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Meta-Analysis
. 2022 Jun;94(6):2317-2330.
doi: 10.1002/jmv.27652. Epub 2022 Mar 21.

The importance of fecal nucleic acid detection in patients with coronavirus disease (COVID-19): A systematic review and meta-analysis

Jin-Qiu Zhou  1 , Gong-Xiang Liu  1 , Xiao-Li Huang  1 , Hua-Tian Gan  1
Affiliations
Meta-Analysis

The importance of fecal nucleic acid detection in patients with coronavirus disease (COVID-19): A systematic review and meta-analysis

Jin-Qiu Zhou et al. J Med Virol. 2022 Jun.

Abstract

Pooled data from 2352 hospitalized coronavirus disease 2019 (COVID-19) patients with viral RNA in feces across 46 studies were analyzed and the pooled prevalence of fecal RNA was 46.8% (95% confidence interval [CI]: 0.383-0.554). The pooled analysis showed that the occurrence of total gastrointestinal (GI) symptoms was 28.5% (95% CI: 0.125-0.44) in COVID-19 patients with fecal RNA, that of both respiratory and GI symptoms was 21.9% (95% CI: 0.09-0.346), that of only GI symptoms was 19.8% (95% CI: 0.107-0.288), and that of only respiratory symptoms was 50.5%（95% CI: 0.267-0.744). The pooled data showed no significant difference in positive fecal RNA between severe and nonsevere cases (odds ratio = 2.009, p = 0.079, 95% CI: 0.922-4.378). During hospital admission, after samples from the respiratory system tested negative for viral RNA, 55.4% (95% CI: 0.418-0.669) of the patients with positive fecal RNA had persistent shedding of fecal RNA and pooled results from the other 4 studies including 848 discharged patients with nucleic acid-negative stool samples indicated that the occurrence of repositive stool swabs was 18.1% (95% CI: 0.028-0.335), that of repositive respiratory swabs was 22.8% (95% CI: 0.003-0.452), that of both repositive stool and respiratory swabs was 19.1% (95% CI: 0.019-0.363), and that of only repositive stool swabs was 9.6% (95% CI: 0.010-0.203). The digestive tract may be an important organ involved in COVID-19 infection and in the excretion of the virus. Because of the potential risk of fecal-oral transmission, giving emphasis on stool swab tests can help increase the detection rate of asymptomatic carriers and reduce missed diagnoses.

Keywords: COVID-19; fecal; meta-analysis; systematic review.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
The workflow of the selection process in coronavirus disease 2019 (COVID‐19) patients with the date of virus RNA in stool
Figure 2
Figure 2
Pooled prevalence of detectable severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) RNA in fecal samples of patients with confirmed coronavirus disease 2019 (COVID‐19) infection
Figure 3
Figure 3
Trial sequential analysis for the nucleic acid‐positive stool of patients with diarrhea compared with those without diarrhea
See this image and copyright information in PMC

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