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. 2023 Apr;14(2):333-343.
doi: 10.1007/s41999-022-00736-z. Epub 2023 Feb 7.

Atypical presentation of COVID-19 in older patients is associated with frailty but not with adverse outcomes

Joy E van Son  1 , Elisabeth C P Kahn  2 , Jessica M van der Bol  3 , Dennis G Barten  4 , Laura C Blomaard  5 , Carmen van Dam  6 , Jacobien Ellerbroek  7 , Steffy W M Jansen  8 , Anita Lekx  4 , Carolien M J van der Linden  8 , Roy Looman  6 , Huub A A M Maas  9 , Francesco U S Mattace-Raso  10 , Simon P Mooijaart  5 , Barbara C van Munster  11 , Annefleur Peters  4 , Harmke A Polinder-Bos  10 , Rosalinde A L Smits  5 , Petra E Spies  2 , Anna Wassenburg  12 , Nora Wassenburg  12 , Hanna C Willems  13 , Henrike J Schouten  2 , Sarah H M Robben  9
Affiliations

Atypical presentation of COVID-19 in older patients is associated with frailty but not with adverse outcomes

Joy E van Son et al. Eur Geriatr Med. 2023 Apr.

Abstract

Purpose: Older patients with COVID-19 can present with atypical complaints, such as falls or delirium. In other diseases, such an atypical presentation is associated with worse clinical outcomes. However, it is not known whether this extends to COVID-19. We aimed to study the association between atypical presentation of COVID-19, frailty and adverse outcomes, as well as the incidence of atypical presentation.

Methods: We conducted a retrospective observational multi-center cohort study in eight hospitals in the Netherlands. We included patients aged ≥ 70 years hospitalized with COVID-19 between February 2020 until May 2020. Atypical presentation of COVID-19 was defined as presentation without fever, cough and/or dyspnea. We collected data concerning symptoms on admission, demographics and frailty parameters [e.g., Charlson Comorbidity Index (CCI) and Clinical Frailty Scale (CFS)]. Outcome data included Intensive Care Unit (ICU) admission, discharge destination and 30-day mortality.

Results: We included 780 patients, 9.5% (n = 74) of those patients had an atypical presentation. Patients with an atypical presentation were older (80 years, IQR 76-86 years; versus 79 years, IQR 74-84, p = 0.044) and were more often classified as severely frail (CFS 6-9) compared to patients with a typical presentation (47.6% vs 28.7%, p = 0.004). Overall, there was no significant difference in 30-day mortality between the two groups in univariate analysis (32.4% vs 41.5%; p = 0.173) or in multivariate analysis [OR 0.59 (95% CI 0.34-1.0); p = 0.058].

Conclusions: In this study, patients with an atypical presentation of COVID-19 were more frail compared to patients with a typical presentation. Contrary to our expectations, an atypical presentation was not associated with worse outcomes.

Keywords: Atypical presentation; COVID-19; Frailty; Older adults; SARS-CoV-2.

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Conflict of interest statement

The authors have no relevant financial or non-financial interests to disclose.

Figures

Fig. 1
Fig. 1
Clinical Frailty Scale category stratified per presentation type. Distribution of Clinical Frailty Scale (CFS) category (fit, pre-frail and frail) per presentation type. The distribution of the CFS is presented as a histogram of the percentages of patients within a given category of the CFS. Patients with an atypical presentation were less often classified as fit and more often classified as frail (p = 0.004, Chi-squared test)
See this image and copyright information in PMC

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