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Meta-Analysis
. 2022 Feb 1;34(2):168-176.
doi: 10.1097/MEG.0000000000002072.

Gastrointestinal symptoms are associated with severity of coronavirus disease 2019: a systematic review and meta-analysis

Weibiao Zeng  1 , Kai Qi  1   2 , Miao Ye  3 , Li Zheng  4 , Xinliang Liu  1 , Sheng Hu  1 , Wenxiong Zhang  1 , Wenjing Tang  2 , Jianjun Xu  1 , Dongliang Yu  1 , Yiping Wei  1
Affiliations
Meta-Analysis

Gastrointestinal symptoms are associated with severity of coronavirus disease 2019: a systematic review and meta-analysis

Weibiao Zeng et al. Eur J Gastroenterol Hepatol. .

Abstract

Objective: Studies have suggested that coronavirus disease 2019 (COVID-19) appears to be more serious in patients with gastrointestinal symptoms. This meta-analysis was conducted to explore the relationship between gastrointestinal symptoms and the severity of COVID-19.

Methods: We searched PubMed, Web of Science, Science Direct, Embase, and Google Scholar on 16 October 2020, to identify observational studies that provided data on gastrointestinal symptoms and severity of COVID-19. Gastrointestinal symptoms include diarrhea, abdominal pain, nausea, and vomiting. The severe rate and the odds ratio (OR) were pooled. Heterogeneity was assessed using the I2 statistic.

Results: A total of 21 studies with 5285 patients were included in this meta-analysis. The severe rate of COVID-19 patients with diarrhea was 41.1% [95% confidence interval (CI): 31.0-51.5%], and the OR of association between diarrhea and severe COVID-19 was 1.41 (95% CI: 1.05-1.89); sensitivity analysis showed that the results for the OR and 95% CI were unstable. For abdominal pain, the severe rate and OR of association with severe COVID-19 were 59.3% (95% CI: 41.3-76.4%) and 2.76 (95% CI: 1.59-4.81), respectively; for nausea, 41.4% (95% CI: 23.2-60.7%) and 0.92 (95% CI: 0.59-1.43), respectively; for vomiting, 51.3% (95% CI: 36.8-65.8%) and 1.68 (95% CI: 0.97-2.92), respectively.

Conclusion: The severe rate was more than 40% in COVID-19 patients with gastrointestinal symptoms. Abdominal pain was associated with a near 2.8-fold increased risk of severe COVID-19; the relationship between diarrhea and the severity of COVID-19 was regionally different; nausea and vomiting were limited in association with an increased risk of severe COVID-19.

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