Gastrointestinal symptoms and disorders related to COVID-19. Lessons learned from gastroenterologists

COVID-19 is mainly a respiratory illness caused by the SARS-CoV-2 but can also lead to GI symptoms. The primary host receptor which mediates the mechanism as SARS-CoV-2 enters the cell is the ACE2 receptor. Therefore, GI symptoms can be common in COVID-19, and in some cases, they are the first manifestation even before fever and respiratory symptoms. In addition, the liver function tests alteration often is related to a worse prognosis. The exact incidence of GI symptoms is a matter of debate. Moreover, wide variation concerning GI symptoms frequency exists, but the predominant ones seem to be diarrhea, anorexia, nausea, vomiting, and abdominal pain or discomfort.This review summarizes the most relevant findings of COVID-19 on the digestive system, including the liver, biliary tract, pancreas, the most common GI symptoms, and the atypical clinical GI manifestations.Copyright © 2022 Sociedad Medica del Hospital General de Mexico. Published by Permanyer.

Hepatitis C Virus Micro-Elimination Program in an Open Population

Introduction and Objectives: Among the WHO, goals for 2030 are to detect >90% of people with HCV and link >80% to treatment. Our institution serves an open population without social security. This study aimed to describe the detection strategy that was carried out in the open population, using two-step HCV detection tests at "Hospital General de Mexico" from January to December 2021. Material(s) and Method(s): The study was conducted in an open population that transits for our hospital for any reason and agreed to take the risk factor questionnaire and the rapid test for the detection of anti-HCV antibodies (RT);those who were reactive underwent viral load (PCR to detect HCV-RNA). Descriptive statistics and the statistical package STATA v.14 were used. Result(s): In 2021, 33,523 subjects were screened;71.5% were women, mean age of 47+/-10 years. Reported at least one risk factor for HCV 53.5%. The most frequent risk factors were: Multiple sexual partners (MSP)/sexually transmitted diseases (STDs) 36.2%, tattoos/piercings 26.7%, surgery before 1995 20.2%, transfusion before 1994 5.4%, health workers after accidental puncture 4.2%. Of the 33,523, 0.7% were reactive in the RT;of them, the PCR was positive in 57.9% (prevalence of viremia= 0.4%). Among the viremic, the risk factors identified were: blood transfusion before 1995 37%, MSP/STDs 35%, surgery before 1995 30%, tattoos/piercings 30%, and drugs 3.5%. Of all viremic, 134 (100%) were linked to attention at the Mexican health sector;114 (85.1%) without insurance treated at our hospital;89 (78%) received DAAs at our institution in 2021 and have completed the time to assess SVR12, per protocol the SVR12 rate was 97.7% (2 failures), by intention to treat SVR12 was 93.2% (2 failures, 1 missing, three deaths from COVID-19). The remaining 25 patients detected in 2021 (22%) and without eligibility continued the protocol for treatment with DAAs during the year 2022. Conclusion(s): The prevalence of HCV was similar to that previously reported. Traditional risk factors such as transfusion or surgery are still very prevalent. Timely diagnosis of HCV allows treatment to be linked to an optimal level of SVR12 in accordance with the WHO goals.Copyright © 2023

ASPARTATE AMINOTRANSFERASE, AGE AND D-DIMER IN COVID-19 PATIENTS: A USEFUL PROGNOSTIC MODEL

Introduction: Some patients with SARSCov-2 infection develop severe disease (SARS);however, the factors associated with severity are not yet fully understood. Some reports indicate that liver injury may be a poor prognostic factor. Aim: To identify the biochemical factors related to the development of SARS with mechanical ventilation (MV) requirement in patients with SARSCov-2 and COVID-19. Methods Type of study: Observational. Cohort study. Procedure: Data from COVID-19 patients were collected at admission time to a tertiary care center. Differential factors were identified between seriously ill SARS+MV patients versus stable patients without MV. Transformation to the natural logarithm of significant variables was performed and multiple linear regression was applied, then a predictive model of severity called AAD (Age-AST-D dimer) was constructed. Results: 166 patients were included, 114(68.7%) men, mean age 50.6±13.3 years-old, 27(16.3%) developed SARS+MV. In the comparative analysis between those with SARS+MV versus stable patients without MV we found significant raises of ALT (225.4±341.2 vs. 41.3±41.1;P=0.003), AST 325.3±382.4 vs. 52.8±47.1;P=0.001), LDH (764.6±401.9 vs. 461.0±185.6;P=0.001), D dimer (7765±9109 vs. 1871±4146;P=0.003), age (58.6±12.7 vs. 49.1±12.8;P=0-001). The results of the regression are shown in the Table, where model 3 was the one that best explained the development of SARS+MV;with these variables was constructed the model called AAD, where: [AAD= 3.896 + ln(age)x-0.218 + ln(AST)x-0.185 + ln(DD)x0.070], where a value ≤ 2.75 had sensitivity=0.797 and 1-specificity= 0.391, AUROC=0.74 (95%CI: 0.62-0.86;P<0.0001), to predict the risk of developing SARS+MV (OR=5.8, 95%CI: 2.2-15.4;P=0.001). Conclusions: Elevation of AST (probable marker of liver damage) is an important predictor of progression to SARS, together with elevation of D-dimer and age early (at admission) and efficiently predict which patients will potentially require MV.

Aspartate aminotransferase as predictor of severity in SARSCoV-2 infection: linear regression model

Background and aim: Some patients with SARSCov-2 infection develop severe disease (SARS);however, the factors associated with severity are not yet fully understood. Some reports indicate that liver injury may be a poor prognostic factor. AIM: To identify the biochemical factors related to the development of SARS with mechanical ventilation (MV) requirement in patients with SARSCov-2 and COVID-19. Methods. Type of Study: Observational. Cohort study. Procedure: Data from COVID-19 patients were collected at admission time to a tertiary care center. Differential factors were identified between seriously ill SARS + MV patients versus stable patients without MV. Transformation to the natural logarithm of significant variables was performed and multiple linear regression was applied, then a predictive model of severity called AAD (Age-AST-D dimer) was constructed. Result(s): 166 patients were included, 114(68.7%) men, mean age 50.6 +/- 13.3 years-old, 27(16.3%) developed SARS + MV. In the comparative analysis between those with SARS + MV versus stable patients without MV we found significant raises of ALT (225.4 +/- 341.2 vs. 41.3 +/- 41.1;P = 0.003), AST 325.3 +/- 382.4 vs. 52.8 +/- 47.1;P = 0.001), LDH (764.6 +/- 401.9 vs. 461.0 +/- 185.6;P = 0.001), D dimer (7765 +/- 9109 vs. 1871 +/- 4146;P = 0.003), age (58.6 +/- 12.7 vs. 49.1 +/- 12.8;P = 0-001). The results of the regression are shown in the Table, where model 3 was the one that best explained the development of SARS + MV;with these variables was constructed the model called AAD, where: [AAD = 3.896 + ln(age)x-0.218 + ln(AST)x-0.185 + ln(DD)x0.070], where a value = 2.75 had sensitivity = 0.797 and 1-specificity = 0.391, AUROC = 0.74 (95%CI: 0.62-0.86;P 0.0001), to predict the risk of developing SARS + MV (OR = 5.8, 95%CI: 2.2-15.4;P = 0.001). Conclusion(s): Elevation of AST (probable marker of liver damage) is an important predictor of progression to SARS, together with elevation of D-dimer and age early (at admission) and efficiently predict which patients will potentially require MV. Conflicts of interest: The authors have no conflicts of interest to declare. [Formula presented] [Formula presented] Copyright © 2020

Impact of liver enzymes on SARSCoV-2 infection and on the severity of clinical disease

Background and aim: SARSCov-2 infection, currently responsible virus for the pandemic, can have a multi-organic impact, recent studies show that liver injury could be a manifestation of the disease, and liver disease could also be related to a worst prognosis. AIM: To compare the characteristics of patients with severe COVID-19 due to SARSCov-2 disease requiring intubation versus stable patients. Methods. Type of Study: Observational, a case-control, nested in a cohort study. Procedure: Complete medical records of patients admitted for COVID-19 at a third level center were reviewed. Clinical and biochemical data were collected and then characteristics between seriously ill patients who required intubation were compared versus stable patients without mechanical ventilation. Result(s): We included 166 patients with COVID-19 due to SARSCov-2 infection, 114(68.7%) were men, mean age was 50.6 +/- 13.3 years old, 27(16.3%) were assessed as seriously ill patients requiring intubation for SARS. The comparative analysis between those who required intubation versus those who remained without requiring intubation showed significant elevation of ALT, AST, LDH and D-dimer, also older age, see Table. Conclusion(s): This is the first study in a Mexican cohort, which demonstrate that seriously ill patients have significant raises of liver enzymes (AST, ALT) with prognostic implications in the SARSCov-2 disease course. Conflicts of interest: The authors have no conflicts of interest to declare.Copyright © 2020