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Characteristics and outcomes of COVID-19 patients admitted to hospital with and without respiratory symptoms

Barbara Wanjiru Citarella et al. Heliyon. .

Abstract

Background: COVID-19 is primarily known as a respiratory illness; however, many patients present to hospital without respiratory symptoms. The association between non-respiratory presentations of COVID-19 and outcomes remains unclear. We investigated risk factors and clinical outcomes in patients with no respiratory symptoms (NRS) and respiratory symptoms (RS) at hospital admission.

Methods: This study describes clinical features, physiological parameters, and outcomes of hospitalised COVID-19 patients, stratified by the presence or absence of respiratory symptoms at hospital admission. RS patients had one or more of: cough, shortness of breath, sore throat, runny nose or wheezing; while NRS patients did not.

Results: Of 178,640 patients in the study, 86.4 % presented with RS, while 13.6 % had NRS. NRS patients were older (median age: NRS: 74 vs RS: 65) and less likely to be admitted to the ICU (NRS: 36.7 % vs RS: 37.5 %). NRS patients had a higher crude in-hospital case-fatality ratio (NRS 41.1 % vs. RS 32.0 %), but a lower risk of death after adjusting for confounders (HR 0.88 [0.83-0.93]).

Conclusion: Approximately one in seven COVID-19 patients presented at hospital admission without respiratory symptoms. These patients were older, had lower ICU admission rates, and had a lower risk of in-hospital mortality after adjusting for confounders.

Keywords: COVID-19; Mortality; Non-respiratory symptoms; Respiratory symptoms; Risk factors.

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Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:IML declared lectures for Gilead, Thermofisher, MSD; advisory board participation for Fresenius Kabi, Advanz Pharma, Gilead, Accelerate, Merck; and consulting fees for Gilead outside of the submitted work.

Figures

Fig. 1
Fig. 1
Flow diagram for the study showing the number of patients included in the analysis.
Fig. 2
Fig. 2
Frequency of comorbidities for all patients, stratified by respiratory symptoms.
Fig. 3
Fig. 3
Kaplan—Meier Plot of patients' outcomes stratified by respiratory symptoms.
Fig. 4
Fig. 4
Boxplots of oxygen saturation (SpO2) for all patients, stratified by respiratory symptoms.
Fig. A.1
Fig. A.1
Countries included in the analysis.
Fig. A.2
Fig. A.2
Frequency of comorbidities for different age groups, stratified by respiratory symptoms.
Fig. A.3
Fig. A.3
Boxplots of oxygen saturation (SpO2) for different age groups, stratified by respiratory symptoms.
See this image and copyright information in PMC

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