Background <p>The prognostic implications of gastrointestinal symptoms and abnormal liver enzymes in COVID-19 patients have shown significant variability. This study aimed to describe the incidence of these manifestations and their correlation with disease severity in a Brazilian population during the early phase of the pandemic, a context with limited published data.</p> Methods <p>This was a prospective cohort study of 253 consecutive patients with SARS-CoV-2 conducted in a tertiary hospital in João Pessoa, Brazil. Patients were evaluated for the presence of gastrointestinal symptoms, elevated liver enzymes, and clinical outcomes (ICU admission, mortality). Statistical analysis included Mann-Whitney, chi-square, or Fisher tests, and logistic regression. Inclusion criteria were a positive rRT-qPCR for SARS-CoV-2 or clinical-radiological findings (CO-RADS 5) with positive serology. Patients were classified as severe or critical based on respiratory rate, oxygen saturation, and organ failure requiring mechanical ventilation or ICU care.</p> Results <p>Forty-nine (19.37%) patients presented with gastrointestinal symptoms. No significant differences were found in ICU admission (20.4% vs. 24.2%, <i>p</i> = 0.707) or mortality (16.2% vs. 18.3%, <i>p</i> = 0.674) between groups with and without these symptoms. Elevation of liver enzymes during hospitalization was associated with a longer hospital stay (median 7 days vs. 5 days, <i>p</i> = 0.0016) but not with ICU admission or mortality.</p> Conclusions <p>In this cohort, gastrointestinal symptoms and elevated liver enzymes at admission were not predictors of mortality. However, in-hospital liver enzyme elevation was associated with a longer hospital stay, highlighting its importance as a marker for resource management rather than mortality risk.</p> Clinical trial number <p>Not applicable.</p>