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Gastroenterological and hepatic manifestations of patients with COVID-19, prevalence, mortality by country, and intensive care admission rate: systematic review and meta-analysis.
BMJ Open Gastroenterol. 2021 03; 8(1)BO

Abstract

BACKGROUND AND AIMS

Patients infected with the SARS-CoV-2 usually report fever and respiratory symptoms. However, multiple gastrointestinal (GI) manifestations such as diarrhoea and abdominal pain have been described. The aim of this study was to evaluate the prevalence of GI symptoms, elevated liver enzymes and mortality of patients with COVID-19.

METHODS

A systematic review and meta-analysis of published studies that included a cohort of patients infected with SARS-CoV-2 were performed from 1 December 2019 to 15 December 2020. Data were collected by conducting a literature search using PubMed, Embase, Scopus, and Cochrane according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We analysed pooled data on the prevalence of individual GI symptoms and elevated liver enzymes and performed subanalyses to investigate the relationship between GI symptoms/elevated liver enzymes, geographical location, mortality, and intensive care unit (ICU) admission.

RESULTS

The available data of 78 798 patients positive for SARS-CoV-2 from 158 studies were included in our analysis. The most frequent manifestations were diarrhoea (16.5%, 95% CI 14.2% to 18.4%), nausea (9.7%, 95% CI 9.0% to 13.2%) and elevated liver enzymes (5.6%, 95% CI 4.2% to 9.1%). The overall mortality and GI mortality were 23.5% (95% CI 21.2% to 26.1%) and 3.5% (95% CI 3.1% to 6.2%), respectively. Subgroup analysis showed non-statistically significant associations between GI symptoms/elevated liver enzymes and ICU admissions (OR=1.01, 95% CI 0.55 to 1.83). The GI mortality was 0.9% (95% CI 0.5% to 2.2%) in China and 10.8% (95% CI 7.8% to 11.3%) in the USA.

CONCLUSION

GI symptoms/elevated liver enzymes are common in patients with COVID-19. Our subanalyses showed that the presence of GI symptoms/elevated liver enzymes does not appear to affect mortality or ICU admission rate. Furthermore, the proportion of GI mortality among patients infected with SARS-CoV-2 varied based on geographical location.

Authors+Show Affiliations

Department of Internal Medicine, Mubarak Al-Kabeer Hospital, Jabreyah, Kuwait dr_mshehab@hotmail.com.Department of Pharmacy Practice, Massachusetts College of Pharmacy and Health Sciences, Boston, Massachusetts, USA. Department of Pharmacy Practice, Kuwait University, Jabreyah, Kuwait.Department of Internal Medicine, Mubark Al-Kabeer Hospital, Jabreyah, Kuwait.Department of Internal Medicine, Farwaniya Hospital, Farwaniya, Kuwait.Department of Internal Medicine, McGill University, Montreal, Québec, Canada.

Pub Type(s)

Journal Article
Meta-Analysis
Systematic Review

Language

eng

PubMed ID

33664052

Citation

Shehab, Mohammad, et al. "Gastroenterological and Hepatic Manifestations of Patients With COVID-19, Prevalence, Mortality By Country, and Intensive Care Admission Rate: Systematic Review and Meta-analysis." BMJ Open Gastroenterology, vol. 8, no. 1, 2021.
Shehab M, Alrashed F, Shuaibi S, et al. Gastroenterological and hepatic manifestations of patients with COVID-19, prevalence, mortality by country, and intensive care admission rate: systematic review and meta-analysis. BMJ Open Gastroenterol. 2021;8(1).
Shehab, M., Alrashed, F., Shuaibi, S., Alajmi, D., & Barkun, A. (2021). Gastroenterological and hepatic manifestations of patients with COVID-19, prevalence, mortality by country, and intensive care admission rate: systematic review and meta-analysis. BMJ Open Gastroenterology, 8(1). https://doi.org/10.1136/bmjgast-2020-000571
Shehab M, et al. Gastroenterological and Hepatic Manifestations of Patients With COVID-19, Prevalence, Mortality By Country, and Intensive Care Admission Rate: Systematic Review and Meta-analysis. BMJ Open Gastroenterol. 2021;8(1) PubMed PMID: 33664052.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Gastroenterological and hepatic manifestations of patients with COVID-19, prevalence, mortality by country, and intensive care admission rate: systematic review and meta-analysis. AU - Shehab,Mohammad, AU - Alrashed,Fatema, AU - Shuaibi,Sameera, AU - Alajmi,Dhuha, AU - Barkun,Alan, PY - 2020/11/10/received PY - 2021/02/01/revised PY - 2021/02/07/accepted PY - 2021/3/5/entrez PY - 2021/3/6/pubmed PY - 2021/3/18/medline KW - COVID-19 KW - gastrointestinal tract KW - liver JF - BMJ open gastroenterology JO - BMJ Open Gastroenterol VL - 8 IS - 1 N2 - BACKGROUND AND AIMS: Patients infected with the SARS-CoV-2 usually report fever and respiratory symptoms. However, multiple gastrointestinal (GI) manifestations such as diarrhoea and abdominal pain have been described. The aim of this study was to evaluate the prevalence of GI symptoms, elevated liver enzymes and mortality of patients with COVID-19. METHODS: A systematic review and meta-analysis of published studies that included a cohort of patients infected with SARS-CoV-2 were performed from 1 December 2019 to 15 December 2020. Data were collected by conducting a literature search using PubMed, Embase, Scopus, and Cochrane according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We analysed pooled data on the prevalence of individual GI symptoms and elevated liver enzymes and performed subanalyses to investigate the relationship between GI symptoms/elevated liver enzymes, geographical location, mortality, and intensive care unit (ICU) admission. RESULTS: The available data of 78 798 patients positive for SARS-CoV-2 from 158 studies were included in our analysis. The most frequent manifestations were diarrhoea (16.5%, 95% CI 14.2% to 18.4%), nausea (9.7%, 95% CI 9.0% to 13.2%) and elevated liver enzymes (5.6%, 95% CI 4.2% to 9.1%). The overall mortality and GI mortality were 23.5% (95% CI 21.2% to 26.1%) and 3.5% (95% CI 3.1% to 6.2%), respectively. Subgroup analysis showed non-statistically significant associations between GI symptoms/elevated liver enzymes and ICU admissions (OR=1.01, 95% CI 0.55 to 1.83). The GI mortality was 0.9% (95% CI 0.5% to 2.2%) in China and 10.8% (95% CI 7.8% to 11.3%) in the USA. CONCLUSION: GI symptoms/elevated liver enzymes are common in patients with COVID-19. Our subanalyses showed that the presence of GI symptoms/elevated liver enzymes does not appear to affect mortality or ICU admission rate. Furthermore, the proportion of GI mortality among patients infected with SARS-CoV-2 varied based on geographical location. SN - 2054-4774 UR - https://www.unboundmedicine.com/medline/citation/33664052/Gastroenterological_and_hepatic_manifestations_of_patients_with_COVID_19_prevalence_mortality_by_country_and_intensive_care_admission_rate:_systematic_review_and_meta_analysis_ DB - PRIME DP - Unbound Medicine ER -