Symptoms at disease onset predict prognosis in COVID-19 disease

Aiyuan Zhou; Qing Song; Yating Peng; Xin Liao; Peng Huang; Wenlong Liu; Zhi Xiang; Qimi Liu; Mingyan Jiang; Xudong Xiang; Dingding Deng; Ping Chen

doi:10.1080/19932820.2021.2010338

Symptoms at disease onset predict prognosis in COVID-19 disease

Libyan J Med. 2022 Dec;17(1):2010338. doi: 10.1080/19932820.2021.2010338.

Authors

Aiyuan Zhou^{1

2

3

4

5}, Qing Song⁶, Yating Peng⁶, Xin Liao⁷, Peng Huang⁸, Wenlong Liu⁹, Zhi Xiang¹⁰, Qimi Liu¹¹, Mingyan Jiang¹², Xudong Xiang¹³, Dingding Deng¹⁴, Ping Chen⁶

Affiliations

¹ Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Changsha, Hunan, China.
² Center of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China.
³ Clinical Research Center for Respiratory Diseases in Hunan Province, Changsha, Hunan, China.
⁴ Hunan Engineering Research Center for Intelligent Diagnosis and Treatment of Respiratory Disease, Changsha, Hunan, China.
⁵ National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, P.R. China.
⁶ Department of Respiratory and Critical Medicine, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
⁷ Department of Respiratory Medicine, Affiliated Shaoyang Central Hospital of University of South China, Shaoyang, Hunan, China.
⁸ Department of Respiratory Medicine, Zhuzhou Central Hospital, Zhuzhou, Hunan, China.
⁹ Department of Respiratory Medicine, Yueyang Second People's Hospital, Designated Hospital of Junshan District, Yueyang, Hunan, China.
¹⁰ Department of Respiratory Medicine, the First People's Hospital of Huaihua affiliated to University of South China, Huaihua, Hunan, China.
¹¹ Department of Respiratory Medicine, the Second People's Hospital of Guilin, Guilin, Guangxi, China.
¹² Department of Respiratory and Critical Medicine, Xiangtan Central Hospital, Xiangtan, Hunan, China.
¹³ Department of Emergency Medicine, Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
¹⁴ Department of Respiratory Medicine, The first Attached Hospital of Shaoyang University, Shaoyang, Hunan, China.

Abstract

The main clinical manifestations of coronavirus disease 2019 (COVID-19) onset are respiratory symptoms, including cough, sputum, and dyspnea. However, a significant proportion of patients initially manifested non-respiratory symptoms, such as fever, myalgia, and diarrhea. Here, we compared the different characteristics and outcomes between the patients with respiratory symptoms and non-respiratory symptoms at illness onset. The patients admitted to the respiratory departments from eight hospitals in Hunan and Guangxi Province with nucleic acid-positive severe acute respiratory syndrome coronavirus (SARS-CoV-2) were recruited. Epidemiological information, clinical manifestations, laboratory findings, and radiological characteristics, treatment regimens, and outcomes data were recorded and analyzed. The median age of the recruited 541 subjects was 43 years (IQR, 33-55). Of the 541 subjects, 404 (74.5%) subjects had initial symptom that were respiratory, while 137 (25.5%) subjects had non-respiratory symptoms. Respiratory COVID-19 subjects had more secondary bacterial infections (8.7% vs 0.0%, P < 0.001), needed the intensive care unit more (9.7% vs 2.2%, P = 0.005), non-invasive ventilation more (7.2% vs 1.5%, P = 0.004), developed ARDS more (11.4% vs 2.2%, P = 0.001) and needed longer time to recover (18.5 vs 16.7 days, P = 0.003) compared to predominately non-respiratory COVID-19 subjects. The multivariate model showed that age (OR = 1.04, P = 0.01), dyspnea (OR = 4.91, P < 0.001) and secondary bacterial infection (OR = 19.8, P < 0.001) were independently associated with development of ARDS among COVID-19 patients. We identify COVID-19 subjects with dyspnea at disease onset who have a worse prognosis. We also demonstrate age and secondary bacterial infections to be independently associated with ARDS development in subjects with COVID-19.ABBREVIATIONS: COVID-19: Coronavirus disease 2019; ARDS: acute respiratory distress syndrome; IQR: interquartile range; ICU: intensive care unit; CDC: Chinese Center for Disease Control and Prevention.

Keywords: ARDS; COVID-19; SARS-CoV-2; outcome; symptoms.

MeSH terms

Adult
COVID-19*
China / epidemiology
Humans
Intensive Care Units
Middle Aged
Prognosis
SARS-CoV-2

Grants and funding

This work was supported by the National Natural Science Foundation of China (Number:81970044).