understand the risk factors for poor clinical outcomes, such as liver injury. Though respiratory symptoms are most common, it is also important to recognize that gastrointestinal symptoms are common and should be considered a reason to test symptomatic patients.

Michelle Long, MD, is an assistant professor of medicine in the department of medicine, section of gastroenterology, at Boston University School of Medicine in Boston, Massachusetts.

You can read an interview with study author Reem Z. Sharaiha, MD, MSc, here, and the abstract of the study here.