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. 2020 Nov-Dec;33(6):615-630.
doi: 10.20524/aog.2020.0527. Epub 2020 Jul 30.

Gastrointestinal predictors of severe COVID-19: systematic review and meta-analysis

Muhammad Aziz  1 , Hossein Haghbin  1 , Wade Lee-Smith  2 , Hemant Goyal  3 , Ali Nawras  4 , Douglas G Adler  5
Affiliations

Gastrointestinal predictors of severe COVID-19: systematic review and meta-analysis

Muhammad Aziz et al. Ann Gastroenterol. 2020 Nov-Dec.

Abstract

Background: COVID-19 pandemic has created a need to identify potential predictors of severe disease. We performed a systematic review and meta-analysis of gastrointestinal predictors of severe COVID-19.

Methods: An extensive literature search was performed using PubMed, Embase, Web of Science and Cochrane. Odds ratio (OR) and mean difference (MD) were calculated for proportional and continuous outcomes using a random-effect model. For each outcome, a 95% confidence interval (CI) and P-value were generated.

Results: A total of 83 studies (26912 patients, mean age 43.5±16.4 years, 48.2% female) were included. Gastrointestinal predictors of severe COVID-19 included the presence of diarrhea (OR 1.50, 95%CI 1.10-2.03; P=0.01), elevated serum aspartate aminotransferase (AST) (OR 4.00, 95%CI 3.02-5.28; P<0.001), and elevated serum alanine aminotransferase (ALT) (OR 2.54, 95%CI 1.91-3.37; P<0.001). Significantly higher levels of mean AST (MD 14.78 U/L, 95%CI 11.70-17.86 U/L; P<0.001), ALT (MD 11.87 U/L, 95%CI 9.23-14.52 U/L; P<0.001), and total bilirubin (MD 2.08 mmol/L, 95%CI 1.36-2.80 mmol/L; P<0.001) were observed in the severe COVID-19 group compared to non-severe COVID-19 group.

Conclusion: Gastrointestinal symptoms and biomarkers should be assessed early to recognize severe COVID-19.

Keywords: COVID-19; SARS-CoV-2; diarrhea; predictors; severe COVID-19.

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Conflict of interest statement

Conflict of Interest: None

Figures

Figure 1
Figure 1
PRISMA diagram
Figure 2
Figure 2
Forest plot demonstrating (A) severe disease in diarrhea vs. no diarrhea, and (B) severe disease in nausea/vomiting vs. no nausea/vomiting
Figure 3
Figure 3
Forest plot demonstrating (A) severe disease in elevated AST vs, normal AST, (B) severe disease in elevated ALT vs. normal ALT, and (C) severe disease in elevated TB vs. normal TB AST, aspartate aminotransferase; ALT, alanine aminotransferase; TB, total bilirubin
Figure 4
Figure 4
Forest plot demonstrating (A) mean serum AST in severe vs. non-severe disease, (B) mean serum ALT in severe vs. non-severe disease, and (C) mean serum TB in severe vs. non-severe disease AST, aspartate aminotransferase; ALT, alanine aminotransferase; TB, total bilirubin
See this image and copyright information in PMC

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