COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study
Tóm tắt
The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men.
Tài liệu tham khảo
Struyf T, Deeks JJ, Dinnes J, Takwoingi Y, Davenport C, Leeflang MM, et al. Signs and symptoms to determine if a patient presenting in primary care or hospital outpatient settings has COVID-19 disease. Cochrane Database Syst Rev. 2020;7(7):Cd013665. https://doi.org/10.1002/14651858.Cd013665.
Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382(18):1708–20. https://doi.org/10.1056/NEJMoa2002032.
Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan. China Lancet. 2020;395(10223):497–506. https://doi.org/10.1016/s0140-6736(20)30183-5.
Liang WH, Guan WJ, Li CC, Li YM, Liang HR, Zhao Y, et al. Clinical characteristics and outcomes of hospitalised patients with COVID-19 treated in Hubei (epicentre) and outside Hubei (non-epicentre): a nationwide analysis of China. Eur Respir J. 2020;55(6):2000562. https://doi.org/10.1183/13993003.00562-2020.
Wang G, Chen W, Jin X, Chen YP. Description of COVID-19 cases along with the measures taken on prevention and control in Zhejiang. China J Med Virol. 2020. https://doi.org/10.1002/jmv.25906.
Giacomelli A, Pezzati L, Conti F, Bernacchia D, Siano M, Oreni L, et al. Self-reported olfactory and taste disorders in patients with severe acute respiratory coronavirus 2 infection: a cross-sectional study. Clin Infect Dis. 2020;71(15):889–90. https://doi.org/10.1093/cid/ciaa330.
Yan CH, Faraji F, Prajapati DP, Boone CE, DeConde AS. Association of chemosensory dysfunction and COVID-19 in patients presenting with influenza-like symptoms. Int Forum Allergy Rhinol. 2020;10(7):806–13. https://doi.org/10.1002/alr.22579.
Manoharan L, Cattrall JWS, Harris C, Newell K, Thomson B, Pritchard MG, et al. Early clinical characteristics of Covid-19: scoping review. MedRxiv. 2020. https://doi.org/10.1101/2020.07.31.20165738.
World Health Organization. WHO COVID-19: Case definitions [WHO/2019-nCoV/Surveillance_Case_Definition/2020.1]. Geneva, Switzerland: World Health Organization, 2020
Centers for Disease Control and Prevention. Coronavirus Disease 2019 (COVID-19) 2020 interim case definition Atlanta, GA: Centers for Disease Control and Prevention; 2020 [cited 2020 9 November]. https://wwwn.cdc.gov/nndss/conditions/coronavirus-disease-2019-covid-19/case-definition/2020/.
Public Health England. COVID19: investigation and initial clinical management of possible cases: Public Health England; 2020 [cited 2020 9 November]. https://www.gov.uk/government/publications/wuhan-novel-coronavirus-initial-investigation-of-possible-cases/investigation-and-initial-clinical-management-of-possible-cases-of-wuhan-novel-coronavirus-wn-cov-infection.
European Centre for Disease Prevention and Control. Case definition for coronavirus disease 2019 (COVID-19), as of 29 May 2020: European Centre for Disease Prevention and Control; 2020 [cited 2020 9 November]. https://www.ecdc.europa.eu/en/covid-19/surveillance/case-definition.
ISARIC clinical characterisation group. Global outbreak research: harmony not hegemony. Lancet Infect Dis. 2020;20(7):770–2.. doi: https://doi.org/10.1016/s1473-3099(20)30440-0.
World Health Organization (2020) International Severe Acute Respiratory and Emerging Infection Consortium. ISARIC/WHO Clinical Characterisation Protocol for Severe Emerging Infections, version 3.2. ISARIC, 2020
COVID-19 CRF (2020) International severe acute respiratory and emerging infection consortium [21 August 2020]. https://isaric.org/research/covid-19-clinical-research-resources/covid-19-crf/
Dunning JW, Merson L, Rohde GGU, Gao Z, Semple MG, Tran D, et al. Open source clinical science for emerging infections. Lancet Infect Dis. 2014;14(1):8–9. https://doi.org/10.1016/s1473-3099(13)70327-x.
Pritchard M, Dankwa EA, Hall M, Baillie JK, Carson G, Docherty A, et al. ISARIC COVID-19 clinical data report. MedRxiv. 2020. https://doi.org/10.1101/2020.07.17.20155218.
Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020;8(5):475–81. https://doi.org/10.1016/s2213-2600(20)30079-5.
Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054–62. https://doi.org/10.1016/s0140-6736(20)30566-3.
Docherty AB, Harrison EM, Green CA, Hardwick HE, Pius R, Norman L, et al. Features of 20 133 UK patients in hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol: prospective observational cohort study. BMJ. 2020;369:m1985. https://doi.org/10.1136/bmj.m1985.
ISARIC 4C (2020) ISARIC 4C protocols 2020 [26 August 2020]. https://isaric4c.net/protocols/.
COVID-19 Critical Care Consortium (2020) COVID-19 Critical Care Consortium Trial Documents 2020 [26 August 2020]. https://www.elso.org/COVID19/ECMOCARD.aspx.
Munblit D, Nekliudov NA, Bugaeva P, Blyuss O, Kislova M, Listovskaya E, et al. StopCOVID cohort: an observational study of 3,480 patients admitted to the Sechenov University hospital network in Moscow city for suspected COVID-19 infection. Clin Infect Dis. 2020. https://doi.org/10.1093/cid/ciaa1535.
Larsen K, Merlo J. Appropriate assessment of neighborhood effects on individual health: integrating random and fixed effects in multilevel logistic regression. Am J Epidemiol. 2005;161(1):81–8. https://doi.org/10.1093/aje/kwi017.
World Bank (2020) World Bank country and lending groups 2020. https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country-and-lending-groups.
Lauretani F, Ravazzoni G, Roberti MF, Longobucco Y, Adorni E, Grossi M, et al. Assessment and treatment of older individuals with COVID 19 multi-system disease: clinical and ethical implications. Acta Biomed. 2020;91(2):150–68. https://doi.org/10.23750/abm.v91i2.9629.
Jung YJ, Yoon JL, Kim HS, Lee AY, Kim MY, Cho JJ. Atypical clinical presentation of geriatric syndrome in elderly patients with pneumonia or coronary artery disease. Ann Geriatr Med Res. 2018;21(4):158–63.
Wester AL, Dunlop O, Melby KK, Dahle UR, Wyller TB. Age-related differences in symptoms, diagnosis and prognosis of bacteremia. BMC Infect Dis. 2013. https://doi.org/10.1186/1471-2334-13-346.
Lu X, Zhang L, Du H, Zhang J, Li YY, Qu J, et al. SARS-CoV-2 infection in children. N Engl J Med. 2020;382(17):1663–5. https://doi.org/10.1056/NEJMc2005073.
Ludvigsson JF. Systematic review of COVID-19 in children shows milder cases and a better prognosis than adults. Acta Paediatr. 2020;109:1088–95. https://doi.org/10.1111/apa.15270.
Swann OV, Holden KA, Turtle L, Pollock L, Fairfield CJ, Drake TM, et al. Clinical characteristics of children and young people admitted to hospital with covid-19 in United Kingdom: prospective multicentre observational cohort study. BMJ. 2020;370:m3249. https://doi.org/10.1136/bmj.m3249%JBMJ.
Millar JE, Neyton L, Seth S, Dunning J, Merson L, Murthy S, et al. Robust, reproducible clinical patterns in hospitalised patients with COVID-19. MedRxiv. 2020. https://doi.org/10.1101/2020.08.14.20168088.
Sierpiński R, Pinkas J, Jankowski M, Zgliczyński WS, Wierzba W, Gujski M, et al. Sex differences in the frequency of gastrointestinal symptoms and olfactory or taste disorders in 1942 nonhospitalized patients with coronavirus disease 2019 (COVID-19). Pol Arch Intern Med. 2020;130(6):501–5. https://doi.org/10.20452/pamw.15414.