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Background: Identification of risk factors for poor prognosis of patients with coronavirus disease 2019 (COVID-19) is necessary to enable the risk stratification and modify the patient's management. Thus, we performed a systematic review and meta-analysis to evaluate the in-hospital mortality and risk factors of death in COVID-19 patients.Methods: All studies were searched via the PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), VIP, and Wanfang databases. The in-hospital mortality of COVID-19 patients was pooled. Odds ratios (ORs) or mean difference (MD) with 95% confidence intervals (CIs) were calculated for evaluation of risk factors.

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Background and Aim. Xuebijing injection is a traditional Chinese medicine compound for the improvement of systemic inflammation response. This meta-analysis of randomized controlled trials (RCTs) aimed to explore the clinical efficacy and safety of Xuebijing injection for the treatment of acute pancreatitis (AP). Methods. PubMed Medline, Embase, Cochrane Library, China National Knowledge Infrastructure, China Biology Medicine disc, VIP, and Wanfang databases were searched. The primary outcome was treatment response. The secondary outcomes included changes in clinical and laboratory indicators and incidence of AP-related complications. Meta-analyses were performed by using a random-effect model. Risk ratios (RRs) with 95% confidence intervals (CIs) or weighted mean differences (WMDs) with 95% CIs were calculated. Results. Overall, 23 RCTs were included. The rates of overall (RR = 1.16; 95% CI = 1.12 to 1.20; P < 0.00001 ) and complete (RR = 1.40; 95% CI = 1.30 to 1.50; P < 0.00001 ) responses were significantly higher in the Xuebijing injection group. After treatment, the levels of interleukin-6 (WMD = −18.22; 95% CI = −23.36 to −13.08; P < 0.00001 ), tumor necrosis factor-α (WMD = −16.44; 95% CI = −20.49 to −12.40; P < 0.00001 ), serum amylase (WMD = −105.61; 95% CI = −173.77 to −37.46; P = 0.002 ), white blood cell (WMD = −1.51; 95% CI = −1.66 to −1.36; P < 0.00001 ), and C-reactive protein (WMD = −11.05; 95% CI = −14.32 to −7.78; P < 0.00001 ) were significantly lower in the Xuebijing injection group. Abdominal pain (WMD = −1.74; 95% CI = −1.96 to −1.52; P < 0.00001 ), abdominal distension (WMD = −1.56; 95% CI = −2.07 to −1.04; P < 0.00001 ), gastrointestinal function (WMD = −2.60; 95% CI = −3.07 to −2.13; P < 0.00001 ), body temperature (WMD = −2.16; 95% CI = −2.83 to −1.49; P < 0.00001 ), serum amylase level (WMD = −1.81; 95% CI = −2.66 to −0.96; P < 0.0001 ), and white blood cell (WMD = −2.16; 95% CI = −2.99 to −1.32; P < 0.00001 ) recovered more rapidly in the Xuebijing injection group. The incidence of multiple organ dysfunction syndrome (RR = 0.18; 95% CI = 0.05 to 0.62; P = 0.006 ), pancreatic pseudocyst (RR = 0.17; 95% CI = 0.04 to 0.77; P = 0.02 ), and renal failure (RR = 0.16; 95% CI = 0.05 to 0.60; P = 0.006 ) was significantly lower in the Xuebijing injection group. Conclusions. Xuebijing injection added on the basis of conventional treatment has a potential benefit for improving the outcomes of AP.

Background: Patients with coronavirus disease 2019 (COVID-19) can present with gastrointestinal (GI) symptoms. However, the prevalence of GI symptoms and their association with outcomes remain controversial in COVID-19 patients.Methods: All COVID-19 patients consecutively admitted to the Wuhan Huoshenshan hospital from February 2020 to April 2020 were collected. Disease severity and outcomes were compared between COVID-19 patients with and without GI symptoms. Logistic regression analyses were performed to evaluate the association of GI symptoms with the composite endpoint and death in COVID-19 patients. A composite endpoint was defined as transfer to intensive care unit, requirement of mechanical ventilation, and death. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated.Results: Overall, 2,552 COVID-19 patients were included. The prevalence of GI symptoms was 21.0% (537/2,552). Diarrhea (8.9%, 226/2,552) was the most common GI symptom. Patients with GI symptoms had significantly higher proportions of severe COVID-19 and worse outcomes than those without. Univariate logistic regression analyses demonstrated that GI symptoms were significantly associated with the composite endpoint (OR = 2.426, 95% CI = 1.608–3.661; P &lt; 0.001) and death (OR = 2.137, 95% CI = 1.209–3.778; P = 0.009). After adjusting for age, sex, and severe/critical COVID-19, GI symptoms were still independently associated with the composite endpoint (OR = 2.029, 95% CI = 1.294–3.182; P = 0.002), but not death (OR = 1.726, 95% CI = 0.946–3.150; P = 0.075). According to the type of GI symptoms, GI bleeding was an independent predictor of the composite endpoint (OR = 8.416, 95% CI = 3.465–20.438, P &lt; 0.001) and death (OR = 6.640, 95% CI = 2.567–17.179, P &lt; 0.001), but not other GI symptoms (i.e., diarrhea, abdominal discomfort, nausea and/or vomiting, constipation, acid reflux and/or heartburn, or abdominal pain).Conclusion: GI symptoms are common in COVID-19 patients and may be associated with their worse outcomes. Notably, such a negative impact of GI symptoms on the outcomes should be attributed to GI bleeding.

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Hypoalbuminemia usually predicts higher mortality, longer hospital stay, and more frequent readmission. 1 About 40%-60% of coronavirus disease (COVID-19) patients develop hypoalbuminemia at admission. 2,3 This may be due to an increase of capillary permeability caused by a systemic inflammatory response, 4 which leads to the leakage of serum albumin (ALB) into interstitial space, 5 poor nutritional status, and impaired liver function. 1 COVID-19 patients with hypoalbuminemia are more severe and/or critical, 2 and have a higher probability of intensive care unit admission and higher risk of death. 6,7 However, few studies have evaluated the dynamic change of serum ALB level in COVID-19 patients with hypoalbuminemia on the patients' death.We retrospectively analyzed the electronic medical records of 3041 patients who were diagnosed with COVID-19 at the Huoshenshan Hospital in Wuhan from February 2020 to April 2020. The inclusion criteria were as follows: (1) COVID-19 patients had a serum ALB level of <35 g/L at admission and/or during hospitalization; and(2) serum ALB level was retested. The exclusion criteria were as follows: (1) COVID-19 patients had pre-existing hepatobiliary diseases, such as chronic liver disease, liver cirrhosis, liver cancer, and bile duct obstruction; and (2) COVID-19 patients did not measure serum ALB level at admission and during hospitalization. This study

Coronavirus disease (COVID-19) patients frequently develop liver biochemical abnormality. However, liver biochemical abnormality in COVID-19 patients with liver cirrhosis is under-recognized. Patients hospitalized during COVID-19 pandemic in China (ie, from February to April 2020) were screened. All of 17 COVID-19 patients with liver cirrhosis consecutively admitted to the Wuhan Huoshenshan Hospital were identified. Meanwhile, 17 age-, sex-, and severity-matched COVID-19 patients without liver cirrhosis admitted to this hospital were selected as a control group; all of 14 cirrhotic patients without COVID-19 consecutively admitted to the Department of Gastroenterology of the General Hospital of Northern Theater Command were selected as another control group. Incidence of liver biochemical abnormality and decompensated events were primarily compared. Among the COVID-19 patients with liver cirrhosis, the incidence of liver biochemical abnormality at admission and during hospitalization were 76.50% and 84.60%, respectively; 7 (41.20%) had decompensated events at admission; 1 was transferred to intensive care unit due to gastrointestinal bleeding. Among the COVID-19 patients without liver cirrhosis, the incidence of liver biochemical abnormality at admission and during hospitalization were 58.80% ( P = .271) and 60.00% ( P = .150), respectively. Among the cirrhotic patients without COVID-19, the incidence of liver biochemical abnormality at admission and during hospitalization were 69.20% ( P = .657) and 81.80% ( P = .855), respectively; 11 (78.60%) had decompensated events at admission ( P = .036). None died during hospitalization among the three groups. Liver biochemical abnormality is common in COVID-19 patients with liver cirrhosis. Management of decompensated events in cirrhotic patients without COVID-19 should not be neglected during COVID-19 pandemic.