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.
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 < 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 < 0.001) and death (OR = 6.640, 95% CI = 2.567–17.179, P < 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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