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Association of digestive symptoms with severity and mortality of COVID-19: A protocol for systematic review and meta-analysis.
Zhang, Yufang MN a; Ma, Peifen MN a; Zhang, Xiu MN b; Pei, Zhuoxi MN c; Wang, Haixia MN d; Dou, Xinman MN a,*
[Article] Medicine. 99(43):e22736, October 23, 2020.

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Background: Gastrointestinal manifestations are common in patients with COVID-19, but the association between specific digestive symptoms and COVID-19 prognosis remains unclear. This study aims to assess whether digestive symptoms are associated with COVID-19 severity and mortality.

Methods: We will search PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials up to September, 2020, to identify studies that compared the prevalence of at least one specific digestive symptom between severe and non-severe COVID-19 patients or between non-survivors and survivors. Two independent reviewers will assess the risk of bias of the included cohort studies using the modified Newcastle-Ottawa Scale. Meta-analyses will be conducted to estimate the pooled prevalence of individual symptoms using the inverse variance method with the random-effects model. We will conduct subgroup analyses, sensitivity analyses, and meta-regression analyses to explore the sources of heterogeneity. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach will be used to assess the quality of the evidence.

Results: The results of this study will be published in a peer-reviewed journal.

Conclusion: Our meta-analysis will comprehensively evaluate the association between different digestive symptoms and the severity and mortality of patients infected with COVID-19. This study will provide evidence to help determine whether special protective measures and treatment options are needed for patients with digestive system comorbidities during the COVID-19 pandemic.

INPLASY registration number: INPLASY202090055.