COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Abdukahil, Sheryl Ann, Abe, Ryuzo, Abel, Laurent, Absil, Lara, Acker, Andrew, Adachi, Shingo, Adam, Elisabeth, Adrião, Diana, Ainscough, Kate, Hssain, Ali Ait, Tamlihat, Younes Ait, Akimoto, Takako, Al-Dabbous, Tala, Al-Fares, Abdulrahman, Al Qasim, Eman, Alalqam, Razi, Alex, Beatrice, Alexandre, Kévin, Alfoudri, Huda, Alidjnou, Kazali Enagnon, Aliudin, Jeffrey, Allavena, Clotilde, Allou, Nathalie, Alves, João, Alves, Rita, Amaral, Maria, Ammerlaan, Heidi, Ampaw, Phoebe, Andini, Roberto, Andrejak, Claire, Angheben, Andrea, Angoulvant, François, Ansart, Séverine, Antonelli, Massimo, De Brito, Carlos Alexandre Antunes, Arabi, Yaseen, Aragao, Irene, Arcadipane, Antonio, Arenz, Lukas, Arlet, Jean-Benoît, Arnold-Day, Christel, Arora, Lovkesh, Artaud-Macari, Elise, Asensio, Angel, Assie, Jean Baptiste, Atique, Anika, Auchabie, Johann, Aumaitre, Hugues, Azemar, Laurène, Azoulay, Cécile, Bach, Benjamin, Bachelet, Delphine, Baillie, J. Kenneth, Bak, Erica, Bakakos, Agamemnon, Banisadr, Firouzé, Barbalho, Renata, Barclay, Wendy S., Barnikel, Michaela, Barrelet, Audrey, Barrigoto, Cleide, Basmaci, Romain, Rincon, Diego Fernando Bautista, Bedossa, Alexandra, Behilill, Sylvie, Beljantsev, Aleksandr, Bellemare, David, Beltrame, Anna, Beluze, Marine, Benech, Nicolas, Benkerrou, Dehbia, Bennett, Suzanne, Bento, LuÍs, Berdal, Jan-Erik, Bergeaud, Delphine, Bertolino, Lorenzo, Bessis, Simon, Bevilcaqua, Sybille, Bhavsar, Krishna, Humaid, Felwa Bin, Bissuel, François, Biston, Patrick, Bitker, Laurent, Blanco-Schweizer, Pablo, Blot, Mathieu, Boccia, Filomena, Bogaert, Debby, Bompart, François, Booth, Gareth, Borges, Diogo, Borie, Raphaël, Bos, Jeannet, Bosse, Hans Martin, Botelho-Nevers, Elisabeth, Bouadma, Lila, Bouchaud, Olivier, Bouchez, Sabelline, Bouhmani, Dounia, Bouhour, Damien, Bouiller, Kévin, Bouillet, Laurence, Bouisse, Camille, Boureau, Anne-Sophie, Bouscambert, Maude, Bouziotis, Jason, Boxma, Bianca, Boyer-Besseyre, Marielle, Boylan, Maria, Braga, Cynthia, Brandenburger, Timo, Brazzi, Luca, Breen, Dorothy, Breen, Patrick, Brickell, Kathy, Brozzi, Nicolas, Buchtele, Nina, Buesaquillo, Christian, Bugaeva, Polina, Buisson, Marielle, Burhan, Erlina, Bustos, Ingrid G., Butnaru, Denis, Cárcel, Sheila, Cabie, André, Cabral, Susana, Caceres, Eder, Callahan, Mia, Calligy, Kate, Calvache, Jose Andres, Camões, João, Campana, Valentine, Campbell, Paul, Canepa, Cecilia, Cantero, Mireia, Caraux-Paz, Pauline, Cardoso, Filipa, Cardoso, Filipe, Cardoso, Sofia, Carelli, Simone, Carlier, Nicolas, Carney, Gayle, Carpenter, Chloe, Carret, Marie-Christine, Carrier, François Martin, Carson, Gail, Casanova, Maire-Laure, Cascão, Mariana, Casimiro, José, Cassandra, Bailey, Castañeda, Silvia, Castanheira, Nidyanara, Castor-Alexandre, Guylaine, Castrillón, Henry, Castro, Ivo, Catarino, Ana, Catherine, François-Xavier, Cavalin, Roberta, Cavalli, Giulio Giovanni, Cavayas, Alexandros, Ceccato, Adrian, Cervantes-Gonzalez, Minerva, Chair, Anissa, Chakveatze, Catherine, Chan, Adrienne, Chand, Meera, Chas, Julie, Chassin, Camille, Chen, Anjellica, Chen, Yih-Sharng, Cheng, Matthew Pellan, Cheret, Antoine, Chiarabini, Thibault, Chica, Julian, Chirouze, Catherine, Chiumello, Davide, Cho, Hwa Jin, Cho, Sung Min, Cholley, Bernard, Cidade, Jose Pedro, Herreros, Jose Miguel Cisneros, Citarella, Barbara Wanjiru, Ciullo, Anna, Clarke, Jennifer, Clohisey, Sara, Codan, Cassidy, Cody, Caitriona, Coelho, Alexandra, Colin, Gwenhaël, Collins, Michael, Colombo, Sebastiano Maria, Combs, Pamela, Connelly, J. P., Connor, Marie, Conrad, Anne, Contreras, Sofía, Cooke, Graham S., Copland, Mary, Cordel, Hugues, Corley, Amanda, Cormican, Sarah, Cornelis, Sabine, Corpuz, Arianne Joy, Corvaisier, Grégory, Couffignal, Camille, Couffin-Cadiergues, Sandrine, Courtois, Roxane, D’Orleans, Charles Crepy, Croonen, Sabine, Crowl, Gloria, Crump, Jonathan, Cruz, Claudina, Csete, Marc, Cucino, Alberto, Cullen, Caroline, Cummings, Matthew, Curley, Gerard, Curlier, Elodie, Custodio, Paula, D’Aragon, Frédérick, Da Silva Filipe, Ana, Da Silveira, Charlene, D’Ortenzio, Eric, Dabaliz, Al-Awwab, Dagens, Andrew B., Dalton, Heidi, Dalton, Jo, Daneman, Nick, Dankwa, Emmanuelle A., Dantas, Jorge, De Castro, Nathalie, De Mendoza, Diego, De Oliveira França, Rafael Freitas, De Rosa, Rosanna, De Silva, Thushan, De Vries, Peter, Dean, David, Debray, Marie-Pierre, Dechert, William, Deconninck, Lauren, Decours, Romain, Delacroix, Isabelle, Delavigne, Karen, Deligiannis, Ionna, Dell’amore, Andrea, Delobel, Pierre, Demonchy, 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Lucia, Tutillo, Diego Rolando Morocho, Motos, Ana, Mouquet, Hugo, Perrot, Clara Mouton, Moyet, Julien, Mullaert, Jimmy, Munblit, Daniel, Murphy, Derek, Murris, Marlène, Myrodia, Dimitra Melia, N’guyen, Yohan, Neant, Nadège, Neb, Holger, Nekliudov, Nikita A., Neto, Raul, Neumann, Emily, Neves, Bernardo, Ng, Pauline Yeung, Ng, Wing Yiu, Choileain, Orna Ni, Nichol, Alistair, Nonas, Stephanie, Noret, Marion, Norman, Lisa, Notari, Alessandra, Noursadeghi, Mahdad, Nowicka, Karolina, Nseir, Saad, Nunez, Jose I., Nyamankolly, Elsa, O’Donnell, Max, O’Hearn, Katie, O’Neil, Conar, Occhipinti, Giovanna, Ogston, Tawnya, Ogura, Takayuki, Oh, Tak-Hyuk, Ohshimo, Shinichiro, Oinam, Budha Charan Singh, Oliveira, Ana Pinho, Oliveira, João, Olliaro, Piero, Ong, David S. 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Azhari, Tedder, Richard S., Teixeira, João, Tellier, Marie-Capucine, Terpstra, Pleun, Terrier, Olivier, Terzi, Nicolas, Tessier-Grenier, Hubert, Thibault, Vincent, Thiberville, Simon-Djamel, Thill, Benoît, Thompson, A. A. Roger, Thompson, Shaun, Thomson, David, Thomson, Emma C., Thuy, Duong Bich, Thwaites, Ryan S., Timashev, Peter S., Timsit, Jean-François, Vijayaraghavan, Bharath Kumar Tirupakuzhi, Toki, Maria, Tonby, Kristian, Santos-Olmo, Rosario Maria Torres, Torres, Antoni, Torres, Margarida, Trioux, Théo, Trieu, Huynh Trung, Tromeur, Cécile, Trontzas, Ioannis, Troost, Jonathan, Trouillon, Tiffany, Tual, Christelle, Tubiana, Sarah, Tuite, Helen, Turtle, Lance C. W., Twardowski, Pawel, Uchiyama, Makoto, Ullrich, Roman, Uribe, Alberto, Usman, Asad, Val-Flores, Luís, Van De Velde, Stijn, Van Den Berge, Marcel, Van Der Feltz, Machteld, Van Der Vekens, Nicky, Van Der Voort, Peter, Van Der Werf, Sylvie, Van Dyk, Marlice, Van Gulik, Laura, Van Hattem, Jarne, Van Lelyveld, Steven, Van Netten, Carolien, Vanel, Noémie, Vanoverschelde, Henk, Vauchy, Charline, Veislinger, Aurélie, Velazco, Jorge, Ventura, Sara, Verbon, Annelies, Vieira, César, Villanueva, Joy Ann, Villar, Judit, Villeneuve, Pierre-Marc, Villoldo, Andrea, Van Vinh Chau, Nguyen, Visseaux, Benoit, Visser, Hannah, Vuorinen, Aapeli, Vuotto, Fanny, Wang, Chih-Hsien, Wei, Jia, Weil, Katharina, Wesselius, Sanne, Wham, Murray, Whelan, Bryan, White, Nicole, Wiedemann, Aurélie, Wille, Keith, Wils, Evert-Jan, Xynogalas, Ioannis, Suen, Jacky Y., Yacoub, Sophie, Yamazaki, Masaki, Yazdanpanah, Yazdan, Yelnik, Cécile, Yerkovich, Stephanie, Yokoyama, Toshiki, Yonis, Hodane, Young, Paul, Yuliarto, Saptadi, Zabbe, Marion, Zacharowski, Kai, Zahran, Maram, Zambon, Maria, Zanella, Alberto, Zawadka, Konrad, Zayyad, Hiba, Zoufaly, Alexander and Zucman, David (2021) 'COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study'. Infection, Vol 49, Issue 5, pp. 889-905.

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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.

Item Type:	Article
Subjects:	QW Microbiology and Immunology > Viruses > QW 160 Viruses (General). Virology WA Public Health > WA 105 Epidemiology WC Communicable Diseases > Virus Diseases > Viral Respiratory Tract Infections. Respirovirus Infections > WC 505 Viral respiratory tract infections WF Respiratory System > WF 100 General works
Faculty: Department:	Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI):	https://doi.org/10.1007/s15010-021-01599-5
Depositing User:	Stacy Murtagh
Date Deposited:	28 Sep 2021 17:18
Last Modified:	28 Sep 2021 17:18
URI:	https://archive.lstmed.ac.uk/id/eprint/19037

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