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      Gastroenterology manifestations and COVID‐19 outcomes: A meta‐analysis of 25,252 cohorts among the first and second waves

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          Abstract

          A meta‐analysis was performed to identify patients with coronavirus disease 2019 (COVID‐19) presenting with gastrointestinal (GI) symptoms during the first and second pandemic waves and investigate their association with the disease outcomes. A systematic search in PubMed, Scopus, Web of Science, ScienceDirect, and EMBASE was performed up to July 25, 2020. The pooled prevalence of the GI presentations was estimated using the random‐effects model. Pairwise comparison for the outcomes was performed according to the GI manifestations' presentation and the pandemic wave of infection. Data were reported as relative risk (RR), or odds ratio and 95% confidence interval. Of 125 articles with 25,252 patients, 20.3% presented with GI manifestations. Anorexia (19.9%), dysgeusia/ageusia (15.4%), diarrhea (13.2%), nausea (10.3%), and hematemesis (9.1%) were the most common. About 26.7% had confirmed positive fecal RNA, with persistent viral shedding for an average time of 19.2 days before being negative. Patients presenting with GI symptoms on admission showed a higher risk of complications, including acute respiratory distress syndrome (RR = 8.16), acute cardiac injury (RR = 5.36), and acute kidney injury (RR = 5.52), intensive care unit (ICU) admission (RR = 2.56), and mortality (RR = 2.01). Although not reach significant levels, subgroup‐analysis revealed that affected cohorts in the first wave had a higher risk of being hospitalized, ventilated, ICU admitted, and expired. This meta‐analysis suggests an association between GI symptoms in COVID‐19 patients and unfavorable outcomes. The analysis also showed improved overall outcomes for COVID‐19 patients during the second wave compared to the first wave of the outbreak.

          Highlights

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            Gastrointestinal (GI) symptoms in COVID‐19 patients were associated with unfavorable outcomes.

          • •

            Cases presenting with GI symptoms on admission were more subjected to complications.

          • •

            GI cohorts of COVID‐19 cases showed a double risk of ICU admission and mortality.

          • •

            Overall outcomes for COVID‐19 patients during the second wave showed improvement compared to the first wave of the outbreak.

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          Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China

          Chaolin Huang, Yeming Wang, Xingwang Li … (2020)
          Summary Background A recent cluster of pneumonia cases in Wuhan, China, was caused by a novel betacoronavirus, the 2019 novel coronavirus (2019-nCoV). We report the epidemiological, clinical, laboratory, and radiological characteristics and treatment and clinical outcomes of these patients. Methods All patients with suspected 2019-nCoV were admitted to a designated hospital in Wuhan. We prospectively collected and analysed data on patients with laboratory-confirmed 2019-nCoV infection by real-time RT-PCR and next-generation sequencing. Data were obtained with standardised data collection forms shared by WHO and the International Severe Acute Respiratory and Emerging Infection Consortium from electronic medical records. Researchers also directly communicated with patients or their families to ascertain epidemiological and symptom data. Outcomes were also compared between patients who had been admitted to the intensive care unit (ICU) and those who had not. Findings By Jan 2, 2020, 41 admitted hospital patients had been identified as having laboratory-confirmed 2019-nCoV infection. Most of the infected patients were men (30 [73%] of 41); less than half had underlying diseases (13 [32%]), including diabetes (eight [20%]), hypertension (six [15%]), and cardiovascular disease (six [15%]). Median age was 49·0 years (IQR 41·0–58·0). 27 (66%) of 41 patients had been exposed to Huanan seafood market. One family cluster was found. Common symptoms at onset of illness were fever (40 [98%] of 41 patients), cough (31 [76%]), and myalgia or fatigue (18 [44%]); less common symptoms were sputum production (11 [28%] of 39), headache (three [8%] of 38), haemoptysis (two [5%] of 39), and diarrhoea (one [3%] of 38). Dyspnoea developed in 22 (55%) of 40 patients (median time from illness onset to dyspnoea 8·0 days [IQR 5·0–13·0]). 26 (63%) of 41 patients had lymphopenia. All 41 patients had pneumonia with abnormal findings on chest CT. Complications included acute respiratory distress syndrome (12 [29%]), RNAaemia (six [15%]), acute cardiac injury (five [12%]) and secondary infection (four [10%]). 13 (32%) patients were admitted to an ICU and six (15%) died. Compared with non-ICU patients, ICU patients had higher plasma levels of IL2, IL7, IL10, GSCF, IP10, MCP1, MIP1A, and TNFα. Interpretation The 2019-nCoV infection caused clusters of severe respiratory illness similar to severe acute respiratory syndrome coronavirus and was associated with ICU admission and high mortality. Major gaps in our knowledge of the origin, epidemiology, duration of human transmission, and clinical spectrum of disease need fulfilment by future studies. Funding Ministry of Science and Technology, Chinese Academy of Medical Sciences, National Natural Science Foundation of China, and Beijing Municipal Science and Technology Commission.
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            Clinical Characteristics of Coronavirus Disease 2019 in China

            Wei-jie Guan, Zheng-yi Ni, Yu Hu … (2020)
            Abstract Background Since December 2019, when coronavirus disease 2019 (Covid-19) emerged in Wuhan city and rapidly spread throughout China, data have been needed on the clinical characteristics of the affected patients. Methods We extracted data regarding 1099 patients with laboratory-confirmed Covid-19 from 552 hospitals in 30 provinces, autonomous regions, and municipalities in mainland China through January 29, 2020. The primary composite end point was admission to an intensive care unit (ICU), the use of mechanical ventilation, or death. Results The median age of the patients was 47 years; 41.9% of the patients were female. The primary composite end point occurred in 67 patients (6.1%), including 5.0% who were admitted to the ICU, 2.3% who underwent invasive mechanical ventilation, and 1.4% who died. Only 1.9% of the patients had a history of direct contact with wildlife. Among nonresidents of Wuhan, 72.3% had contact with residents of Wuhan, including 31.3% who had visited the city. The most common symptoms were fever (43.8% on admission and 88.7% during hospitalization) and cough (67.8%). Diarrhea was uncommon (3.8%). The median incubation period was 4 days (interquartile range, 2 to 7). On admission, ground-glass opacity was the most common radiologic finding on chest computed tomography (CT) (56.4%). No radiographic or CT abnormality was found in 157 of 877 patients (17.9%) with nonsevere disease and in 5 of 173 patients (2.9%) with severe disease. Lymphocytopenia was present in 83.2% of the patients on admission. Conclusions During the first 2 months of the current outbreak, Covid-19 spread rapidly throughout China and caused varying degrees of illness. Patients often presented without fever, and many did not have abnormal radiologic findings. (Funded by the National Health Commission of China and others.)
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              Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

              Fei Zhou, Ting Yu, Ronghui Du … (2020)
              Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p<0·0001), and d-dimer greater than 1 μg/mL (18·42, 2·64–128·55; p=0·0033) on admission. Median duration of viral shedding was 20·0 days (IQR 17·0–24·0) in survivors, but SARS-CoV-2 was detectable until death in non-survivors. The longest observed duration of viral shedding in survivors was 37 days. Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.
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                Author and article information

                Contributors
                Rami M. Elshazli:
                ORCID: https://orcid.org/0000-0002-3381-2641
                Relshazly@horus.edu.eg
                Adam Kline:
                ORCID: https://orcid.org/0000-0001-5939-2684
                akline1@tulane.edu
                Abdelaziz Elgaml:
                ORCID: http://orcid.org/0000-0001-6790-5849
                Elgamel3a@mans.edu.eg
                Mohamed H. Aboutaleb:
                ORCID: https://orcid.org/0000-0002-3954-5783
                maboutaleb@horus.edu.eg
                Mohamed M. Salim:
                ORCID: https://orcid.org/0000-0003-4429-6504
                mmasalim@mans.edu.eg
                Ruhul Munshi:
                ORCID: https://orcid.org/0000-0002-8616-6081
                munshicmc46@gmail.com
                Nicholas Mankowski:
                ORCID: https://orcid.org/0000-0002-2116-4747
                nmankowski@tulane.edu
                Mohammad H. Hussein:
                ORCID: https://orcid.org/0000-0001-8278-7094
                mhussein1@tulane.edu
                Abdallah S. Attia:
                ORCID: https://orcid.org/0000-0003-2163-0637
                aattia@tulane.edu
                Eman A. Toraih:
                ORCID: http://orcid.org/0000-0001-9267-3787
                etoraih@tulane.edu
                Ahmad Settin:
                ORCID: https://orcid.org/0000-0003-4840-2327
                settin60@gmail.com
                Mary Killackey:
                ORCID: https://orcid.org/0000-0003-3546-6946
                mkillack@tulane.edu
                Emad Kandil:
                ORCID: https://orcid.org/0000-0001-5895-4403
                ekandil@tulane.edu
                Journal
                Journal ID (nlm-ta): J Med Virol
                Journal ID (iso-abbrev): J Med Virol
                Journal ID (doi): 10.1002/(ISSN)1096-9071
                Journal ID (publisher-id): JMV
                Title: Journal of Medical Virology
                Publisher: John Wiley and Sons Inc. (Hoboken )
                ISSN (Print): 0146-6615
                ISSN (Electronic): 1096-9071
                Publication date (Electronic): 23 February 2021
                Electronic Location Identifier: 10.1002/jmv.26836
                Affiliations
                [ 1 ] Department of Biochemistry and Molecular Genetics, Faculty of Physical Therapy Horus University ‐ Egypt New Damietta Egypt
                [ 2 ] School of Medicine Tulane University New Orleans Louisiana USA
                [ 3 ] Department of Microbiology and Immunology, Faculty of Pharmacy Mansoura University Mansoura Egypt
                [ 4 ] Department of Microbiology and Immunology, Faculty of Pharmacy Horus University ‐ Egypt New Damietta Egypt
                [ 5 ] Department of Pharmaceutical Chemistry, Faculty of Pharmacy Horus University ‐ Egypt New Damietta Egypt
                [ 6 ] Department of Pharmaceutical Analytical Chemistry, Faculty of Pharmacy Mansoura University Mansoura Egypt
                [ 7 ] Department of Surgery, School of Medicine Tulane University New Orleans Louisiana USA
                [ 8 ] Division of Endocrine and Oncologic Surgery, Department of Surgery, School of Medicine Tulane University New Orleans Louisiana USA
                [ 9 ] Genetics Unit, Histology and Cell Biology Department, Faculty of Medicine Suez Canal University Ismailia Egypt
                [ 10 ] Pediatrics and Genetics Department, Faculty of Medicine Mansoura University Mansoura Egypt
                [ 11 ] Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine Suez Canal University Ismailia Egypt
                [ 12 ] Department of Biochemistry, College of Medicine Northern Border University Arar Saudi Arabia
                Author notes
                [*] [* ] Correspondence Eman Toraih, Department of Surgery, Tulane University, School of Medicine, New Orleans, LA, USA.

                Email: etoraih@ 123456tulane.edu

                Rami M. Elshazli, Department of Biochemistry and Molecular Genetics, Faculty of Physical Therapy, Horus University - Egypt, New Damietta, Egypt.

                Email: Relshazly@ 123456horus.edu.eg

                Author information
                https://orcid.org/0000-0002-3381-2641
                https://orcid.org/0000-0001-5939-2684
                http://orcid.org/0000-0001-6790-5849
                https://orcid.org/0000-0002-3954-5783
                https://orcid.org/0000-0003-4429-6504
                https://orcid.org/0000-0001-7917-7973
                https://orcid.org/0000-0002-8616-6081
                https://orcid.org/0000-0002-2116-4747
                https://orcid.org/0000-0001-8278-7094
                https://orcid.org/0000-0003-2163-0637
                http://orcid.org/0000-0001-9267-3787
                https://orcid.org/0000-0003-4840-2327
                https://orcid.org/0000-0003-3546-6946
                https://orcid.org/0000-0003-1252-8403
                https://orcid.org/0000-0001-5895-4403
                Article
                Publisher ID: JMV26836
                DOI: 10.1002/jmv.26836
                PMC ID: 8014082
                PubMed ID: 33527440
                SO-VID: a2199799-0fa4-4992-8771-fe60b6c2d071
                Copyright © © 2021 Wiley Periodicals LLC
                License:

                This article is being made freely available through PubMed Central as part of the COVID-19 public health emergency response. It can be used for unrestricted research re-use and analysis in any form or by any means with acknowledgement of the original source, for the duration of the public health emergency.

                History
                Date revision received : 09 January 2021
                Date received : 04 December 2020
                Date accepted : 28 January 2021
                Page count
                Figures: 4, Tables: 3, Pages: 29, Words: 12839
                Categories
                Subject: Review
                Subject: Reviews
                Custom metadata
                source-schema-version-number 2.0
                edited-state corrected-proof
                details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:6.0.1 mode:remove_FC converted:01.04.2021

                ScienceOpen disciplines: Microbiology & Virology
                Keywords: covid‐19,git,meta‐analysis,pandemic,sars‐cov‐2
                Data availability:
                ScienceOpen disciplines: Microbiology & Virology
                Keywords: covid‐19, git, meta‐analysis, pandemic, sars‐cov‐2

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