Gastrointestinal Symptoms and Elevation in Liver Enzymes in COVID-19 Infection: A Systematic Review and Meta-Analysis

Abstract

Background Corona virus has become a global health pandemic since its origin in Wuhan, China, in December 2019. The present systematic review and meta-analysis aims to assess gastrointestinal symptoms and liver enzymes trend in corona virus infection. Methods Pooled proportions were calculated using both fixed and random effects model. Weighted mean difference and 95% CI were calculated. Results We included 15 relevant articles in the meta-analysis (n = 3762). The pooled proportion of patients with nausea/vomiting was 7.00% (95% CI = 6.00-8.00) while that of diarrhea was 6.00% (95% CI = 5.00-7.00). Weighted mean difference of aspartate aminotransferase (AST), alanine aminotransferase (ALT) in non-severe COVID-19 patients was higher by 20.54 U/liter (95% CI = 19.95-21.13) and 21.38 U/liter (95% CI = 20.92-21.84) while that in severe patients was higher by 22.70 U/liter (95% CI = 19.09-26.45) and by 22.94 U/liter (95% CI = 20.46-25.42) respectively, as compared to general population. Pooled proportions showed ALT levels to be elevated in 16.00% (95% CI = 14.00-18.00) of patients with non-severe and 25.00% (95% CI = 20.00-31.00) of patients with severe COVID-19. Weighted mean difference of albumin and platelet count was found to be lower by 3.28 g/liter (95% CI = 3.05-3.50) and by 14.21 x 10 9 /liter (95% CI = 11.87-16.55) in non-severe patients and by 11.39 g/liter (95% CI = 10.16-12.63) and 40.70 x 10 9 /liter (95% CI = 33.62-47.77) in severe patients. Conclusions Our meta-analysis shows that patients with COVID-19 infection can present with nausea, vomiting and diarrhea in addition to elevated liver enzymes including AST, ALT and a decline in albumin and platelet count which is more marked in severe disease.

Prevalence of Long COVID-associated symptoms in adults with and without SARS-CoV-2 infection in Germany: Results of the population-based study “Corona Monitoring Nationwide 2021/22” (RKI-SOEP-2)

“…Estimates in this meta-analysis are higher than in this study, possibly due to the exclusion of individuals >65 yol here. The wide range of prevalence estimates across studies may result from differences between countries and the severity of COVID-19 infection in study populations, but most probably also indicate the use of non-harmonized measurement tools and the lack of comparison against control groups (22).…”

The enzymes in COVID-19: A review

“…It's known that SARS-CoV-2 uses ACE-2 as a viral receptor to enter the human host cell, so it is not surprising that the physiological changes and ACE-2 expression increase in some organs such as lung and stomach are present in many recent studies [ [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] ]. The Creatine Kinase Myocardial Band (CK-MB) elevation in some patients with COVID-19 was associated with heart failure, was suggest by Qin et al [ 28 ] and Shafi et al, 2020 [ 29 ].…”

“…It is interesting to notice that liver abnormalities, proved by elevated ALT and AST were found in up to 54% of patients, when comparing studies. Even with the liver damage, there has been no reports on liver failure due to COVID-19 [ 23 ]. According to Boregowda et al .…”

The Relationship of Diarrhea in COVID-19 Patients With Transaminitis, Severity, and Mortality

“…Apart from worsening the patient's prognosis, diarrhea symptoms are also known to increase the transaminase enzyme so that patients develop transaminitis. A systematic review by Puli et al (2020) shows that diarrhea symptoms are associated with increased levels of the transaminase enzyme. 8 Another study by Hao et al (2020) has shown that patients with elevated transaminase enzymes mostly have diarrhea symptoms.…”

“…A systematic review by Puli et al (2020) shows that diarrhea symptoms are associated with increased levels of the transaminase enzyme. 8 Another study by Hao et al (2020) has shown that patients with elevated transaminase enzymes mostly have diarrhea symptoms. in Indonesia so that further research is needed on the relationship between diarrhea symptoms and transaminitis, especially in Indonesia.…”