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Clinically, Covid\u201019 patients manifest fever with dry cough, fatigue and dyspnoea, and in severe cases develop into acute respiratory distress syndrome (ARDS), sepsis and multi\u2010organ failure. These severe patients are characterized by hyperinflammation with highly increased pro\u2010inflammatory cytokines including IL\u20106, IL\u201017 and TNF\u2010alpha as well as C\u2010reactive protein, which are accompanied by decreased lymphocyte counts. Clinical evidence supports that gut microbiota dysregulation is common in Covid\u201019 and plays a key role in the pathogenesis of Covid\u201019. In this narrative review, we summarize the roles of intestinal dysbiosis in Covid\u201019 pathogenesis and posit that the associated mechanisms are being mediated by gut bacterial metabolites. Based on this premise, we propose possible clinical implications. Various risk factors could be causal for severe Covid\u201019, and these include advanced age, concomitant chronic disease, SARS\u2010CoV\u20102 infection of enterocytes, use of antibiotics and psychological distress. Gut dysbiosis is associated with risk factors and severe Covid\u201019 due to decreased commensal microbial metabolites, which cause reduced anti\u2010inflammatory mechanisms and chronic low\u2010grade inflammation. The preconditioned immune dysregulation enables SARS\u2010CoV\u20102 infection to progress to an uncontrolled hyperinflammatory response. Thus, a pre\u2010existing gut microbiota that is diverse and abundant could be beneficial for the prevention of severe Covid\u201019, and supplementation with commensal microbial metabolites may facilitate and augment the treatment of severe Covid\u201019.<\/jats:p>","DOI":"10.1002\/rmv.2211","type":"journal-article","created":{"date-parts":[[2021,1,15]],"date-time":"2021-01-15T13:50:51Z","timestamp":1610718651000},"page":"1-13","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":51,"title":["Altered gut microbial metabolites could mediate the effects of risk factors in Covid\u201019"],"prefix":"10.1002","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1977-6143","authenticated-orcid":false,"given":"Jiezhong","family":"Chen","sequence":"first","affiliation":[{"name":"Research Department Medlab Clinical  Sydney 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