Comparison of laboratory characteristics of gastrointestinal symptoms and nongastrointestinal symptoms in patients infected with COVID-19: a systematic review and meta-analysis

Abstract

Background: The Coronavirus Disease 2019 (COVID-19) pandemic poses a massive crisis to global public health. Gastrointestinal (GI) symptoms are increasingly reported in COVID-19. The characteristics of laboratory findings of COVID-19 are critical for clinical diagnosis and treatment.

Objectives: The study aimed to summarize laboratory features in COVID-19 with GI symptoms and non-GI symptoms.

Design: This study was a systematic review and meta-analysis. Electronic literature searches were conducted for studies that included patients infected COVID-19 with GI symptoms and non-GI symptoms. GI symptoms included diarrhea, abdominal pain, nausea and vomiting, and anorexia. This study used a random-effects model to assess pooled data.

Data sources and methods: We systematically searched PubMed, Embase, Cochrane, Web of Science for studies through 31 October 2021, with no language restrictions. We used the following search terms: 'COVID-19' OR '2019-nCoV' OR 'SARS-CoV-2' OR 'coronavirus 2019' OR 'severe acute respiratory syndrome coronavirus 2' OR 'coronavirus' OR 'novel coronavirus' OR 'nCoV' AND 'gastrointestinal symptoms' OR 'digestive symptoms' AND 'clinical feature' OR 'clinical characteristics.' Data mostly originated from Chinese and American studies.

Results: Of 796 identified studies, 14 were eligible and were included in our analysis (N = 8396 participants). Meta-analysis showed that GI symptoms group had an elevated alanine aminotransferase (ALT) [pooled mean difference (MD), 4.5 U/L; 95% confidence interval, [0.45, 8.55]; p = 0.03; I ² = 87%]. No publication bias was detected by Begg's and Egger's regression test (p = 0.130). COVID-19 with the GI symptoms also showed a trend toward decreased white blood cell count, lymphopenia, neutrophilia, thrombocytopenia and elevated total bilirubin.

Conclusion: GI symptoms are common in COVID-19. No significant differences were found in most laboratory indicators except elevated ALT.

Registration: CRD42020209039 (PROSPERO).

Keywords: COVID-19; gastrointestinal symptom; laboratory indicator; nongastrointestinal symptom.

Figure 1.

Study selection.

Figure 2.

Results of meta-analysis comparing lab abnormalities in COVID-19 patients with GI symptoms versus non-GI symptoms (a and b). (c–f, and j) Illustrate neutrophil count, WBC count, lymphocytes count, PLT, and AST having a downward trend. (g–i) Illustrate TBil, LDH, and CRP having an upward trend. However, the difference between the two groups was not statistically significant. AST, aspartate aminotransferase; CI, confidence interval; CRP, C-reactive protein; MD, mean difference; LDH, Lactate dehydrogenase; PLT, platelet; SMD, standardized mean difference; TBil, total bilirubin; WBC, white blood cell.

Figure 3.

Forest plot of ALT in COVID-19 patients with gastrointestinal (GI) symptoms versus non-GI symptoms (a, all included studies; c, included studies from China), Figure 3b and 3d illustrated ALT had an upward trend (b, all included studies; d, included studies from China). ALT, alanine aminotransferase; CI, confidence interval; MD, mean difference. *Represents p < 0.05.

Figure 4.

Sensitivity analysis of ALT. ALT, alanine aminotransferase.