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Background: COVID-19 pandemic has created a need to identify potential predictors of severe disease We performed a systematic review and meta-analysis of gastrointestinal predictors of severe COVID-19 Methods: An extensive literature search was performed using PubMed, Embase, Web of Science and Cochrane Odds ratio (OR) and mean difference (MD) were calculated for proportional and continuous outcomes using a random-effect model For each outcome, a 95% confidence interval (CI) and P-value were generated Results: A total of 83 studies (26912 patients, mean age 43 5+/-16 4 years, 48 2% female) were included Gastrointestinal predictors of severe COVID-19 included the presence of diarrhea (OR 1 50, 95%CI 1 10-2 03;P=0 01), elevated serum aspartate aminotransferase (AST) (OR 4 00, 95%CI 3 02-5 28;P<0 001), and elevated serum alanine aminotransferase (ALT) (OR 2 54, 95%CI 1 91-3 37;P<0 001) Significantly higher levels of mean AST (MD 14 78 U/L, 95%CI 11 70-17 86 U/L;P<0 001), ALT (MD 11 87 U/L, 95%CI 9 23-14 52 U/L;P<0 001), and total bilirubin (MD 2 08 mmol/L, 95%CI 1 36-2 80 mmol/L;P<0 001) were observed in the severe COVID-19 group compared to non-severe COVID-19 group Conclusion: Gastrointestinal symptoms and biomarkers should be assessed early to recognize severe COVID-19
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