Gastrointestinal symptoms are associated with a lower risk of hospitalization and mortality and outcomes in COVID-19

Abstract

Background We aimed to find the association between gastrointestinal (GI) and respiratory symptoms with mortality and hospitalization among COVID-19 patients. Methods We analyzed the registered data of COVID-19 patients from February 20, 2020, to March 10, 2021. Depending on the patients’ disease symptoms, four categories were defined: patients with only GI symptoms, patients with only respiratory symptoms, patients with both symptoms, and patients with other symptoms. Logistic regression analysis was used to assess the association of groups with outcomes. Results A total of 42,964 patients from 23 hospitals were included, of which 26.5% patients had at least one or more GI symptoms. Of total patients, 51.58% patients were hospitalized among which 22.8% had at least one or more GI symptoms. GI symptoms significantly decreased the odds of mortality (OR 0.72, 95% CI 0.56–0.92), but respiratory symptoms increased the odds for mortality (1.36: 1.24–1.50), compared with patients with other symptoms. Moreover, the odds ratio of patients who had both respiratory and GI symptoms increased (1.52: 1.31–1.78) compared with patients with other symptoms. The same results were observed for hospitalization as the outcome. Conclusions Our study showed that the presence of GI symptoms in COVID-19 at the time of admission was associated with a lower odds of hospitalization and mortality; however, this association had higher odds for respiratory symptoms.

Meta‐analysis of the demographic and prognostic significance of gastrointestinal symptoms in COVID‐19 patients

“…Further, 78 studies were excluded as 61 were single‐arm studies and 17 did not provide sufficient data. Therefore, 24 comparative observational studies 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 were deemed appropriate for inclusion (Fig. 1 ).…”

“…Of the 24 studies included in this review, 20 reported on hospitalized patients only. 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 34 , 36 The remainder 14 , 33 , 35 , 37 provided data on a mixed cohort of patients including those hospitalized (in‐patients) and those not admitted (outpatients/ambulatory).…”

“…Moreover, 18 of our included studies 15 , 16 , 17 , 18 , 22 , 24 , 25 , 26 , 27 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 assessed GI symptoms only once at the time of presentation to a healthcare facility. One study assessed GI symptoms both on presentation and during hospital admission.…”

“…Further, 78 studies were excluded as 61 were single‐arm studies and 17 did not provide sufficient data. Therefore, 24 comparative observational studies 14–37 were deemed appropriate for inclusion (Fig. 1).…”

“…In view of unknown prognostic significance of GI symptoms associated with COVID‐19, we conducted a comprehensive literature search and identified 24 comparative observational studies 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 reporting a total of 51 522 COVID‐19 patients of whom 6544 patients had GI symptoms and 44 978 patients did not have any GI symptoms. The subsequent meta‐analysis of outcomes demonstrated that the presence of GI symptoms was associated with similar risk of mortality, ICU admission, and length of hospital stay when compared with their absence.…”