Gastrointestinal and liver involvement in patients with COVID-19

Abstract

Gastrointestinal symptoms and liver injury are not uncommon in patients with COVID-19, as stated in the systematic review and meta-analysis reported by Ren Mao and colleagues.1Mao R Qiu Y He JS et al.Manifestations and prognosis of gastrointestinal and liver involvement in patients with COVID-19: a systematic review and meta-analysis.Lancet Gastroenterol Hepatol. 2020; 5: 667-678Summary Full Text Full Text PDF PubMed Scopus (536) Google Scholar However, we have some concerns about the study. First, when doing pooled analyses of the overall prevalence of abnormal liver chemistry and liver injury, it would be more appropriate to analyse the data stratified by the severity of COVID-19. As stated by the investigators, patients with severe COVID-19 have a greater risk of liver injury than do patients with non-severe COVID-19. Hence, the overall prevalence of increased aminotransferases and liver injury is influenced by the proportion of patients with severe COVID-19 included; the more studies enrolling patients with severe COVID-19 in the meta-analysis, the higher the prevalence of increased aminotransferases and liver injury is likely to be. Consequently, a subgroup analysis based on the severity of COVID-19 is more valuable to assess the prevalence of liver injury than is a pooled analysis. Second, not all abnormal liver function tests mean that patients with COVID-19 have liver injury.2Xu Y Gu J Cardiac and muscle injury might partially contribute to elevated aminotransferases in COVID-19 patients.Clin Gastroenterol Hepatol. 2020; (published online May 11.)DOI:10.1016/j.cgh.2020.04.042Summary Full Text Full Text PDF Scopus (10) Google Scholar, 3Bangash MN Patel J Parekh D COVID-19 and the liver: little cause for concern.Lancet Gastroenterol Hepatol. 2020; 5: 529-530Summary Full Text Full Text PDF PubMed Scopus (280) Google Scholar Elevated aminotransferases might partly result from myocardial injury and muscle injury.2Xu Y Gu J Cardiac and muscle injury might partially contribute to elevated aminotransferases in COVID-19 patients.Clin Gastroenterol Hepatol. 2020; (published online May 11.)DOI:10.1016/j.cgh.2020.04.042Summary Full Text Full Text PDF Scopus (10) Google Scholar, 3Bangash MN Patel J Parekh D COVID-19 and the liver: little cause for concern.Lancet Gastroenterol Hepatol. 2020; 5: 529-530Summary Full Text Full Text PDF PubMed Scopus (280) Google Scholar Some of the studies included in Mao and colleagues' meta-analysis1Mao R Qiu Y He JS et al.Manifestations and prognosis of gastrointestinal and liver involvement in patients with COVID-19: a systematic review and meta-analysis.Lancet Gastroenterol Hepatol. 2020; 5: 667-678Summary Full Text Full Text PDF PubMed Scopus (536) Google Scholar only reported data for hypertransaminaemia.4Cao B Wang Y Wen D et al.A trial of lopinavir-ritonavir in adults hospitalized with severe COVID-19.N Engl J Med. 2020; 382: 1787-1799Crossref PubMed Scopus (3420) Google Scholar, 5Cai J Xu J Lin D et al.A case series of children with 2019 novel coronavirus infection: clinical and epidemiological features.Clin Infect Dis. 2020; (published online Feb 28.)DOI:10.1093/cid/ciaa198Crossref Scopus (502) Google Scholar, 6Huang C Wang Y Li X et al.Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China.Lancet. 2020; 395: 497-506Summary Full Text Full Text PDF PubMed Scopus (27324) Google Scholar When doing their pooled analysis of the prevalence of liver injury, Mao and colleagues1Mao R Qiu Y He JS et al.Manifestations and prognosis of gastrointestinal and liver involvement in patients with COVID-19: a systematic review and meta-analysis.Lancet Gastroenterol Hepatol. 2020; 5: 667-678Summary Full Text Full Text PDF PubMed Scopus (536) Google Scholar considered hypertransaminaemia as liver injury. We do not think this is appropriate. As a result, the prevalence of liver injury might be overestimated in patients with COVID-19. We declare no competing interests. YX and PL contributed equally to this Correspondence. Manifestations and prognosis of gastrointestinal and liver involvement in patients with COVID-19: a systematic review and meta-analysisOur study showed that digestive symptoms and liver injury are not uncommon in patients with COVID-19. Increased attention should be paid to the care of this unique group of patients. Full-Text PDF Gastrointestinal and liver involvement in patients with COVID-19We read with interest the systematic review and meta-analysis by Ren Mao and colleagues1 that aimed to quantify the effect of COVID-19 on the digestive system. The study concluded that digestive symptoms and liver injury are common among patients with COVID-19 and that patients with severe disease have a higher risk of developing gastrointestinal symptoms and liver injury than do patients with non-severe COVID-19. However, we would like to highlight a couple of potential limitations to the method. Full-Text PDF Gastrointestinal and liver involvement in patients with COVID-19 – Authors' replyWe thank Yongxing Xu and colleagues and Francisco J Barrera and colleagues for their comments on our meta-analysis about gastrointestinal and liver involvement in patients with COVID-19.1 Full-Text PDF