Manifestations and prognosis of gastrointestinal and liver involvement in patients with COVID-19: a systematic review and meta-analysis

Research output: Contribution to journalArticle

Standard

Manifestations and prognosis of gastrointestinal and liver involvement in patients with COVID-19 : a systematic review and meta-analysis. / Mao, Ren; Qiu, Yun; He, Jin-Shen; Tan, Jin-Yu; Li, Xue-Hua; Liang, Jie; Shen, Jun; Zhu, Liang-Ru; Chen, Yan; Iacucci, Marietta; Ng, Siew C; Ghosh, Subrata; Chen, Min-Hu.

In: The Lancet Gastroenterology and Hepatology, Vol. 5, No. 7, 31.07.2020, p. 667-678.

Research output: Contribution to journalArticle

Harvard

APA

Vancouver

Author

Mao, Ren ; Qiu, Yun ; He, Jin-Shen ; Tan, Jin-Yu ; Li, Xue-Hua ; Liang, Jie ; Shen, Jun ; Zhu, Liang-Ru ; Chen, Yan ; Iacucci, Marietta ; Ng, Siew C ; Ghosh, Subrata ; Chen, Min-Hu. / Manifestations and prognosis of gastrointestinal and liver involvement in patients with COVID-19 : a systematic review and meta-analysis. In: The Lancet Gastroenterology and Hepatology. 2020 ; Vol. 5, No. 7. pp. 667-678.

Bibtex

@article{4b8aa38dcce64caeb1e154450c6822b5,
title = "Manifestations and prognosis of gastrointestinal and liver involvement in patients with COVID-19: a systematic review and meta-analysis",
abstract = "Background: The prevalence and prognosis of digestive system involvement, including gastrointestinal symptoms and liver injury, in patients with COVID-19 remains largely unknown. We aimed to quantify the effects of COVID-19 on the digestive system. Methods: In this systematic review and meta-analysis, we systematically searched PubMed, Embase, and Web of Science for studies published between Jan 1, 2020, and April 4, 2020. The websites of WHO, CDC, and major journals were also searched. We included studies that reported the epidemiological and clinical features of COVID-19 and the prevalence of gastrointestinal findings in infected patients, and excluded preprints, duplicate publications, reviews, editorials, single case reports, studies pertaining to other coronavirus-related illnesses, and small case series (<10 cases). Extracted data included author; date; study design; country; patient demographics; number of participants in severe and non-severe disease groups; prevalence of clinical gastrointestinal symptoms such as vomiting, nausea, diarrhoea, loss of appetite, abdominal pain, and belching; and digestive system comorbidities including liver disease and gastrointestinal diseases. Raw data from studies were pooled to determine effect estimates. Findings: We analysed findings from 35 studies, including 6686 patients with COVID-19, that met inclusion criteria. 29 studies (n=6064) reported gastrointestinal symptoms in patients with COVID-19 at diagnosis, and the pooled prevalence of digestive system comorbidities was 4% (95% CI 2–5; range 0–15; I 2=74%). The pooled prevalence of digestive symptoms was 15% (10–21; range: 2–57; I 2=96%) with nausea or vomiting, diarrhoea, and loss of appetite being the three most common symptoms. The pooled prevalence of abnormal liver functions (12 studies, n=1267) was 19% (9–32; range 1–53; I 2=96%). Subgroup analysis showed patients with severe COVID-19 had higher rates of gastrointestinal symptoms (odds ratio [OR] 1·60 [95% CI 1·09–2·36]; p=0·0020; I 2=44%) and liver injury (2·20 [1·60–3·02]; p<0·00001; I 2=36%) compared with those with non-severe disease. Patients in Hubei province, where the initial COVID-19 outbreak occurred, were more likely to present with abnormal liver functions (p<0·0001) compared with those outside of Hubei. Paediatric patients with COVID-19 had a similar prevalence of gastrointestinal symptoms to those of adult patients. 10% (95% CI 4–19; range 3–23; I 2=97%) of patients presented with gastrointestinal symptoms alone without respiratory features. Patients who presented with gastrointestinal system involvement had delayed diagnosis (standardised mean difference 2·85 [95% CI 0·22–5·48]; p=0·030; I 2=73%). Patients with gastrointestinal involvement had a higher prevalence of complication (OR 2·51 [95% CI 1·62–3·89]; p<0·0001; I 2=0%). Interpretation: Our study showed that digestive symptoms and liver injury are not uncommon in patients with COVID-19. Increased attention should be paid to the care of this unique group of patients. Funding: None. ",
keywords = "Betacoronavirus, Coronavirus Infections/complications, Gastrointestinal Diseases/diagnosis, Humans, Liver Diseases/diagnosis, Pandemics, Pneumonia, Viral/complications, Prevalence, Prognosis",
author = "Ren Mao and Yun Qiu and Jin-Shen He and Jin-Yu Tan and Xue-Hua Li and Jie Liang and Jun Shen and Liang-Ru Zhu and Yan Chen and Marietta Iacucci and Ng, {Siew C} and Subrata Ghosh and Min-Hu Chen",
note = "{\textcopyright} 2020 Elsevier Ltd. All rights reserved.",
year = "2020",
month = jul,
day = "31",
doi = "10.1016/S2468-1253(20)30126-6",
language = "English",
volume = "5",
pages = "667--678",
journal = "The Lancet Gastroenterology and Hepatology",
issn = "2468-1253",
publisher = "Elsevier",
number = "7",

}

RIS

TY - JOUR

T1 - Manifestations and prognosis of gastrointestinal and liver involvement in patients with COVID-19

T2 - a systematic review and meta-analysis

AU - Mao, Ren

AU - Qiu, Yun

AU - He, Jin-Shen

AU - Tan, Jin-Yu

AU - Li, Xue-Hua

AU - Liang, Jie

AU - Shen, Jun

AU - Zhu, Liang-Ru

AU - Chen, Yan

AU - Iacucci, Marietta

AU - Ng, Siew C

AU - Ghosh, Subrata

AU - Chen, Min-Hu

N1 - © 2020 Elsevier Ltd. All rights reserved.

PY - 2020/7/31

Y1 - 2020/7/31

N2 - Background: The prevalence and prognosis of digestive system involvement, including gastrointestinal symptoms and liver injury, in patients with COVID-19 remains largely unknown. We aimed to quantify the effects of COVID-19 on the digestive system. Methods: In this systematic review and meta-analysis, we systematically searched PubMed, Embase, and Web of Science for studies published between Jan 1, 2020, and April 4, 2020. The websites of WHO, CDC, and major journals were also searched. We included studies that reported the epidemiological and clinical features of COVID-19 and the prevalence of gastrointestinal findings in infected patients, and excluded preprints, duplicate publications, reviews, editorials, single case reports, studies pertaining to other coronavirus-related illnesses, and small case series (<10 cases). Extracted data included author; date; study design; country; patient demographics; number of participants in severe and non-severe disease groups; prevalence of clinical gastrointestinal symptoms such as vomiting, nausea, diarrhoea, loss of appetite, abdominal pain, and belching; and digestive system comorbidities including liver disease and gastrointestinal diseases. Raw data from studies were pooled to determine effect estimates. Findings: We analysed findings from 35 studies, including 6686 patients with COVID-19, that met inclusion criteria. 29 studies (n=6064) reported gastrointestinal symptoms in patients with COVID-19 at diagnosis, and the pooled prevalence of digestive system comorbidities was 4% (95% CI 2–5; range 0–15; I 2=74%). The pooled prevalence of digestive symptoms was 15% (10–21; range: 2–57; I 2=96%) with nausea or vomiting, diarrhoea, and loss of appetite being the three most common symptoms. The pooled prevalence of abnormal liver functions (12 studies, n=1267) was 19% (9–32; range 1–53; I 2=96%). Subgroup analysis showed patients with severe COVID-19 had higher rates of gastrointestinal symptoms (odds ratio [OR] 1·60 [95% CI 1·09–2·36]; p=0·0020; I 2=44%) and liver injury (2·20 [1·60–3·02]; p<0·00001; I 2=36%) compared with those with non-severe disease. Patients in Hubei province, where the initial COVID-19 outbreak occurred, were more likely to present with abnormal liver functions (p<0·0001) compared with those outside of Hubei. Paediatric patients with COVID-19 had a similar prevalence of gastrointestinal symptoms to those of adult patients. 10% (95% CI 4–19; range 3–23; I 2=97%) of patients presented with gastrointestinal symptoms alone without respiratory features. Patients who presented with gastrointestinal system involvement had delayed diagnosis (standardised mean difference 2·85 [95% CI 0·22–5·48]; p=0·030; I 2=73%). Patients with gastrointestinal involvement had a higher prevalence of complication (OR 2·51 [95% CI 1·62–3·89]; p<0·0001; I 2=0%). Interpretation: Our study showed that digestive symptoms and liver injury are not uncommon in patients with COVID-19. Increased attention should be paid to the care of this unique group of patients. Funding: None.

AB - Background: The prevalence and prognosis of digestive system involvement, including gastrointestinal symptoms and liver injury, in patients with COVID-19 remains largely unknown. We aimed to quantify the effects of COVID-19 on the digestive system. Methods: In this systematic review and meta-analysis, we systematically searched PubMed, Embase, and Web of Science for studies published between Jan 1, 2020, and April 4, 2020. The websites of WHO, CDC, and major journals were also searched. We included studies that reported the epidemiological and clinical features of COVID-19 and the prevalence of gastrointestinal findings in infected patients, and excluded preprints, duplicate publications, reviews, editorials, single case reports, studies pertaining to other coronavirus-related illnesses, and small case series (<10 cases). Extracted data included author; date; study design; country; patient demographics; number of participants in severe and non-severe disease groups; prevalence of clinical gastrointestinal symptoms such as vomiting, nausea, diarrhoea, loss of appetite, abdominal pain, and belching; and digestive system comorbidities including liver disease and gastrointestinal diseases. Raw data from studies were pooled to determine effect estimates. Findings: We analysed findings from 35 studies, including 6686 patients with COVID-19, that met inclusion criteria. 29 studies (n=6064) reported gastrointestinal symptoms in patients with COVID-19 at diagnosis, and the pooled prevalence of digestive system comorbidities was 4% (95% CI 2–5; range 0–15; I 2=74%). The pooled prevalence of digestive symptoms was 15% (10–21; range: 2–57; I 2=96%) with nausea or vomiting, diarrhoea, and loss of appetite being the three most common symptoms. The pooled prevalence of abnormal liver functions (12 studies, n=1267) was 19% (9–32; range 1–53; I 2=96%). Subgroup analysis showed patients with severe COVID-19 had higher rates of gastrointestinal symptoms (odds ratio [OR] 1·60 [95% CI 1·09–2·36]; p=0·0020; I 2=44%) and liver injury (2·20 [1·60–3·02]; p<0·00001; I 2=36%) compared with those with non-severe disease. Patients in Hubei province, where the initial COVID-19 outbreak occurred, were more likely to present with abnormal liver functions (p<0·0001) compared with those outside of Hubei. Paediatric patients with COVID-19 had a similar prevalence of gastrointestinal symptoms to those of adult patients. 10% (95% CI 4–19; range 3–23; I 2=97%) of patients presented with gastrointestinal symptoms alone without respiratory features. Patients who presented with gastrointestinal system involvement had delayed diagnosis (standardised mean difference 2·85 [95% CI 0·22–5·48]; p=0·030; I 2=73%). Patients with gastrointestinal involvement had a higher prevalence of complication (OR 2·51 [95% CI 1·62–3·89]; p<0·0001; I 2=0%). Interpretation: Our study showed that digestive symptoms and liver injury are not uncommon in patients with COVID-19. Increased attention should be paid to the care of this unique group of patients. Funding: None.

KW - Betacoronavirus

KW - Coronavirus Infections/complications

KW - Gastrointestinal Diseases/diagnosis

KW - Humans

KW - Liver Diseases/diagnosis

KW - Pandemics

KW - Pneumonia, Viral/complications

KW - Prevalence

KW - Prognosis

UR - http://www.scopus.com/inward/record.url?scp=85084548027&partnerID=8YFLogxK

U2 - 10.1016/S2468-1253(20)30126-6

DO - 10.1016/S2468-1253(20)30126-6

M3 - Article

C2 - 32405603

VL - 5

SP - 667

EP - 678

JO - The Lancet Gastroenterology and Hepatology

JF - The Lancet Gastroenterology and Hepatology

SN - 2468-1253

IS - 7

ER -