We appreciate the interest of Li et al1 in our systematic review and meta-analysis evaluating the prevalence of gastrointestinal (GI) symptoms and the association with mortality in patients with coronavirus disease 2019 (COVID-19).2 Li et al performed an updated meta-analysis with a larger sample size to explore the effect of GI symptoms on mortality associated with COVID-19. On the basis of adjusted effect estimates (controlling for potential confounders), they found no association between GI symptoms and mortality (pooled effect 0.93; 95% CI, 0.75 to 1.16; P=.535). The results remain consistent in multiple subgroup analyses. Because of the lack of risk of bias assessment of the included studies, it is hard to ascertain the quality of included evidence. Moreover, different follow-up duration of the included studies could affect mortality estimates.
The results of their pooled meta-analysis are similar to our study with some differences.2 Because of the lack of reporting of uniform data on confounders and comorbidities, our findings were based on crude estimates. Since then, additional studies have been published, with COVID-19 being a widely researched topic. We completely agree that certain risk factors, including age, sex, and comorbidities could affect the mortality in patients with COVID-19.3
Another similar meta-analysis suggested an increased risk of severe COVID-19 with GI symptoms compared with those without GI symptoms (odds ratio, 3.97; 95% CI, 1.49 to 10.62; P=.006).4 Patients with GI symptoms conceivably had delayed COVID-19 diagnosis, which may have led to severe COVID-19 and worse outcomes. A recent study found that despite the presence of severe acute respiratory syndrome coronavirus 2 antigens in the intestinal tissue, the inflammatory response observed was mild. The authors also found a significant reduction (P<.001) in disease severity and mortality in patients presenting with any GI symptoms compared with those without GI symptoms, independent of age, sex, and comorbid conditions.5
Based on the current literature, it can be proposed that patients with COVID-19 and GI symptoms do not have an increased risk of mortality.
Footnotes
Potential Competing Interests: The authors report no competing interests.
References
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