Prevalence and Mortality of COVID-19 Patients With Gastrointestinal Symptoms: A Systematic Review and Meta-analysis

Abstract

Objective: To perform a systematic review and meta-analysis evaluating the prevalence of gastrointestinal (GI) symptoms and mortality in patients with coronavirus disease 2019 (COVID-19) diagnosed. Methods: A systematic search of MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus was performed from December 1, 2019 to May 7, 2020. Observational studies including adults with COVID-19 infection and reporting GI symptoms were included. The primary outcome was assessing the weighted pooled prevalence (WPP) of GI symptoms in patients with COVID-19 infection. Secondary outcomes were WPP of overall mortality, and mortality in patients with COVID-19 infection with GI symptoms. Results: A total of 78 studies with 12,797 patients were included. Among GI symptoms (at onset of illness in 6, at admission in 17, data given separately for both in 3, and data unavailable in 52 studies), the WPP of diarrhea was 12.4% (95% CI, 8.2% to 17.1%), I 2 ¼94%; nausea and/or vomiting, 9.0% (95% CI, 5.5% to 12.9%), I 2 ¼93%; loss of appetite, 22.3% (95% CI, 11.2% to 34.6%, I 2 ¼94%; and abdominal pain, 6.2% (95% CI, 2.6% to 10.3%), I 2 ¼92%. Mortality among patients with GI symptoms (0.4%; 95% CI, 0% to 1.1%; I 2 ¼74%) was similar to overall mortality (2.1%; 95% CI, 0.2% to 4.7%; I 2 ¼94%), P¼.15. Most studies had high risk of bias and overall quality of evidence was low to very low for all outcomes. Conclusion: Gastrointestinal symptoms are seen in up to 1 in 5 patients with COVID-19 infection. More high-quality evidence is needed to confirm these findings and explore factors causing mortality in these patients.

Association of liver steatosis and fibrosis with clinical outcomes in patients with SARS-CoV-2 infection (COVID-19)

“…( 24 ) Another systematic review and meta-analysis which included 12,797 patients reported that mortality in the group of patients with GI symptoms (0.4% [IC95%, 0-1.1%; I 2 = 74%]) was similar ( p = 0.15) to overall mortality (2.1% [IC95%, 0.2-4.7%; I 2 = 94%]). ( 25 )…”

Implications of SARS‐CoV‐2 infection for neurogastroenterology

“…Since gastrointestinal symptoms mainly occur before respiratory and systemic involvement, 124,125 several authors evaluated whether digestive symptoms occurrence represents an unfavorable prognostic factor. 76,100,126 In a pivotal metanalysis on 4 studies, Gul et al 127 (95% CI, 0% to 1.1%). 76,100,126 On the other hand, the occurrence of gastrointestinal symptoms may be useful in predicting nasopharyngeal swab positivity (OR 1.7).…”

“…76,100,126 In a pivotal metanalysis on 4 studies, Gul et al 127 (95% CI, 0% to 1.1%). 76,100,126 On the other hand, the occurrence of gastrointestinal symptoms may be useful in predicting nasopharyngeal swab positivity (OR 1.7). 73…”

Hepatology and the “new reality” ushered in by the COVID-19 pandemic

“…The role of COVID-19 in the pathogenesis of gastrointestinal symptoms associated with viral infections has been the subject of a number of publications, many reporting a high prevalence of nausea, vomiting, abdominal pain, diarrhea and anorexia) [ [2] , [3] , [4] ]. More importantly, fecal viral shedding of SARS-CoV-2 is a potential transmission mechanism currently under investigation [ 5 ].…”

“…Only two patients had previous chronic liver disease, and the global mortality rate reached 7.1%. While there is no conclusive evidence thus far of a specific mechanism causing liver damage from COVID-19, at least five theories have been proposed: [ 1 ] direct cytopathic damage [ 2 ], systemic inflammatory response [ 3 ], liver hypoxia and ischemia [ 4 ], acute-on-chronic liver injury, and [ 5 ] drug-induced liver injury [ 11 ]. We are barely beginning to understand the dynamics of COVID-19, and therefore additional clinical and epidemiological data are needed in order to develop risk predictors, identify high-risk populations, and propose new public-health policies.…”