Prospective Study in 355 Patients With Suspected COVID-19 Infection: Value of Cough, Subjective Hyposmia, and Hypogeusia

Abstract

Objective: To evaluate the incidence of certain symptoms in a population of health workers exposed to coronavirus disease 2019 patients.

Study design: Case-control study.

Methods: The study was conducted at a tertiary care hospital from March 1 to April 7, 2020. Health workers with suspected coronavirus disease 2019 (COVID-19) infection were included. The presence of COVID-19 was detected by using real-time polymerase chain reaction (RT-PCR) methods. Positive and negative RT-PCR patients were used as case and control groups, respectively. This study analyzed the incidence of COVID-19 symptoms in both patient groups. Visual analog scales were used for self-assessment of smell and taste disorders, ranging from 0 (no perception) to 10 (excellent perception).

Results: There were 215 (60.6%) patients with positive RT-PCR and 140 (39.4%) patients with negative RT-PCR. The presence of symptoms such as hyposmia hypogeusia, dysthermia, and cough were strongly associated with a positive RT-PCR. The association of cough and subjective hyposmia had 5.46 times higher odds of having a positive test. The receiver operating characteristic (ROC) analysis showed that a fever higher than 37.45°C resulted in sensitivity and specificity of 0.65 and 0.61, respectively. A total of 138 cases (64.1%) and 114 cases (53%) had subjective hyposmia and hypogeusia, respectively. The 85.4% of these patients recovered olfactory function within the first 14 days of the onset of the symptoms.

Conclusion: There is a significant association between positive RT-PCR and subjective hyposmia. The association of subjective hyposmia and cough increase significantly the odds of having a positive RT-PCR. The measurement of fever as the only method for screening of COVID-19 infection resulted in a poor association.

Level of evidence: 3 Laryngoscope, 130:2674-2679, 2020.

Keywords: Hyposmia, hypogeusia, COVID-19, odds ratio, incidence, ROC.

Fig. 1

Symptoms associated with COVID‐19 infection. The ordinate axis consists of percentages of patients. COVID‐19 = coronavirus disease 2019. [Color figure can be viewed in the online issue, which is available at www.laryngoscope.com.]

Fig. 2

ROC curve showing the capacity of degrees centigrade increase in predicting a positive PCR for COVID‐19. The area under the curve was 0.671. The analysis showed that a fever higher than 37.45°C results in sensitivity and specificity of 0.65 and 0.61, respectively. COVID‐19 = coronavirus disease 2019; PCR = polymerase chain reaction; ROC = receiver operating characteristic. [Color figure can be viewed in the online issue, which is available at www.laryngoscope.com.]