Gastrointestinal Manifestations of SARS-CoV-2 Infection and Virus Load in Fecal Samples From a Hong Kong Cohort: Systematic Review and Meta-analysis
Gastrointestinal Manifestations of SARS-CoV-2 Infection and Virus Load in Fecal Samples From a Hong Kong Cohort: Systematic Review and Meta-analysis
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DOI：
10.1053/j.gastro.2020.03.065
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发表时间：
2020-07-01
期刊：
影响因子：
29.4
通讯作者：
Leung, Wai K.
中科院分区：
文献类型：
--
作者：
Cheung, Ka Shing;Hung, Ivan F. N.;Leung, Wai K.
背景与目的：严重急性呼吸综合征冠状病毒2型（SARS-CoV-2）感染导致2019冠状病毒病（COVID-19），其特征是发热、呼吸道和胃肠道症状以及病毒RNA脱落到粪便中。我们对已发表的胃肠道症状和粪便中病毒检测进行了系统回顾和荟萃分析，并总结了香港COVID-19患者队列的数据。方法：我们收集了香港COVID-19患者队列的数据（N = 59;诊断时间为2020年2月2日至2月29日），并检索了截至2020年3月11日的PubMed、Embase、科克伦和3个中文数据库，根据系统性综述和荟萃分析（PRISMA）指南的首选报告项目。我们使用随机效应模型分析了总体和个体胃肠道症状（食欲不振、恶心、呕吐、腹泻和腹痛或不适）患病率的汇总数据。研究结果：在香港的59名COVID-19患者中，15名患者（25. 4%）有胃肠道症状，9名患者（15. 3%）的粪便病毒RNA检测呈阳性。在有和无腹泻的患者中，粪便病毒RNA检出率分别为38.5%和8.7%（P =.02）。腹泻患者粪便病毒载量中位数为5.1 log（10）拷贝/毫升，而无腹泻患者为3.9 log（10）拷贝/毫升（P = 0.06）。在一项包含4243名患者的60项研究的荟萃分析中，所有胃肠道症状的合并患病率为17.6%。（95%置信区间[CI]，12.3 - 24.5）; 11.8%的非重度COVID-19患者有胃肠道症状（95%CI，4.1 - 29.1），17.1%的重度COVID-19患者有胃肠道症状（95%CI，6.9 - 36.7）。在荟萃分析中，粪便样本病毒RNA阳性的合并患病率为48.1%（95%CI，38.3 - 57.9）;在这些样本中，70.3%的呼吸道标本病毒丢失后采集的样本病毒检测呈阳性（95% CI，49.6 - 85.1）。在对香港COVID-19患者队列数据的分析和对出版物结果的荟萃分析中，我们发现17.6%的COVID-19患者有胃肠道症状。48.1%的患者粪便标本中检出病毒RNA，甚至在呼吸道标本检测结果阴性后采集的粪便中也检出病毒RNA。因此，卫生保健工作者在收集COVID-19患者的粪便样本或进行内窥镜检查时应谨慎，即使在患者康复期间也是如此。
BACKGROUND & AIMS: Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19), which has been characterized by fever, respiratory, and gastrointestinal symptoms as well as shedding of virus RNA into feces. We performed a systematic review and meta-analysis of published gastrointestinal symptoms and detection of virus in stool and also summarized data from a cohort of patients with COVID-19 in Hong Kong.METHODS: We collected data from the cohort of patients with COVID-19 in Hong Kong (N = 59; diagnosis from February 2 through February 29, 2020),and searched PubMed, Embase, Cochrane, and 3 Chinese databases through March 11, 2020, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We analyzed pooled data on the prevalence of overall and individual gastrointestinal symptoms (loss of appetite, nausea, vomiting, diarrhea, and abdominal pain or discomfort) using a random effects model. RESULTS: Among the 59 patients with COVID-19 in Hong Kong, 15 patients (25.4%) had gastrointestinal symptoms, and 9 patients (15.3%) had stool that tested positive for virus RNA. Stool viral RNA was detected in 38.5% and 8.7% among those with and without diarrhea, respectively (P = .02). The median fecal viral load was 5.1 log(10) copies per milliliter in patients with diarrhea vs 3.9 log(10) copies per milliliter in patients without diarrhea (P = .06). In a meta-analysis of 60 studies comprising 4243 patients, the pooled prevalence of all gastrointestinal symptoms was 17.6% (95% confidence interval [CI], 12.3-24.5); 11.8% of patients with nonsevere COVID-19 had gastrointestinal symptoms (95% CI, 4.1-29.1), and 17.1% of patients with severe COVID-19 had gastrointestinal symptoms (95% CI, 6.9-36.7). In the meta-analysis, the pooled prevalence of stool samples that were positive for virus RNA was 48.1% (95% CI, 38.3-57.9); of these samples, 70.3% of those collected after loss of virus from respiratory specimens tested positive for the virus (95% CI, 49.6-85.1).CONCLUSIONS: In an analysis of data from the Hong Kong cohort of patients with COVID-19 and a meta-analysis of findings from publications, we found that 17.6% of patients with COVID-19 had gastrointestinal symptoms. Virus RNA was detected in stool samples from 48.1% patients, even in stool collected after respiratory samples had negative test results. Health care workers should therefore exercise caution in collecting fecal samples or performing endoscopic procedures in patients with COVID-19, even during patient recovery.