Title: Gastrointestinal symptoms are associated with a lower risk of hospitalization and
mortality and Outcomes in COVID-19
Version: 0 Date: 06 Dec 2021
Reviewer's report:
This is a good study to assess the outcomes of GI / GI+RS  on hospitalization and mortality.
However, I have some comments :
1.  ABSTRACT :
- The background states: "aimed to find the association between Gastrointestinal (GI) AND
RESPIRATORY symptoms with mortality and hospitalization". The conclusion mentions
only GI outcomes. The conclusion does not completely address the aims mentioned in the
background.
2. INTRODUCTION:
-The introduction summarizes the rationale of the study.
-"Although gastrointestinal symptoms are usually associated with a poor prognosis in Covid-19
patients, they have associated with adverse outcomes in very severe patients": This statement
is not clear. Kindly clarify.
-Paragraph 2: " hepatobiliary trace" - please change to hepatobiliary tree.
-Please change COVID-19 in a uniform pattern throughout the manuscript.
3. METHODS:
-The age group taken into consideration is >=30. Any reason why 30 is taken as cut-off for the
study?
-Definitions are not clear (line 2) :  "Gastrointestinal symptoms were defined as any Stomach
ache, nausea, vomit, diarrhea, anorexia, and fever, muscular pain, loss of consciousned,
convulsion, headache, dizziness, parcy of the limb, organ lesion "
- "Parcy of limb" - did you mean palsy? I may be wrong but please verify
- How do you define organ damage?
-Please correct "consciousned" - line 4
-2nd paragraph in definitions: I understood that mortality in this study is applied for in-hospital
mortality. ("Finally, it was impossible to follow up on discharged patients, so determining
the mortality of patients with Quid only included patients who died in the hospital."- from
discussion) If yes, kindly detail it in the methods section
4. RESULTS:
-Line 3  " rate was 52.58%". In the table, the hospitalization rate is 52.88%. Please change the
percentage in line 3 as the table shows the accurate calculation
- Paragraph 5, line 4: Change "goup" to group
- paragraph 7 line 1: "prolong hospitalization (more than 6 days)" but according to the table, it
is "(#median 6 days)" which means the text should be more than 5 days.
- In the same paragraph: "3794(8.83%) were outpatient, " - In the table, 3794 are deaths. Please
change the statement accordingly
- Paragraph 8 line 6: "Gestational symptoms only significantly decreased the odds of mortality
"-  Change gestational to GI
5. DISCUSSION:
- "In a systematic review study, the prevalence of symptoms as fever, cough, sore throat,
diarrhea, nausea, vomiting, and shortness of breath, respectively (23). " Did you mean the
sequence of symptoms from most common to least common? If yes, please make it clear in the
sentence
- "The logistic regression analysis results showed that pregnancy symptoms reduce the
probability of mortality (as a preventive factor),". Did you mean GI symptoms? Please change
accordingly
- "The average number of hospitalization days was 4.18 ± 7.41 days,":  Please verify
- In the last 3 paragraphs, "patients with Quid " was mentioned twice- Did you mean patients
with COVID-19?
- "Also, Pert and Missing data in this study are very low."- What is pert? can you clarify?
-"In our study, GI symptoms decrease the risk of Covid-19 related mortality (but not
hospitalization) in the total population. This protective effect is highly significant among non-
hospitalized patients while not among hospitalized cases. " - How was mortality compared when
deaths after discharge of inpatients were not taken into account? Were the outpatients followed
up? If yes, can you mention the duration of the mortality study period?
-"Respiratory symptoms were higher among patients who had gastrointestinal and respiratory
symptoms simultaneously than patients who had only respiratory symptoms." - Kindly clarify
this statement. Did you mean the patients with GI/RS group had more/multiple respiratory
symptoms or severe respiratory symptoms than the RS group alone?
Title: Gastrointestinal symptoms are associated with a lower risk of hospitalization and
mortality and Outcomes in COVID-19
Version: 0 Date: 06 Dec 2021
Reviewer's report:
This is a good study to assess the outcomes of GI / GI+RS  on hospitalization and mortality.
However, I have some comments :
1.  ABSTRACT :
- The background states: "aimed to find the association between Gastrointestinal (GI) AND
RESPIRATORY symptoms with mortality and hospitalization". The conclusion mentions
only GI outcomes. The conclusion does not completely address the aims mentioned in the
background.
2. INTRODUCTION:
-The introduction summarizes the rationale of the study.
-"Although gastrointestinal symptoms are usually associated with a poor prognosis in Covid-19
patients, they have associated with adverse outcomes in very severe patients": This statement
is not clear. Kindly clarify.
-Paragraph 2: " hepatobiliary trace" - please change to hepatobiliary tree.
-Please change COVID-19 in a uniform pattern throughout the manuscript.
3. METHODS:
-The age group taken into consideration is >=30. Any reason why 30 is taken as cut-off for the
study?
-Definitions are not clear (line 2) :  "Gastrointestinal symptoms were defined as any Stomach
ache, nausea, vomit, diarrhea, anorexia, and fever, muscular pain, loss of consciousned,
convulsion, headache, dizziness, parcy of the limb, organ lesion "
- "Parcy of limb" - did you mean palsy? I may be wrong but please verify
- How do you define organ damage?
-Please correct "consciousned" - line 4
-2nd paragraph in definitions: I understood that mortality in this study is applied for in-hospital
mortality. ("Finally, it was impossible to follow up on discharged patients, so determining
the mortality of patients with Quid only included patients who died in the hospital."- from
discussion) If yes, kindly detail it in the methods section
4. RESULTS:
-Line 3  " rate was 52.58%". In the table, the hospitalization rate is 52.88%. Please change the
percentage in line 3 as the table shows the accurate calculation
- Paragraph 5, line 4: Change "goup" to group
- paragraph 7 line 1: "prolong hospitalization (more than 6 days)" but according to the table, it
is "(#median 6 days)" which means the text should be more than 5 days.
- In the same paragraph: "3794(8.83%) were outpatient, " - In the table, 3794 are deaths. Please
change the statement accordingly
- Paragraph 8 line 6: "Gestational symptoms only significantly decreased the odds of mortality
"-  Change gestational to GI
5. DISCUSSION:
- "In a systematic review study, the prevalence of symptoms as fever, cough, sore throat,
diarrhea, nausea, vomiting, and shortness of breath, respectively (23). " Did you mean the
sequence of symptoms from most common to least common? If yes, please make it clear in the
sentence
- "The logistic regression analysis results showed that pregnancy symptoms reduce the
probability of mortality (as a preventive factor),". Did you mean GI symptoms? Please change
accordingly
- "The average number of hospitalization days was 4.18 ± 7.41 days,":  Please verify
- In the last 3 paragraphs, "patients with Quid " was mentioned twice- Did you mean patients
with COVID-19?
- "Also, Pert and Missing data in this study are very low."- What is pert? can you clarify?
-"In our study, GI symptoms decrease the risk of Covid-19 related mortality (but not
hospitalization) in the total population. This protective effect is highly significant among non-
hospitalized patients while not among hospitalized cases. " - How was mortality compared when
deaths after discharge of inpatients were not taken into account? Were the outpatients followed
up? If yes, can you mention the duration of the mortality study period?
-"Respiratory symptoms were higher among patients who had gastrointestinal and respiratory
symptoms simultaneously than patients who had only respiratory symptoms." - Kindly clarify
this statement. Did you mean the patients with GI/RS group had more/multiple respiratory
symptoms or severe respiratory symptoms than the RS group alone?
Please review this paper.
user
Title: Gastrointestinal symptoms are associated with a lower risk of hospitalization and
mortality and Outcomes in COVID-19
Version: 0 Date: 06 Dec 2021
Reviewer's report:
This is a good study to assess the outcomes of GI / GI+RS  on hospitalization and mortality.
However, I have some comments :
1.  ABSTRACT :
- The background states: "aimed to find the association between Gastrointestinal (GI) AND
RESPIRATORY symptoms with mortality and hospitalization". The conclusion mentions
only GI outcomes. The conclusion does not completely address the aims mentioned in the
background.
2. INTRODUCTION:
-The introduction summarizes the rationale of the study.
-"Although gastrointestinal symptoms are usually associated with a poor prognosis in Covid-19
patients, they have associated with adverse outcomes in very severe patients": This statement
is not clear. Kindly clarify.
-Paragraph 2: " hepatobiliary trace" - please change to hepatobiliary tree.
-Please change COVID-19 in a uniform pattern throughout the manuscript.
3. METHODS:
-The age group taken into consideration is >=30. Any reason why 30 is taken as cut-off for the
study?
-Definitions are not clear (line 2) :  "Gastrointestinal symptoms were defined as any Stomach
ache, nausea, vomit, diarrhea, anorexia, and fever, muscular pain, loss of consciousned,
convulsion, headache, dizziness, parcy of the limb, organ lesion "
- "Parcy of limb" - did you mean palsy? I may be wrong but please verify
- How do you define organ damage?
-Please correct "consciousned" - line 4
-2nd paragraph in definitions: I understood that mortality in this study is applied for in-hospital
mortality. ("Finally, it was impossible to follow up on discharged patients, so determining
the mortality of patients with Quid only included patients who died in the hospital."- from
discussion) If yes, kindly detail it in the methods section
4. RESULTS:
-Line 3  " rate was 52.58%". In the table, the hospitalization rate is 52.88%. Please change the
percentage in line 3 as the table shows the accurate calculation
- Paragraph 5, line 4: Change "goup" to group
- paragraph 7 line 1: "prolong hospitalization (more than 6 days)" but according to the table, it
is "(#median 6 days)" which means the text should be more than 5 days.
- In the same paragraph: "3794(8.83%) were outpatient, " - In the table, 3794 are deaths. Please
change the statement accordingly
- Paragraph 8 line 6: "Gestational symptoms only significantly decreased the odds of mortality
"-  Change gestational to GI
5. DISCUSSION:
- "In a systematic review study, the prevalence of symptoms as fever, cough, sore throat,
diarrhea, nausea, vomiting, and shortness of breath, respectively (23). " Did you mean the
sequence of symptoms from most common to least common? If yes, please make it clear in the
sentence
- "The logistic regression analysis results showed that pregnancy symptoms reduce the
probability of mortality (as a preventive factor),". Did you mean GI symptoms? Please change
accordingly
- "The average number of hospitalization days was 4.18 ± 7.41 days,":  Please verify
- In the last 3 paragraphs, "patients with Quid " was mentioned twice- Did you mean patients
with COVID-19?
- "Also, Pert and Missing data in this study are very low."- What is pert? can you clarify?
-"In our study, GI symptoms decrease the risk of Covid-19 related mortality (but not
hospitalization) in the total population. This protective effect is highly significant among non-
hospitalized patients while not among hospitalized cases. " - How was mortality compared when
deaths after discharge of inpatients were not taken into account? Were the outpatients followed
up? If yes, can you mention the duration of the mortality study period?
-"Respiratory symptoms were higher among patients who had gastrointestinal and respiratory
symptoms simultaneously than patients who had only respiratory symptoms." - Kindly clarify
this statement. Did you mean the patients with GI/RS group had more/multiple respiratory
symptoms or severe respiratory symptoms than the RS group alone?
assistant