Hepatobiliary system and intestinal injury in new coronavirus infection (COVID-19): A retrospective study

Table 1 Changes of alanine aminotransferase, aspartate aminotransferase and serum bilirubin in patients with coronavirus disease 19 compared with the control group, depending on the severity of the disease

Indication	COVID-19 patients (n = 80)	Control Group (n = 17)	P value	COVID-19-patients, mild severity (n = 19)	COVID-19-patients, moderate severity (n = 61)	P value
ALT, IU/L	75 (21-96)	21 (5-30)	< 0.05	57 (16-65)	89 (79-96)	< 0.05
AST, IU/L	81 (26-112)	26 (8-35)	< 0.05	60 (20-69)	102 (90;112)	< 0.05
Total bilirubin, µmol /L	63.2 (13.8-70.2)	22.1 (5.4-25.3)	< 0.05	41.3 (22.8-62.1)	72.4 (35.2-89.2)	< 0.05

Compared with control group, patients with COVID-19 had increased level of ALT (35; 43.7%), AST (45; 56.2%) and total bilirubin (32; 39.4%). COVID-19: Coronavirus disease 19; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase.

Table 2 Changes of liver/spleen density in patients with coronavirus disease 19, depending on the severity of the disease

Indication	Density, HU		P value
	COVID-19 patients, mild severity (n = 19)	COVID-19 patients, moderate severity (n = 61)
Liver	48.52 (43.7-52.1)	42.63 (39.2-47.8)	< 0.05
Spleen	47.41 (42.1-51.5)	48.78 (43.4-52.8)	0.47
Liver/spleen ratio	1.02 (0.92-1.09)	0.87 (0.69-0.98)	< 0.05

After first CT, the lower of liver density < 45 HU was noted in 28 (34.7%). Patients with moderate severity had significantly lower liver density 42.6 HU (39.2-47.8), compare with patients with mild COVID-19 48.5 HU (43.7-52.1) (P < 0.05). The liver/spleen density ratio was also lower in moderate severity group, 0.87 (0.69-0.98) and 1.02 (0.92-1.09) (P < 0.05) suggest. COVID-19: Coronavirus disease 19; HU: Hounsfield unit; CT: Computed tomography.

Table 3 Factors characterizing intestinal permeability in patients with coronavirus disease 19 compared with the control group, depending on the severity of the disease Me (UQ; LQ)

Indication	COVID-19 patients (n = 80)	Control Group (n = 17)	P value	COVID-19 patients, mild severity (n = 19)	COVID-19 patients, moderate severity (n = 61)	P value
Fecal calprotectin (mg/g)	87.5 (53.525-227.75)	109.65 (23.275-213.75)	0.97	53.1 (21.0-153.0)	105.0 (58.2-236.0)	0.018
Zonulin, feces (ng/mL)	141 (110-180)	64.4 (32.1-74.8)	0.003	134.9 (78.8-167.5)	143 (119-155.9)	0.74
Zonulin, blood (ng/mL)	67.9 (20.3-77.8)	85.7 (23.0-98.1)	0.039	67.9 (20.3-76.1)	71.1 (20.0-81.7)	0.55

The content of fecal calprotectin in the control group and in patients with COVID-19 did not differ statistically significantly. At the same time, the concentration of zonulin in feces in patients with COVID-19 was statistically significantly higher than in the control group (P = 0.003). At the same time, the content of zonulin in the blood in patients with COVID-19 was lower than in the control group (P = 0.046). COVID-19: Coronavirus disease 19.

Table 4 Intestinal microbiota indications in coronavirus disease 19 patients compared with the control group Me (UQ; LQ)

Symptom	Patients with COVID-19 (n = 80)	Control group (n = 17)	P value
Eubacterium/Cl. Coccoides, amt. × 105/г	6849 (3380-7987)	8211 (2996-10987)	0.17
Herpes, amt. × 105/г	0.00 (0.00-1808.25)	3610 (1914-5316)	0.001
Propionibacterium/Cl. Subterminale, amt. × 105/г	2706 (1614-3476)	1992 (704-2118)	0.0016
Bifidobacteria, amt. × 105/г	3768 (2000-4678)	4614 (1653-6123)	0.13
Fungus, amt. × 105/г	1200 (423-1851)	540 (384-774)	0.0406
Lactobacillus, amt. × 105/г	7488 (4221-8790)	4309 (2521-5198)	0.0016
The ratio of anaerobic to aerobic flora	1.801 (0.718-3.01)	1.983 (0.637-3.09)	0.39
The ratio of beneficial flora to opportunistic	1.009 (0.359-2.110)	0.992 (0.300-1.990)	0.86
Beneficial flora, amt. × 105/г	20953 (5508-36018)	19126 (3930-35764)	0.18
Sum, amt. × 105/г	44651 (8152-97098)	42566 (6297-89016)	0.33
Large intestine (anaerobes), amt. × 105/г	26171 (7088-44099)	24964 (4423-43871)	0.44
Small intestine (aerobes), amt. × 105/г	15944 (4620-19087)	13570 (3692-20114)	0.06
Opportunistic flora, amt. × 105/г	21927 (5493-25900)	19849 (3690-23983)	0.11
Cytomegalovirus, amt. × 105/г	0.00 (0.00-40.00)	0.00 (0.00-0.00)	0.12
Endotoxin (sum), amt. × 105/г	2.44 (1.21-6.11)	0.689 (0.490-1.11)	0.0000779

Propionibacterium /Cl. Subterminale, content of fungi, lactobacill ratios significantly changed among mild and moderate COVID-19 patients compared with the control group. It is extremely important to note a significant (more than 3 times) and statistically significant (P = 0.0000779) increase in endotoxin content. At the same time, the content of endotoxin in feces in patients with mild to moderate severity of new coronavirus infection did not differ significantly. COVID-19: Coronavirus disease 19.