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Indian Journal of Gastroenterology
Published in: Indian Journal of Gastroenterology 3/2020

01-06-2020 | Coronavirus | Original Article

Gastrointestinal and hepatic manifestations of Corona Virus Disease-19 and their relationship to severe clinical course: A systematic review and meta-analysis

Authors: Ashish Kumar, Anil Arora, Praveen Sharma, Shrihari Anil Anikhindi, Naresh Bansal, Vikas Singla, Shivam Khare, Abhishyant Srivastava

Published in: Indian Journal of Gastroenterology | Issue 3/2020

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Abstract

Background

Many case series on Corona Virus Disease (COVID-19) have reported gastrointestinal (GI) and hepatic manifestations in a proportion of cases; however, the data is conflicting. The relationship of GI and hepatic involvement with severe clinical course of COVID-19 has also not been explored.

Objectives

The main objectives were to determine the frequency of GI and hepatic manifestations of COVID-19 and to explore their relationship with severe clinical course.

Methods

We searched PubMed for studies published between January 1, 2020, and March 25, 2020, with data on GI and hepatic manifestations in adult patients with COVID-19. These data were compared between patients with severe and good clinical course using the random-effects model and odds ratio (OR) as the effect size. If the heterogeneity among studies was high, sensitivity analysis was performed for each outcome.

Results

We included 62 studies (8301 patients) in the systematic review and 26 studies (4676 patients) in the meta-analysis. Diarrhea was the most common GI symptom (9%), followed by nausea/vomiting (5%) and abdominal pain (4%). Transaminases were abnormal in approximately 25%, bilirubin in 9%, prothrombin time (PT) in 7%, and low albumin in 60%. Up to 20% patients developed severe clinical course, and GI and hepatic factors associated with severe clinical course were as follows: diarrhea (OR 2), high aspartate aminotransferase (OR 1.4), high alanine aminotransferase (OR 1.6), high bilirubin (OR 2.4), low albumin (OR 3.4), and high PT (OR 3).

Conclusions

GI and hepatic involvement should be sought in patients with COVID-19 since it portends severe clinical course. The pathogenesis of GI and hepatic involvement needs to be explored in future studies.
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Metadata
Title
Gastrointestinal and hepatic manifestations of Corona Virus Disease-19 and their relationship to severe clinical course: A systematic review and meta-analysis
Authors
Ashish Kumar
Anil Arora
Praveen Sharma
Shrihari Anil Anikhindi
Naresh Bansal
Vikas Singla
Shivam Khare
Abhishyant Srivastava
Publication date
01-06-2020
Publisher
Springer India
Published in
Indian Journal of Gastroenterology / Issue 3/2020
Print ISSN: 0254-8860
Electronic ISSN: 0975-0711
DOI
https://doi.org/10.1007/s12664-020-01058-3

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