Gastrointestinal symptoms are associated with severity of coronavirus disease 2019: a systematic review and meta-analysis

Objective Studies have suggested that coronavirus disease 2019 (COVID-19) appears to be more serious in patients with gastrointestinal symptoms. This meta-analysis was conducted to explore the relationship between gastrointestinal symptoms and the severity of COVID-19. Methods We searched PubMed, Web of Science, Science Direct, Embase, and Google Scholar on 16 October 2020, to identify observational studies that provided data on gastrointestinal symptoms and severity of COVID-19. Gastrointestinal symptoms include diarrhea, abdominal pain, nausea, and vomiting. The severe rate and the odds ratio (OR) were pooled. Heterogeneity was assessed using the I 2 statistic. Results A total of 21 studies with 5285 patients were included in this meta-analysis. The severe rate of COVID-19 patients with diarrhea was 41.1% [95% confidence interval (CI): 31.0–51.5%], and the OR of association between diarrhea and severe COVID-19 was 1.41 (95% CI: 1.05–1.89); sensitivity analysis showed that the results for the OR and 95% CI were unstable. For abdominal pain, the severe rate and OR of association with severe COVID-19 were 59.3% (95% CI: 41.3–76.4%) and 2.76 (95% CI: 1.59–4.81), respectively; for nausea, 41.4% (95% CI: 23.2–60.7%) and 0.92 (95% CI: 0.59–1.43), respectively; for vomiting, 51.3% (95% CI: 36.8–65.8%) and 1.68 (95% CI: 0.97–2.92), respectively. Conclusion The severe rate was more than 40% in COVID-19 patients with gastrointestinal symptoms. Abdominal pain was associated with a near 2.8-fold increased risk of severe COVID-19; the relationship between diarrhea and the severity of COVID-19 was regionally different; nausea and vomiting were limited in association with an increased risk of severe COVID-19.