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 & Aims Patient infected with the SARS-COV2 usually report fever and respiratory symptoms. However, multiple gastrointestinal (GI) manifestations such as diarrhea and abdominal pain has been described. The aim of this study was to evaluate the prevalence of GI, liver function test (LFT) abnormalities, and mortality of COVID19 patients. Methods We performed a systematic review and meta-analysis of published studies that included cohort of patients infected with SARSCOV2 from December 1st, 2019 to July 1st, 2020. We collected data from the cohort of patients with COVID19 by conducting a literature search using PubMed, Embase, Scopus, and Cochrane according to the preferred reporting Items for Systematic Reviews and MetaAnalyses (PRISMA) guidelines. We analyzed pooled data on the prevalence of overall and individual gastrointestinal symptoms, LFTs abnormalities and performed subanalyses to investigate the relationship between gastrointestinal symptoms, geographic location, fatality, and ICU admission. Results The available data of 17,802 positive patients for SARS-COV2 from 120 studies were included in our analysis. The most frequent manifestations were diarrhea, nauseated elevated LFTs. The overall and GI fatality were 7.2% , and 1% respectively. Subgroup analysis showed non statistically significant associations between GI symptoms/LFTs abnormalities and ICU admissions (OR=3.41, 95%). The GI mortality rate was 0.58% in China and 3.5% in the United States. Conclusion Digestive symptoms and LFTs abnormalities are common in COVID-19 patients. Our subanalysis shows that the presence of gastrointestinal and liver manifestations does not appear to affect mortality, or ICU admission rate. However, the mortality rate was higher in the United States compared to China.

Impact of COVID‐19 in Liver Disease Progression

“…COVID-19 pandemic, obesity and diabetes have been linked with a bad disease prognosis (17,59). Elevated levels of the liver enzymes AST/ALT (≥2× the upper limit of normal, i.e., 80 U/L]) are common, and are independently associated with adverse clinical outcomes among COVID-19 patients (60)(61)(62). In one study, AST/ALT elevations were observed in 235 patients classified as having severe COVID-19 (56).…”

“…(17,59) Elevated levels of the liver enzymes AST/ALT (≥2× the upper limit of normal [i.e., 80 U/L]) are common, and are independently associated with adverse clinical outcomes among patients with COVID-19. (60)(61)(62) In one study, AST/ALT elevations were observed in 235 patients classified as having severe COVID-19. (56) Another study included 31,461 adults with COVID-19, and found that moderate/severe liver disease was significantly associated with mortality (odds ratio [OR], 2.62; 95% confidence interval [CI], 1.53 to 4.47).…”

Understanding clinical characteristics influencing adverse outcomes of Omicron infection: a retrospective study with propensity score matching from a Fangcang hospital

“…However, some studies did not report such findings, and even the presence of gastrointestinal symptoms is associated with lower circulating cytokine levels, reduced disease severity, and reduced mortality (Dong et al, 2020;Tabesh et al, 2022). Two recent meta-analysis also suggested no difference in mortality between patients with and without gastrointestinal symptoms (Shehab et al, 2021;Wang et al, 2022). These results indicate that the role of gastrointestinal involvement in the course of COVID-19 requires further investigation.…”