ASSOCIATION OF GASTROINTESTINAL SYMPTOMS WITH OUTCOMES IN COVID-19 HOSPITALIZATIONS: A SYSTEMATIC REVIEW AND META-ANALYSIS

ABSTRACT

Introduction: The coronavirus disease 2019 (COVID-19) pandemic is a global health crisiswhich has caused a significant healthcare burden. Fever, cough and dyspnea are the classicsymptoms of COVID-19 but emerging literature has reported diarrhea, vomiting, loss ofappetite and other gastrointestinal symptoms (GI) as well. In this meta-analysis, we evaluatedthe association of diarrhea, vomiting and anorexia with outcomes in COVID-19 hospitalizedpatients.Methods: Data from observational studies describing GI symptoms and outcomes of COVID-19 hospitalized patients from December 1, 2019 till June 30, 2020 was extracted followingMOOSE guidelines with a consensus of four independent reviewers. Adverse outcomes weredefined as admission to the intensive care unit (ICU), oxygen saturation <90%, invasivemechanical ventilation (IMV), severe disease and in-hospital mortality. Data was analyzedusing Review Manager 5.4. The odds ratio (OR) and 95% confidence interval (95%CI) wereobtained and forest plots were created using random-effects models.Results: Out of 24 studies with 13,741 confirmed COVID-19 patients, 17 studies (4087patients), 5 studies (897 patients) and 5 studies (1751 patients) provided data on COVID-19 hospital outcomes and GI symptoms of diarrhea, anorexia and vomiting respectively. In patients with poor outcomes, the prevalence of diarrhea was 13.3%(187/1398), anorexia37%(172/464) and vomiting 7.6%(67/883). In meta-analysis, patients with anorexia(OR4.27;95%CI2.73–6.67;p<0.00001) and vomiting (OR1.85;95%CI1.13–3.05;p=0.02)had higher odds of poor outcomes compared to better outcomes with 0% heterogeneity (p=0.68 and p=0.91) respectively. Patients with diarrhea had no significant association withpoor outcomes (OR1.04 (95%CI0.75–1.44;p=0.81) with 23% heterogeneity (p=0.19).Conclusion: Our meta-analysis suggests that COVID-19 patients with anorexia and vomitinghad higher risk of poor outcomes and disease severity. Future studies should focus onwhether identification of GI invasion along with fecal PCR testing will help in early triageof high risk patients and improve outcomes.(Figure Presented)Figure 1 Forest Plot of Anorexia with Outcome in COVID-19 hospitalizations(Figure Presented)Figure 2 Forest Plot of Vomiting with Outcome in COVID-19 hospitalizations(Figure Presented)Figure 3 Forest Plot of Diarrhea with Outcome in COVID-19 hospitalizations