Background

The prevalence and prognosis of digestive system involvement, including gastrointestinal symptoms and liver injury, in patients with COVID-19 remains largely unknown. We aimed to quantify the effects of COVID-19 on the digestive system.

Methods

In this systematic review and meta-analysis, we systematically searched PubMed, Embase, and Web of Science for studies published between Jan 1, 2020, and April 4, 2020. The websites of WHO, CDC, and major journals were also searched. We included studies that reported the epidemiological and clinical features of COVID-19 and the prevalence of gastrointestinal findings in infected patients, and excluded preprints, duplicate publications, reviews, editorials, single case reports, studies pertaining to other coronavirus-related illnesses, and small case series (<10 cases). Extracted data included author; date; study design; country; patient demographics; number of participants in severe and non-severe disease groups; prevalence of clinical gastrointestinal symptoms such as vomiting, nausea, diarrhoea, loss of appetite, abdominal pain, and belching; and digestive system comorbidities including liver disease and gastrointestinal diseases. Raw data from studies were pooled to determine effect estimates.

Findings

We analysed findings from 35 studies, including 6686 patients with COVID-19, that met inclusion criteria. 29 studies (n=6064) reported gastrointestinal symptoms in patients with COVID-19 at diagnosis, and the pooled prevalence of digestive system comorbidities was 4% (95% CI 2–5; range 0–15; I²=74%). The pooled prevalence of digestive symptoms was 15% (10–21; range: 2–57; I²=96%) with nausea or vomiting, diarrhoea, and loss of appetite being the three most common symptoms. The pooled prevalence of abnormal liver functions (12 studies, n=1267) was 19% (9–32; range 1–53; I²=96%). Subgroup analysis showed patients with severe COVID-19 had higher rates of abdominal pain (odds ratio [OR] 7·10 [95% CI 1·93–26·07]; p=0·003; I²=0%) and abnormal liver function including increased ALT (1·89 [1·30–2·76]; p=0·0009; I²=10%) and increased AST (3·08 [2·14–4·42]; p<0·00001; I²=0%) compared with those with non-severe disease. Patients in Hubei province, where the initial COVID-19 outbreak occurred, were more likely to present with abnormal liver functions (p<0·0001) compared with those outside of Hubei. Paediatric patients with COVID-19 had a similar prevalence of gastrointestinal symptoms to those of adult patients. 10% (95% CI 4–19; range 3–23; I²=97%) of patients presented with gastrointestinal symptoms alone without respiratory features. Patients who presented with gastrointestinal system involvement had delayed diagnosis (standardised mean difference 2·85 [95% CI 0·22–5·48]; p=0·030; I²=73%). Patients with gastrointestinal involvement tended to have a poorer disease course (eg, acute respiratory distress syndrome OR 2·96 [95% CI 1·17–7·48]; p=0·02; I²=0%).

Interpretation

Our study showed that digestive symptoms and liver injury are not uncommon in patients with COVID-19. Increased attention should be paid to the care of this unique group of patients.

Funding

None.

中文翻译：

---

COVID-19 患者胃肠道和肝脏受累的表现和预后：系统评价和荟萃分析。

 背景

COVID-19 患者消化系统受累（包括胃肠道症状和肝损伤）的患病率和预后仍很大程度上未知。我们的目的是量化 COVID-19 对消化系统的影响。

 方法

在这次系统综述和荟萃分析中，我们系统地检索了 PubMed、Embase 和 Web of Science 2020 年 1 月 1 日至 2020 年 4 月 4 日期间发表的研究。还检索了 WHO、CDC 和主要期刊的网站。我们纳入了报告 COVID-19 流行病学和临床特征以及感染患者胃肠道检查结果流行率的研究，并排除了预印本、重复出版物、评论、社论、单例报告、与其他冠状病毒相关疾病有关的研究以及小型研究。病例系列（<10 例）。提取的数据包括作者；日期;研究设计；国家;患者人口统计；严重和非严重疾病组的参与者人数；临床胃肠道症状的患病率，如呕吐、恶心、腹泻、食欲不振、腹痛和嗳气；以及消化系统合并症，包括肝脏疾病和胃肠道疾病。汇集研究的原始数据以确定效果估计。

 发现

我们分析了 35 项研究的结果，其中包括 6686 名符合纳入标准的 COVID-19 患者。 29 项研究 (n=6064) 报告了 COVID-19 患者在诊断时出现胃肠道症状，消化系统合并症的汇总患病率为 4%（95% CI 2-5；范围 0-15； I ² =74%）。消化系统症状的汇总患病率为 15%（10-21；范围：2-57； I ² =96%），其中恶心或呕吐、腹泻和食欲不振是三种最常见的症状。肝功能异常的汇总患病率（12 项研究，n=1267）为 19%（9-32；范围 1-53； I ² =96%）。亚组分析显示，重症 COVID-19 患者腹痛发生率较高（比值比 [OR] 7·10 [95% CI 1·93–26·07]；p=0·003； I ² =0%），肝功能异常，包括 ALT 升高 (1·89 [1·30–2·76]；p=0·0009； I ² =10%) 和 AST 升高 (3·08 [2·14–4·42]；p <0 id=25>I ² =0%)与非严重疾病患者相比。在首次爆发 COVID-19 的湖北省，患者更有可能出现肝功能异常 (p<0 id=27>I ² =97%)，其中仅出现胃肠道症状而无呼吸系统特征的患者。出现胃肠系统受累的患者诊断延迟（标准化平均差 2·85 [95% CI 0·22–5·48]；p=0·030； I ² =73%）。胃肠道受累患者的病程往往较差（例如，急性呼吸窘迫综合征 OR 2·96 [95% CI 1·17–7·48]；p=0·02； I ² =0%）。

 解释

我们的研究表明，消化系统症状和肝损伤在 COVID-19 患者中并不少见。应更加关注这一独特患者群体的护理。

 资金

 没有任何。