COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study
Sheryl Ann Abdukahil, Ryuzo Abe, Laurent Abel, Lara Absil, Andrew Acker, Shingo Adachi, Elisabeth Adam, Diana Adrião, Kate Ainscough, Ali Ait Hssain, Younes Ait Tamlihat, Takako Akimoto, Tala Al-dabbous, Abdulrahman Al‐Fares, Eman Al Qasim, Razi Alalqam, Beatrice Alex, Kévin Alexandre, Huda Alfoudri, Kazali Enagnon Alidjnou, Jeffrey Aliudin, Clotilde Allavena, Nathalie Allou, João Alves, Rita Vieira Alves, Maria Esméria Corezola do Amaral, Heidi Ammerlaan, Phoebe Ampaw, Roberto Andini, Claire Andréjak, Andrea Angheben, François Angoulvant, Séverine Ansart, Massimo Antonelli, Carlos Alexandre Antunes de Brito, Yaseen M. Arabi, Irene Aragão, Antonio Arcadipane, Lukas Arenz, Jean‐Benoît Arlet, Christel Arnold-Day, Lovkesh Arora, Élise Artaud-Macari, Ángel Asensio, Jean‐Baptiste Assié, Anika Atique, Johann Auchabie, Hugues Aumaître, Laurène Azemar, Cécile Azoulay, Benjamin Bach, Delphine Bachelet, J. Kenneth Baillie, Erica Bak, Agamemnon Bakakos, Firouzé Bani‐Sadr, Renata Barbalho, William Barclay, Michaela Barnikel, Audrey Barrelet, Cleide Barrigoto, Romain Basmaci, Diego Fernando Bautista Rincón, Alexandra Bedossa, Sylvie Behilill, Aleksandr Beljantsev, David Bellemare, Anna Beltrame, Marine Beluze, Nicolas Benech, Dehbia Benkerrou, Suzanne Bennett, Luís Bento, Jan‐Erik Berdal, Delphine Bergeaud, Lorenzo Bertolino, Simon Bessis, Sybille Bevilcaqua, Krishna Bhavsar, Felwa Bin Humaid, François Bissuel, Patrick Biston, Laurent Bitker, Pablo Blanco-Schweizer, Mathieu Blot, Filomena Boccia, Debby Bogaert, François Bompart, Gareth Booth, Diogo Borges, Raphaël Borie, Jeannet C. Bos, Hans Martin Bosse, Élisabeth Botelho-Nevers, Lila Bouadma, Olivier Bouchaud, Sabelline Bouchez, Dounia Bouhmani, Damien Bouhour, Kévin Bouiller
Abstract
BACKGROUND: The 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. METHODS: International, 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. INTERPRETATION: This 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.