THE ROLE OF DIGESTIVE MANIFESTATIONS IN COVID-19 MORTALITY: EVIDENCES FROM BRAZIL'S FIRST EPIDEMIC WAVE
Elvis Paim Ferreira1, Mariana da Silva Arbués2, André Castro Lyra1,3
1Faculdade de Medicina da Bahia - UFBA; Salvador, BA, Brasil.
Arquivos De Gastroenterologia
|December 11, 2025
Summary
Gastrointestinal symptoms and liver enzyme abnormalities are key indicators of COVID-19 severity. Diarrhea, elevated liver enzymes, and low albumin levels predict mortality in hospitalized patients.
Area of Science:
- Hepatology
- Infectious Diseases
- Gastroenterology
Background:
- COVID-19 (SARS-CoV-2) primarily causes respiratory illness but also affects the gastrointestinal (GI) tract and liver.
- GI and hepatic manifestations correlate with COVID-19 severity and patient outcomes.
- Understanding these associations is vital for patient management, especially in diverse healthcare systems like Brazil's.
Purpose of the Study:
- To determine the frequency of hepatic and GI injuries in hospitalized COVID-19 patients.
- To analyze the association between these injuries and patient outcomes (discharge or death).
Main Methods:
- A retrospective cross-sectional study of 3,555 hospitalized COVID-19 patients in Brazilian private hospitals (March-December 2020).
- Data collected included demographics, comorbidities, GI symptoms (diarrhea, nausea/vomiting, abdominal pain), liver enzymes (ALT, AST), and outcomes.
- Logistic regression identified predictors of mortality.
Main Results:
- 42.2% of patients had at least one GI symptom; diarrhea was most common (15%).
- Deceased patients showed significantly higher ALT and AST levels, with a higher AST/ALT ratio.
- Diarrhea was linked to lower mortality, while chronic liver disease and hypoalbuminemia predicted death.
Conclusions:
- Hepatic abnormalities and GI symptoms are significant markers of COVID-19 severity.
- Diarrhea, altered liver enzymes, and serum albumin levels are key predictors of mortality.
- Future strategies should include hepatic monitoring, nutritional support, and interventions for high-risk populations.
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