Age-Related Changes in Clinical Presentation of Covid-19: the EPICOVID19 Web-Based Survey

Caterina Trevisan; Marianna Noale; Federica Prinelli; Stefania Maggi; Aleksandra Sojic; Mauro Di Bari; Sabrina Molinaro; Luca Bastiani; Andrea Giacomelli; Massimo Galli; Fulvio Adorni; Raffaele Antonelli Incalzi; Claudio Pedone; EPICOVID19 Working Group

doi:10.1016/j.ejim.2021.01.028

Age-Related Changes in Clinical Presentation of Covid-19: the EPICOVID19 Web-Based Survey

Eur J Intern Med. 2021 Apr:86:41-47. doi: 10.1016/j.ejim.2021.01.028. Epub 2021 Jan 29.

Affiliations

¹ National Research Council-Neuroscience Institute, Aging Branch, Via Vincenzo Maria Gallucci 16, 35128 Padova, Italy; Geriatrics Unit, Department of Medicine (DIMED), University of Padova, Via Giustiniani 2, 35128 Padova, Italy.
² National Research Council-Neuroscience Institute, Aging Branch, Via Vincenzo Maria Gallucci 16, 35128 Padova, Italy.
³ National Research Council-Institute of Biomedical Technologies, Epidemiology Unit, Via Fratelli Cervi 93, 20090 Segrate, Italy. Electronic address: federica.prinelli@itb.cnr.it.
⁴ National Research Council-Institute of Biomedical Technologies, Epidemiology Unit, Via Fratelli Cervi 93, 20090 Segrate, Italy.
⁵ Geriatric Intensive Care Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Viale Peraccini 18, 50139 Florence, Italy.
⁶ National Research Council-Institute of Clinical Physiology, Epidemiology and Health Research Laboratory, Via G. Moruzzi 1, 56124 Pisa, Italy.
⁷ Infectious Diseases Unit, Department of Biomedical and Clinical Sciences L. Sacco, Università di Milano, ASST Fatebenefratelli Sacco, 20157 Milan, Italy.
⁸ Geriatrics Unit, Department of Medicine, Biomedical Campus of Rome, via Alvaro del Portillo, 21, 00128 Rome, Italy.

Abstract

Background: The influence of aging and multimorbidity on Covid-19 clinical presentation is still unclear.

Objectives: We investigated whether the association between symptoms (or cluster of symptoms) and positive SARS-CoV-2 nasopharyngeal swab (NPS) was different according to patients' age and presence of multimorbidity.

Methods: The study included 6680 participants in the EPICOVID19 web-based survey, who reported information about symptoms from February to June 2020 and who underwent at least one NPS. Symptom clusters were identified through hierarchical cluster analysis. The associations between symptoms (and clusters of symptoms) and positive NPS were investigated through multivariable binary logistic regression in the sample stratified by age (<65 vs ≥65 years) and number of chronic diseases (0 vs 1 vs ≥2).

Results: The direct association between taste/smell disorders and positive NPS was weaker in older and multimorbid patients than in their younger and healthier counterparts. Having reported no symptoms reduced the chance of positive NPS by 86% in younger (95%CI: 0.11-0.18), and by 46% in older participants (95%CI: 0.37-0.79). Of the four symptom clusters identified (asymptomatic, generic, flu-like, and combined generic and flu-like symptoms), those associated with a higher probability of SARS-CoV-2 infection were the flu-like for older people, and the combined generic and flu-like for the younger ones.

Conclusions: Older age and pre-existing chronic diseases may influence the clinical presentation of Covid-19. Symptoms at disease onset tend to aggregate differently by age. New diagnostic algorithms considering age and chronic conditions may ease Covid-19 diagnosis and optimize health resources allocation.

Trial registration: NCT04471701 (ClinicalTrials.gov).

Keywords: 95% confidence intervals - CIs; Aged; COVID-19; Differential Diagnosis; European Union General Data Protection Regulation - EU GDPR; Multimorbidity Abbreviations SARS-CoV-2 nasopharyngeal swab - NPS; Odds ratios – OR; Symptom Cluster.

MeSH terms

Aged
Aged, 80 and over
COVID-19 Testing
COVID-19*
Humans
Internet
SARS-CoV-2
Surveys and Questionnaires

Associated data

ClinicalTrials.gov/NCT04471701