Gastrointestinal and hepatic manifestations of Corona Virus Disease-19 and their relationship to severe clinical course:
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ORIGINAL ARTICLE
Gastrointestinal and hepatic manifestations of Corona Virus Disease-19 and their relationship to severe clinical course: A systematic review and meta-analysis Ashish Kumar 1 & Anil Arora 1 & Praveen Sharma 1 & Shrihari Anil Anikhindi 1 & Naresh Bansal 1 & Vikas Singla 1 & Shivam Khare 1 & Abhishyant Srivastava 2 Received: 15 April 2020 / Accepted: 19 May 2020 # Indian Society of Gastroenterology 2020
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. Keywords 2019-nCoV . Coronavirus . COVID-19 . nCoV-2019 . Novel coronavirus . SARS-CoV-2
Introduction
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12664-020-01058-3) contains supplementary material, which is available to authorized users. * Ashish Kumar [email protected] 1
Institute of Liver, Gastroenterology, and Pancreatico-Biliary Sciences, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi 110 060, India
2
Dr. Baba Saheb Ambedkar Medical College and Hospital, Rohini, New Delhi 110 085, India
Corona Virus Disease (COVID-19) is a new disease, which within 3 months of its origin, has now spread to more than two hundred countries and territories around the world, affecting more than 4,342,000 people and caused more than 292,000 deaths, as of 13 May 2020 [1]. On 11 March 2020, the World Health Organization (WHO) had de
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