Gastroenterology manifestations and COVID‐19 outcomes: A meta‐analysis of 25,252 cohorts among the first and second waves

Abstract

A meta-analysis was performed to identify patients with coronavirus disease 2019 presenting with gastrointestinal (GI) symptoms during the first and second pandemic waves and investigate their association with the disease outcomes. A systematic search in PubMed, Scopus, Web of Science, ScienceDirect, and EMBASE was performed up to July 25, 2020. The pooled prevalence of the GI presentations was estimated using the random-effects model. Pairwise comparison for the outcomes was performed according to the GI manifestations' presentation and the pandemic wave of infection. Data were reported as relative risk (RR), or odds ratio and 95% confidence interval. Of 125 articles with 25,252 patients, 20.3% presented with GI manifestations. Anorexia (19.9%), dysgeusia/ageusia (15.4%), diarrhea (13.2%), nausea (10.3%), and hematemesis (9.1%) were the most common. About 26.7% had confirmed positive fecal RNA, with persistent viral shedding for an average time of 19.2 days before being negative. Patients presenting with GI symptoms on admission showed a higher risk of complications, including acute respiratory distress syndrome (RR = 8.16), acute cardiac injury (RR = 5.36), and acute kidney injury (RR = 5.52), intensive care unit (ICU) admission (RR = 2.56), and mortality (RR = 2.01). Although not reach significant levels, subgroup-analysis revealed that affected cohorts in the first wave had a higher risk of being hospitalized, ventilated, ICU admitted, and expired. This meta-analysis suggests an association between GI symptoms in COVID-19 patients and unfavorable outcomes. The analysis also showed improved overall outcomes for COVID-19 patients during the second wave compared to the first wave of the outbreak.

SARS-CoV-2 Viral Entry Proteins in Hyperandrogenemic Female Mice: Implications for Women with PCOS and COVID-19

“…Although acute respiratory system dysfunction is the primary symptom of COVID-19, the presence of digestive system disruptions in COVID-19 is increasingly recognized [ 64 ]. Moreover, a recent meta-analysis of patients with COVID-19 presenting with gastrointestinal symptoms on admission showed a higher risk of respiratory, cardiac, and renal complications, including increased mortality [ 65 ]. Women with PCOS have an increased risk of other gastrointestinal issues including irritable bowel syndrome [ 66 , 67 ], which may itself portend a higher risk of infection [ 64 ].…”

The Role of Dysbiosis in Critically Ill Patients With COVID-19 and Acute Respiratory Distress Syndrome

“…Gastrointestinal symptoms have been also associated with reduced number of circulating lymphocytes, and the circulating lymphocytes were inversely associated with virus discharge in stool (58). Moreover, a recent meta-analysis on gastrointestinal symptoms of SARS-CoV-2 infection concluded that gastrointestinal symptoms on admission were associated more with complications, including ARDS, acute cardiac injury, and acute kidney injury (57).…”

Management of patients with digestive diseases during the COVID-19 pandemic. Clinical Practice Guidelines by the Russian scientific medical society of internal medicine (RSMSIM) and the Gastroenterological Scientific Society of Russia (2nd edition)

“…Наиболее распространенными были анорексия (19,9%), дисгевзия / агевзия (15,4%), диарея (13,2%), тошнота (10,3%) и гематомезис (9,1%). Около 26,7% пациентов подтвердили положительную фекальную РНК с постоянным выделением вируса в среднем в течение 19,2 дней [11].…”

“…Бутлерова, 49 10 Федеральное государственное бюджетное образовательное учреждение высшего образования «Чувашский государственный университет им. И. Н. Ульянова», 428015, Россия, г. Чебоксары, Московский проспект, 45 11 Бюджетное учреждение высшего образования ХМАО-Югры «Сургутский государственный университет», 628412, Россия, Ханты-Мансийский автономный Округ-Югра, г. Сургут, пр. Ленина, 1 12 Федеральный исследовательский центр «Информатика и управление» Российской академии наук, 119333, Москва, ул.…”