Gastrointestinal predictors of severe COVID-19: systematic review and meta-analysis

Ann Gastroenterol. 2020 Nov-Dec;33(6):615-630. doi: 10.20524/aog.2020.0527. Epub 2020 Jul 30.


Background: COVID-19 pandemic has created a need to identify potential predictors of severe disease. We performed a systematic review and meta-analysis of gastrointestinal predictors of severe COVID-19.

Methods: An extensive literature search was performed using PubMed, Embase, Web of Science and Cochrane. Odds ratio (OR) and mean difference (MD) were calculated for proportional and continuous outcomes using a random-effect model. For each outcome, a 95% confidence interval (CI) and P-value were generated.

Results: A total of 83 studies (26912 patients, mean age 43.5±16.4 years, 48.2% female) were included. Gastrointestinal predictors of severe COVID-19 included the presence of diarrhea (OR 1.50, 95%CI 1.10-2.03; P=0.01), elevated serum aspartate aminotransferase (AST) (OR 4.00, 95%CI 3.02-5.28; P<0.001), and elevated serum alanine aminotransferase (ALT) (OR 2.54, 95%CI 1.91-3.37; P<0.001). Significantly higher levels of mean AST (MD 14.78 U/L, 95%CI 11.70-17.86 U/L; P<0.001), ALT (MD 11.87 U/L, 95%CI 9.23-14.52 U/L; P<0.001), and total bilirubin (MD 2.08 mmol/L, 95%CI 1.36-2.80 mmol/L; P<0.001) were observed in the severe COVID-19 group compared to non-severe COVID-19 group.

Conclusion: Gastrointestinal symptoms and biomarkers should be assessed early to recognize severe COVID-19.

Keywords: COVID-19; SARS-CoV-2; diarrhea; predictors; severe COVID-19.