Characteristics and outcomes of COVID-19 patients admitted to hospital with and without respiratory symptoms.
Citarella BW., Kartsonaki C., Ibáñez-Prada ED., Gonçalves BP., Baruch J., Escher M., Pritchard MG., Wei J., Philippy F., Dagens A., Hall M., Lee J., Kutsogiannis DJ., Wils E-J., Fernandes MA., Tirupakuzhi Vijayaraghavan BK., Panda PK., Martin-Loeches I., Ohshimo S., Fatoni AZ., Horby P., Dunning J., Rello J., Merson L., Rojek A., Vaillant M., Olliaro P., Reyes LF., ISARIC Clinical Characterisation Group None.
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.