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Probiotics improve symptoms of patients with COVID-19 through gut-lung axis: a systematic review and meta-analysis

Tian et al., Frontiers in Nutrition, doi:10.3389/fnut.2023.1179432, PROSPERO CRD42023398309
May 2023  
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Probiotics for COVID-19
18th treatment shown to reduce risk in March 2021
 
*, now with p = 0.0000013 from 26 studies.
No treatment is 100% effective. Protocols combine treatments. * >10% efficacy, ≥3 studies.
4,400+ studies for 79 treatments. c19early.org
Systematic review and meta-analysis of 10 studies (8 RCTs and 2 retrospective studies) with 1,198 COVID-19 patients showing improved overall symptoms, reduced diarrhea duration, lower C-reactive protein levels, and shorter hospital stays with various probiotic interventions compared to placebo or standard care. Authors suggest probiotics may alleviate gastrointestinal and respiratory symptoms in COVID-19 through modulation of the gut-lung axis.
The immune effects of probiotics are strain-specific.
2 meta analyses show significant improvements with probiotics for hospitalization1 and recovery1,2.
Currently there are 26 probiotics for COVID-19 studies, showing 61% lower mortality [37‑76%], 38% lower ventilation [-87‑79%], 21% lower ICU admission [-20‑48%], 13% lower hospitalization [5‑21%], and 40% fewer cases [10‑60%].
Tian et al., 22 May 2023, peer-reviewed, 7 authors, trial PROSPERO CRD42023398309. Contact: pant414@163.com.
This PaperProbioticsAll
Probiotics improve symptoms of patients with COVID-through gut-lung axis: a systematic review and meta-analysis
Linda L D Zhong, Ali Chaari, Imad Omar Al Kassaa, Liang Yao, Yong Tian, Hongmei Ran, Xudong Wen, Guochuan Fu, Xiaofang Zhou, Rui Liu, Tao Pan
Background: Multi system symptoms such as gastrointestinal tract and respiratory tract exist in coronavirus disease (COVID-) patients. There is a lack of reliable evidence to prove that probiotics are e ective in improving these symptoms. In this study, we aimed to evaluate the e cacy of probiotics in metaanalysis. Methods: We systematically searched PubMed, Embase, Web of Science, and Cochrane Library up to February , . Randomized controlled trials or high quality retrospective studies comparing the e cacy of probiotics as supplementation with non-probiotics in improving symptoms for patients with COVID-were included. This meta-analysis assessed endpoints using Review Manager . . Result: Ten citations comprising patients with COVID-were included. The results showed that probiotics could increase the number of people with overall symptom improvement (RR = . , % CI [ . , . ], P = . ) and shorten the duration (days) of overall symptoms (MD = -. , % CI [-. , -. ], P = . ). For the duration (days) of specific symptoms, probiotics could improve diarrhea (MD = -. , % CI [-. , -. ], P < . ), cough (MD = -. , % CI [-. , . ], P = . ) and shortness of breath (MD = -. , % CI [-. , -. ], P = . ). Probiotics had no obvious e ect on fever, headache and weakness. For inflammation, probiotics could e ectively reduce C-reactive Protein (CRP) serum level (mg/L) (MD = -. , % CI [-. , -. ], P < . ). Regarding hospital stay (days), probiotics group was shorter than non-probiotics group (MD = -. , % CI [-. , -. ], P = . ). Conclusion: To some extent probiotics could improve the overall symptoms, inflammatory reaction and shorten hospital stay of patients with COVID-. Probiotics may improve gastrointestinal symptoms (such as improving intestinal flora and reducing the duration of diarrhea) and further improve respiratory symptoms through the gut-lung axis.
Author contributions Data curation and writing-review and editing: YT, HR, XW, and GF. Formal analysis: XW and RL. Funding acquisition: XW and TP. Investigation: YT and RL. Methodology: YT and HR. Project administration: YT, XW, and TP. Software: YT and XZ. Supervision and visualization: GF. Writing-original draft: YT, XW, and XZ. All authors contributed to the article and approved the submitted version. Conflict of interest The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Publisher's note All claims expressed in this article are solely those of the authors and do not necessarily represent those of Supplementary material The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fnut.2023. 1179432/full#supplementary-material
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There is a lack of reliable evidence to prove that probiotics are effective in ' 'improving these symptoms. In this study, we aimed to evaluate the efficacy of probiotics in ' 'meta-analysis.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We ' 'systematically searched PubMed, Embase, Web of Science, and Cochrane Library up to February ' '15, 2023. Randomized controlled trials or high quality retrospective studies comparing the ' 'efficacy of probiotics as supplementation with non-probiotics in improving symptoms for ' 'patients with COVID-19 were included. This meta-analysis assessed endpoints using Review ' 'Manager 5.3.</jats:p></jats:sec><jats:sec><jats:title>Result</jats:title><jats:p>Ten ' 'citations comprising 1198 patients with COVID-19 were included. The results showed that ' 'probiotics could increase the number of people with overall symptom improvement (RR = 1.62, ' '95% CI [1.10, 2.38], <jats:italic>P</jats:italic> = 0.01) and shorten the duration (days) of ' 'overall symptoms (MD = −1.26, 95% CI [−2.36, −0.16], <jats:italic>P</jats:italic> = 0.02). ' 'For the duration (days) of specific symptoms, probiotics could improve diarrhea (MD = −2.12, ' '95% CI [−2.41, −1.83], <jats:italic>P</jats:italic> &amp;lt; 0.00001), cough (MD = −2.21, 95% ' 'CI [-4.56, 0.13], <jats:italic>P</jats:italic> = 0.06) and shortness of breath (MD = −1.37, ' '95% CI [-2.22, −0.53], P = 0.001). Probiotics had no obvious effect on fever, headache and ' 'weakness. For inflammation, probiotics could effectively reduce C-reactive Protein (CRP) ' 'serum level (mg/L) (MD = −4.03, 95% CI [−5.12, −2.93], <jats:italic>P</jats:italic> &amp;lt; ' '0.00001). Regarding hospital stay (days), probiotics group was shorter than non-probiotics ' 'group (MD = −0.98, 95% CI [−1.95, −0.01], <jats:italic>P</jats:italic> = ' '0.05).</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>To some extent ' 'probiotics could improve the overall symptoms, inflammatory reaction and shorten hospital ' 'stay of patients with COVID-19. 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