Abstract
BackgroundThe ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms.MethodsInternational, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms.Results‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country.InterpretationThis international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men.
Highlights
The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19
We excluded 24 336 who did not have documented SARS-CoV-2 confirmation, 3290 with missing data, and 5794 who developed COVID19 after admission to hospital. 6094 patients were admitted to hospital with asymptomatic COVID-19, with the greatest proportion in the age band 10–20 years (46% of patients admitted in that age group)
The greatest proportion of asymptomatic patients was in Malaysia (49%), where hospitalization was compulsory throughout the data collection period for people with COVID-19
Summary
The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%) They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs men 71, 70, 67; 93%, each P < 0.001). Defining presenting symptoms of COVID-19 is further complicated by clinical experience suggesting that patients frequently present with atypical symptoms other than cough, fever and shortness of breath. This variation in the clinical characterisation of COVID-19 is problematic, as case definitions are used to guide clinical diagnosis, disease surveillance, and public health interventions
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