Gastroenterological and hepatic manifestations of patients with COVID-19, prevalence, mortality by country, and intensive care admission rate: systematic review and meta-analysis

Abstract

Background and aimsPatients infected with the SARS-CoV-2 usually report fever and respiratory symptoms. However, multiple gastrointestinal (GI) manifestations such as diarrhoea and abdominal pain have been described. The aim of this study was to evaluate the prevalence of GI symptoms, elevated liver enzymes and mortality of patients with COVID-19.MethodsA systematic review and meta-analysis of published studies that included a cohort of patients infected with SARS-CoV-2 were performed from 1 December 2019 to 15 December 2020. Data were collected by conducting a literature search using PubMed, Embase, Scopus, and Cochrane according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We analysed pooled data on the prevalence of individual GI symptoms and elevated liver enzymes and performed subanalyses to investigate the relationship between GI symptoms/elevated liver enzymes, geographical location, mortality, and intensive care unit (ICU) admission.ResultsThe available data of 78 798 patients positive for SARS-CoV-2 from 158 studies were included in our analysis. The most frequent manifestations were diarrhoea (16.5%, 95% CI 14.2% to 18.4%), nausea (9.7%, 95% CI 9.0% to 13.2%) and elevated liver enzymes (5.6%, 95% CI 4.2% to 9.1%). The overall mortality and GI mortality were 23.5% (95% CI 21.2% to 26.1%) and 3.5% (95% CI 3.1% to 6.2%), respectively. Subgroup analysis showed non-statistically significant associations between GI symptoms/elevated liver enzymes and ICU admissions (OR=1.01, 95% CI 0.55 to 1.83). The GI mortality was 0.9% (95% CI 0.5% to 2.2%) in China and 10.8% (95% CI 7.8% to 11.3%) in the USA.ConclusionGI symptoms/elevated liver enzymes are common in patients with COVID-19. Our subanalyses showed that the presence of GI symptoms/elevated liver enzymes does not appear to affect mortality or ICU admission rate. Furthermore, the proportion of GI mortality among patients infected with SARS-CoV-2 varied based on geographical location.

Prognostic Factors and Predictors of In-Hospital Mortality Among COVID-19 Patients Admitted to the Intensive Care Unit: An Aid for Triage, Counseling, and Resource Allocation

“…The development of in-hospital complications was observed more commonly in those who died, with the most significant being AKI, cardiac arrest with ROSC, coagulopathy, and septic shock. These predominated amongst the deceased group as opposed to those discharged and were similarly witnessed in multiple studies [33,34].…”

Impact of biologics and small molecules for Inflammatory Bowel Disease on COVID-19 Related Hospitalization: A Systematic Review and Meta-analysis

“…Additionally, a recent study showed that GI manifestations of COVID-19 are also common in patients with inflammatory bowel disease (IBD). 6 However, current data shows patients with IBD were not at higher risk for COVID-19 infection. 7 Patients with IBD are often requiring long-term maintenance medical therapy.…”

Gastrointestinal Bleeding, but Not Other Gastrointestinal Symptoms, Is Associated With Worse Outcomes in COVID-19 Patients

“…After adjusting for confounding factors, the presence of GI symptoms was still an independent predictor of the composite endpoint, but not death, which indicated that the influence of GI symptoms on the outcomes may not be as strong as the severity of COVID-19. Two previous meta-analyses found that GI symptoms were not associated with death, but they did not include GI bleeding as one type of GI symptoms ( 25 , 26 ). Our study further evaluated whether various types of GI symptoms were associated with the composite endpoint and death, and found that GI bleeding was an independent predictor of the composite endpoint and death.…”