COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Abstract

Background 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. Methods 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. Results ‘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. Interpretation 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.

Characteristics and outcomes of an international cohort of 400,000 hospitalised patients with Covid-19

“…Loss or altered smell or taste were not commonly reported, with a high proportion of missing values for these two symptoms (39.1% for loss of smell and 40.5% for taste). We have previously described the associations of age and gender with presenting symptoms (16). Prevalence of symptoms by age was similar when we restricted our analysis to patients with laboratory-confirmed SARS-CoV-2 (Supplementary figure 3), but there were more missing values (Supplementary figure 4).…”

Clinical characteristics, systemic complications, and in-hospital outcomes for patients with COVID-19 in Latin America. LIVEN-Covid-19 study: A prospective, multicenter, multinational, cohort study

“…Lower respiratory tract infections range from mild to severe, with varying degrees of systemic complications and COVID-19 is not the exception [ 8 , 24 , 25 ]. There are robust data linking older age, male sex, and obesity with a greater risk of developing severe COVID-19 [ 13 , 26 – 28 ].…”

“…The mortality rate of patients infected with SARS-CoV-2 that require hospital admission ranges between 3% and 88%, being higher in those admitted to the ICU [ 6 , 7 ]. The main characteristics of patients who develop severe COVID-19 are older age, male, obesity, and several comorbid conditions [ 8 – 10 ]. Strikingly, these clinical characteristics and outcomes have been described in high-income countries [ 6 , 11 – 14 ].…”

Clinical and Epidemiological Characteristics of 1283 Pediatric Patients with Coronavirus Disease 2019 during the First and Second Waves of the Pandemic—Results of the Pediatric Part of a Multicenter Polish Register SARSTer

“…When comparing the prevalence of these symptoms in different age groups, we found that fever and rhinitis were significantly more common in children aged 0–5 years and weakness in those aged > 10–18 years. The relationship between age and the prevalence of symptoms was demonstrated in a UK pediatric study [ 17 ] and a multinational study with both pediatric and adult populations [ 20 ]. In contrast to others, Badal et al reported headache as the most common symptom, which was present in 60–74% of pediatric patients [ 16 ].…”