Digestive Involvement of the Coronavirus Disease 2019: Need Attention on the 'Gut-Type' in the Novel Coronaviral Infection

Background: Coronavirus disease 2019（COVID-19）is an emerged infection raised wide concerns for the pneumonia and respiratory manifestations. Also, digestive complications are frequently observed in COVID-19 patients but the significance remains undetermined. Methods: A retrospective analysis of alimentary symptoms, liver dysfunctions and other clinical parameters of 514 hospitalized COVID-19 patients (282 mild, 162 severe and 70 critical cases) admitted to the 3 designated medical units of Wuhan Union Hospital from Jan 20 to Feb 29, 2020 was performed. Findings: 1) A series of alimentary symptoms, including poor appetite(50.2%), diarrhea(25.5%), nausea(16.3%), vomit(11.9%) and abdominal pain(3.3%), presented in COVID-19 patients. 2) Diarrhea was common gastrointestinal symptom with higher morbidity in the severe and critical patients (32.1% and 27.1% respectively), and 13.2% patients developed diarrhea in the first 3 days after onset of symptoms. Those with diarrhea were reported more apparent systemic inflammation and liver injury in severe and critical cases compared with patients without diarrhea. 3) Notably, 31 patients (6.03%) presented with diarrhea in the absence of respiratory symptoms. These patients were observed less systemic inflammatory activity relative to diarrhea patients combined with respiratory symptoms. 4) Also, liver injury was high incident in COVID-19 patients with increased alanine aminotransferase (43.3%), aspartate transaminase (36.7%) and decreased albumin (80.9%), but less increased total bilirubin(10.9%) and direct bilirubin(14.2%), which were more serious in the severe to critical patients. Interpretation: Our data favored the enteric tropism in the process of novel SARS-CoV-2 infection. There may be a “gut-type” in the clinical prevention and management that differ from the “lung-type” in COVID-19 sufferers. Funding Statement: This study was supported by grants of a novel coronavirus pneumonia emergency science and technology projects from the Science and Technology Department of Hubei Province, China (2020FCA014), and the projects of international cooperation and exchanges from the National Natural Science Foundation of China (NSFC), China (No. 81720108006). Declaration of Interests: The authors declare that they have no competing interests. Ethics Approval Statement: This study was approved by the Medical Ethical Review Committee, Union Hospital of Huazhong University of Science and Technology, China ([2020] No.0033).