key: cord-0859391-f5203jel
authors: Li, Yang; Hou, Hongjie; Yang, Haiyan
title: Lack of Significant Association Between Gastrointestinal Symptoms and COVID-19 Mortality: An Updated Meta-Analysis Based on Adjusted Effect Estimates
date: 2021-04-20
journal: Mayo Clin Proc
DOI: 10.1016/j.mayocp.2021.04.011
sha: ddb723a4c66d66aea23f9ec90c9e4f61ffcaf91b
doc_id: 859391
cord_uid: f5203jel

nan

To the Editor: Recently, a meta-analysis by Tariq et al has reported that the mortality of coronavirus disease 2019 patients with gastrointestinal (GI) symptoms (0.4%; 95% confidence interval (CI): 0%-1.1%) was similar to the overall mortality (2.1%; 95% CI, 0.2%-4.7%) (1) . This is an extremely interesting study.

However, their findings were based on limited sample sizes. Moreover, the pooled effects from Tariq et al. 's study were based on crude effect estimates. Various factors such as age, gender and comorbidities (such as diabetes, hypertension and cerebrovascular disease, etc.) affected the clinical outcomes of COVID-19 patients (2) (3) (4) (5) , suggesting that these factors might influence the relationship between GI symptoms and COVID-19 mortality. So, an updated meta-analysis based on adjusted effect estimates is needed to clarify the association between GI symptoms and COVID-19 mortality.

We carried out an electronic search in PubMed, Web of Science and EMBASE until March 9 th , 2021. The following keywords were used: (("COVID-19" or "2019-nCoV" or "SARS-CoV-2" or "coronavirus disease 2019") and ("GI" or "gastrointestinal symptoms") and ("mortality" or "death" or "fatality" or "deceased" or "non-survivor" or "died")). All peer-reviewed studies written in English investigating the relationship between GI symptoms and COVID-19 mortality based on adjusted effects were included. We excluded reviews, case reports, duplicated papers and studies without complete data. All data analyses were performed by The forest plot demonstrated that GI symptoms were not significantly associated with COVID-19 mortality on the basis of adjusted effect estimates (A); Sensitivity analysis showed that our results were stable and robust (B); Publication bias was evaluated by Begg's test (C) and Egger's test (D). 

Dyspnea at presentation, Mental disturbance at presentation, Comorbidity (Treating cancer, Diabetes, Hypertension, Chronic cardiac disease, Chronic pulmonary disease, Chronic renal disease, Dementia), Hemoglobin, Absolute lymphocyte counts (Group II, ≥ 500-< 1000/mm 3 , Group I

Vital signs on admission (Blood O 2 saturation < 92%, Tachypnea >22 bpm, Disorder of conciousness, SBP < 90 or/and DBP < 60 mmHg, q-SOFA ≥ 2), Chest X-ray on admission (Bilateral infiltration), Laboratory findings on admission (Albumin < 34 g/L, Lymphocytes ≤ 800/µL, Creatinine, D-Dimer > 0.49 ng/dL, hs-CRP > 8 mg/L, Lactate dehydrogenase > 250 U/L, Hemoglobin, Leucocyte count

Multi-morbidities, Smoking, Diabetes, Obesity, Heart failure, CAD, Lung disease, Cancer, History of stroke, Dementia, Fever, Dyspnea, Hypotension, Pneumonia, CRP, Admission to hospital

The values of age are mean ± standard deviation (SD) or median (interquartile range, IQR); the values of male are n (%)

Abbreviations: OR, odds ratio

NLR, neutrophil to lymphocyte ratio; hs-CRP, high sensitivity C-reactive protein; BUN, blood urea nitrogen; NT-proBNP, N-terminal pro-B-type natriuretic peptide

CAD, coronary artery disease

congestive heart failure; COPD, chronic obstructive pulmonary disease; CT, cycle threshold; CFS, clinical frailty scale; NLR, neutrophil-to-lymphocyte ratio; SES, socio-economic status

CKD, chronic kidney disease

CLD, chronic liver disease

ARDS, acute respiratory distress syndrome

WBC, white blood cells

BMI, body mass index