Gastroenterology manifestations and COVID-19 outcomes: A meta-analysis of 25,252 cohorts among the first and second waves

Abstract

A meta-analysis was performed to identify patients with coronavirus disease 2019 (COVID-19) presenting with gastrointestinal (GI) symptoms during the first and second pandemic waves and investigate their association with the disease outcomes. A systematic search in PubMed, Scopus, Web of Science, ScienceDirect, and EMBASE was performed up to July 25, 2020. The pooled prevalence of the GI presentations was estimated using the random-effects model. Pairwise comparison for the outcomes was performed according to the GI manifestations' presentation and the pandemic wave of infection. Data were reported as relative risk (RR), or odds ratio and 95% confidence interval. Of 125 articles with 25,252 patients, 20.3% presented with GI manifestations. Anorexia (19.9%), dysgeusia/ageusia (15.4%), diarrhea (13.2%), nausea (10.3%), and hematemesis (9.1%) were the most common. About 26.7% had confirmed positive fecal RNA, with persistent viral shedding for an average time of 19.2 days before being negative. Patients presenting with GI symptoms on admission showed a higher risk of complications, including acute respiratory distress syndrome (RR = 8.16), acute cardiac injury (RR = 5.36), and acute kidney injury (RR = 5.52), intensive care unit (ICU) admission (RR = 2.56), and mortality (RR = 2.01). Although not reach significant levels, subgroup-analysis revealed that affected cohorts in the first wave had a higher risk of being hospitalized, ventilated, ICU admitted, and expired. This meta-analysis suggests an association between GI symptoms in COVID-19 patients and unfavorable outcomes. The analysis also showed improved overall outcomes for COVID-19 patients during the second wave compared to the first wave of the outbreak.

Keywords: COVID-19; GIT; SARS-CoV-2; meta-analysis; pandemic.

Figure 1

Selection of eligible studies and their geographic region. (A) Flowchart for systematic literature search (B) Mapping the geographic distribution of the studies

Figure 2

Prevalence of gastrointestinal manifestations. (A) The proportion of patients with COVID‐19 presenting with gastrointestinal symptoms. One‐arm meta‐analysis was applied. Overall proportion and confidence intervals are shown. Subgroup analysis was performed stratifying studies by the date of publication (during the first wave; < May 15, or during the second wave; > May 15) and by geographical regions (Asia, Europe, America, and Mexico). (B) The proportion of gastrointestinal symptoms in COVID‐19 cohorts. (C) Prevalence of fecal shedding confirmed by fecal RNA RT‐PCR. (D) Duration of viral shedding (days). CI, confidence interval; COVID‐19, coronavirus disease 2019; RT‐PCR, reverse‐transcription polymerase chain reaction

Figure 3

Subgroup analysis for pooled one‐arm meta‐analysis of COVID‐19 outcomes by the pandemic wave. Odds ratio and 95% confidence intervals were reported. p values comparing the first and second waves were estimated using Student's t‐test. ARDS, acute respiratory distress syndrome; COVID‐19, coronavirus disease 2019

Figure 4

Subgroup analysis for pooled pairwise comparison analysis of coronavirus diease‐2019 outcomes by the pandemic wave. (A) Clinical outcomes. (B) Admission outcomes were compared between cohorts presented with versus without gastrointestinal manifestations. CI, confidence interval