Hepatic and Gastrointestinal Complications during COVID-19: A Meta-Analysis of Meta-Analyses
DOI:
https://doi.org/10.36570/jduhs.2024.1.1737Keywords:
Coronavirus, COVID-19, Cirrhosis, Liver Disease, SARS-CoV-2Abstract
Objective: This meta-analysis is aimed to quantify the findings of different meta-analyses performed on the association of hepatic and gastrointestinal complications and corona virus diesease (COVID-19) severity.
Methods: Four databases i.e., PubMed, Google Scholar, Cochrane, and Web of science were used for the systematic search of the literature from January 2020 till July 2021. “Quality of Reporting of Meta-analyses (QUOROM) checklist was used to examine the comprehensiveness of reporting in the meta-analysis. Sixteen systematic review and meta-analysis studies met inclusion criteria.
Results: Pooled results indicated that diarrhea was a significant symptom in COVID-19 patients (OR=2.70, 95% CI 1.16 to 6.29, p-value 0.020) along with abdominal pain (OR=3.87, 95% CI 2.86 to 5.23, p-value <0.001), nausea (OR=2.81, 95% CI 1.13 to 6.97, p-value 0.030), and vomiting (OR= 2.91, 95% CI 1.31 to 6.49, p-value 0.009). Pooled results also indicated a rise in alanine transaminase (ALT) level (OR= 3.81, 95% CI 1.71 to 8.45 p-value <0.001) and bilirubin level (OR=2.89, 95% CI 1.38 to 6.04, p-value <0.001) in COVID-19 patients. A significant association of aminotransferase (AST) with COVID-19 (OR=5.81, 95% CI 2.82 to 12, p-value <0.001) was also present.
Conclusion: Severe acute respiratory syndrome coronavirus-2 can cause damage to the liver cells which may lead to an elevated level of inflammatory markers and liver enzymes (ALT/AST).
Downloads
References
Parohan M, Yaghoubi , Seraji A. Liver injury is associated with severe coronavirus disease 2019 (COVID-19) infection: A systematic review and meta-analysis of retrospective studies. Hepatol Res 2020; 50:924-35. doi:10.1111/hepr.13510
Youssef M, H Hussein M, Attia AS, M Elshazli R, Omar M, Zora G, et al. COVID-19 and liver dysfunction: A systematic review and meta-analysis of retrospective studies. J Med Virol 2020; 92:1825-33. doi:10.1002/jmv.26055
Abdulla S, Hussain A, Azim D, Abduallah EH, Elawamy H, Nasim S, et al. COVID-19-Induced Hepatic Injury: A Systematic Review and Meta-Analysis. Cureus 2020; 12:e10923. doi:10.7759/cureus.10923
Wang H, Qiu P, Liu J, Wang F, Zhao Q. The liver injury and gastrointestinal symptoms in patients with Coronavirus Disease 19: A systematic review and meta-analysis. Clin Res Hepatol Gastroenterol 2020; 44:653-61. doi:10.1016/j.clinre.2020.04.01
Mao R, Qiu Y, He JS, Tan JY, Li XH, Liang J, et al. Manifes-tations and prognosis of gastrointestinal and liver involvement in patients with COVID-19: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol 2020; 5:667-78. doi:10.1016/S2468-1253(20)30126-6
Hayashi Y, Wagatsuma K, Nojima M, Yamakawa T, Ichimiya T, Yokoyama Y, et al. The characteristics of gastrointestinal symptoms in patients with severe COVID-19: a systematic review and meta-analysis. J Gastroenterol 2021; 56:409–20. doi:10.1007/s00535-021-01778-z
Kovalic AJ, Satapathy SK, Thuluvath PJ. Prevalence of chronic liver disease in patients with COVID-19 and their clinical outcomes: a systematic review and meta-analysis. Hepatol Int 2020; 14:612–20. doi:10.1007/s12072-020-10078-2
Saini RK, Saini N, Ram S, Soni SL, Suri V, Malhotra P, et al. COVID-19 associated variations in liver function parameters: a retrospective study. Postgrad Med J 2022; 98:91–7. doi:10.1136/postgradmedj-2020-138930
Kumar MP, Mishra S, Jha DK, Shukla J, Choudhury A, Mohindra R, et al. Coronavirus disease (COVID-19) and the liver: a comprehensive systematic review and meta-analysis. Hepatol Int 2020; 14:711–22. doi:10.1007/s12072-020-10071-9
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JPA, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Ann Intern Med 2009; 151:W65-94. doi:10.7326/0003-4819-151-4-200908180-00136
Moher D, Cook DJ, Eastwood S, Olkin I, Rennie D, Stroup DF. Improving the quality of reports of meta-analyses of randomised controlled trials: The QUOROM statement. Onkologie 2000; 23:597–602. doi:10.1159/000055014
Shea BJ, Grimshaw JM, Wells GA, Boers M, Andersson N, Hamel C, et al. Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol 2007; 7:10. doi:10.1186/1471-2288-7-10
Pieper D, Buechter RB, Li L, Prediger B, Eikermann M. Systematic review found AMSTAR, but not R(evised)-AMSTAR, to have good measurement properties. J Clin Epidemiol 2015; 68:574-83. doi:10.1016/j.jclinepi.2014.12.009
Shea BJ, Hamel C, Wells GA, Bouter LM, Kristjansson E, Grimshaw J, et al. AMSTAR is a reliable and valid measurement tool to assess the methodological quality of systematic reviews. J Clin Epidemiol 2009; 62:1013–20. doi:10.1016/j.jclinepi.2008.10.009
Pollock M, Fernandes RM, Hartling L. Evaluation of AMS-TAR to assess the methodological quality of systematic reviews in overviews of reviews of healthcare interventions. BMC Med Res Methodol 2017; 17:48. doi:10.1186/s12874-017-0325-5
Sharma A, Jaiswal P, Kerakhan Y, Saravanan L, Murtaza Z, Zergham A, et al. Liver disease and outcomes among COVID-19 hospitalized patients - A systematic review and meta-analysis. Ann Hepatol 2021; 21:100273. doi:10.1016/j.aohep.2020.10.001
Wan J, Wang X, Su S, Zhang Y, Jin Y, Shi Y, et al. Digestive symptoms and liver injury in patients with coronavirus disease 2019 (COVID-19): A systematic review with meta-analysis. JGH Open 2020; 4:1047–58. doi:10.1002/jgh3.12428
Wu ZH, Yang DL. A meta-analysis of the impact of COVID-19 on liver dysfunction. Eur J Med Res 2020; 25:54. doi:10.1186/s40001-020-00454-x
Zhao X, Lei Z, Gao F, Xie Q, Jang K, Gong J. The impact of coronavirus disease 2019 (COVID-19) on liver injury in China: A systematic review and meta-analysis. Medicine 2021; 100:e24369. doi:10.1097/MD.0000000000024369
Samidoust P, Samidoust A, Samadani AA, Khoshdoz S. Risk of hepatic failure in COVID-19 patients. A systematic review and meta-analysis. Infez Med 2020; 28:96–103.
Zarifian A, Zamiri Bidary M, Arekhi S, Rafiee M, Gholamalizadeh H, Amiriani A, et al. Gastrointestinal and hepatic abnormalities in patients with confirmed COVID-19: A systematic review and meta-analysis. J Med Virol 2021; 93:336–50. doi:10.1002/jmv.26314
Bzeizi K, Abdulla M, Mohammed N, Alqamish J, Jamshidi N, Broering D. Effect of COVID-19 on liver abnormalities: a systematic review and meta-analysis. Sci Rep 2021; 11:10599. doi:10.1038/s41598-021-89513-9
Paliogiannis P, Mangoni AA, Cangemi M, Fois AG, Carru C, Zinellu A. Serum albumin concentrations are
associated with disease severity and outcomes in coro-navirus 19 disease (COVID-19): a systematic review and meta-analysis. Clin Exp Med 2021; 21:343–54. doi:10.1007/s10238-021-00686-z
Ampuero J, Sánchez Y, García-Lozano MR, Maya-Miles D, Romero Gomez M. Impact of liver injury on the severity of COVID-19: a systematic review with meta-analysis. Rev Esp Enferm Dig 2021; 113:125–35. doi:10.17235/reed.2020.7397/2020
Rokkas T. Gastrointestinal involvement in COVID-19: a systematic review and meta-analysis. Ann Gastroenterol [Internet]. 2020; 33(4):355–65. Available doi.org/10.20524/aog.2020.0506
Zeng W, Qi K, Ye M, Zheng L, Liu X, Hu S, et al. Gastroint-estinal symptoms are associated with severity of coronavirus disease 2019: a systematic review and meta-analysis: A systematic review and meta-analysis. Eur J Gastroenterol Hepatol [Internet]. 2022; 34(2): 168–76. doi.org/ 10.1097/meg.0000000000002072
Zhang J, Garrett S, Sun J. Gastrointestinal symptoms, pathophysiology, and treatment in COVID-19. Genes Dis. 2021; 8(4):385-400. doi.org/10.1016/j.gendis.2020.08.013.
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Jaseela Majeed, Sapna Yadav, Rekha Garg Garg, Danish Kamal, Ramsha Iqbal, Palka Mittal, Abhishek Dadhich, Puneeta Ajmera
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Articles published in the Journal of Dow University of Health Sciences are distributed under the terms of the Creative Commons Attribution Non-Commercial License https://creativecommons.org/ licenses/by-nc/4.0/. This license permits use, distribution and reproduction in any medium; provided the original work is properly cited and initial publication in this journal.