Characteristics and outcomes of COVID-19 patients admitted to hospital with and without respiratory symptoms

Barbara Wanjiru Citarella; Christiana Kartsonaki; Elsa D. Ibáñez-Prada; Bronner P. Gonçalves; Joaquin Baruch; Martina Escher; Mark G. Pritchard; Jia Wei; Fred Philippy; Andrew Dagens; Matthew Hall; James Lee; Demetrios James Kutsogiannis; Evert Jan Wils; Marília Andreia Fernandes; Bharath Kumar Tirupakuzhi Vijayaraghavan; Prasan Kumar Panda; Ignacio Martin-Loeches; Shinichiro Ohshimo; Arie Zainul Fatoni; Peter Horby; Jake Dunning; Jordi Rello; Laura Merson; Amanda Rojek; Michel Vaillant; Piero Olliaro; Luis Felipe Reyes; S. A. Moharam; Sabriya Abdalasalam; Alaa Abdalfattah Abdalhadi; Naana Reyam Abdalla; Walaa Abdalla; Almthani Hamza Abdalrheem; Ashraf Abdalsalam; Saedah Abdeewi; Esraa Hassan Abdelgaum; Mohamed Abdelhalim; Mohammed Abdelkabir; Israa Abdelrahman; Sheryl Ann Abdukahil; Lamees Adil Abdulbaqi; Salaheddin Abdulhamid; Widyan Abdulhamid; Nurul Najmee Abdulkadir; Eman Abdulwahed; Rawad Abdunabi; Ryuzo Abe; Laurent Abel; Ahmed Mohammed Abodina; the ISARIC Clinical Characterisation Group

doi:10.1016/j.heliyon.2024.e29591

Characteristics and outcomes of COVID-19 patients admitted to hospital with and without respiratory symptoms

Barbara Wanjiru Citarella^*, Christiana Kartsonaki, Elsa D. Ibáñez-Prada, Bronner P. Gonçalves, Joaquin Baruch, Martina Escher, Mark G. Pritchard, Jia Wei, Fred Philippy, Andrew Dagens, Matthew Hall, James Lee, Demetrios James Kutsogiannis, Evert Jan Wils, Marília Andreia Fernandes, Bharath Kumar Tirupakuzhi Vijayaraghavan, Prasan Kumar Panda, Ignacio Martin-Loeches, Shinichiro Ohshimo, Arie Zainul FatoniPeter Horby, Jake Dunning, Jordi Rello, Laura Merson, Amanda Rojek, Michel Vaillant, Piero Olliaro, Luis Felipe Reyes, S. A. Moharam, Sabriya Abdalasalam, Alaa Abdalfattah Abdalhadi, Naana Reyam Abdalla, Walaa Abdalla, Almthani Hamza Abdalrheem, Ashraf Abdalsalam, Saedah Abdeewi, Esraa Hassan Abdelgaum, Mohamed Abdelhalim, Mohammed Abdelkabir, Israa Abdelrahman, Sheryl Ann Abdukahil, Lamees Adil Abdulbaqi, Salaheddin Abdulhamid, Widyan Abdulhamid, Nurul Najmee Abdulkadir, Eman Abdulwahed, Rawad Abdunabi, Ryuzo Abe, Laurent Abel, Ahmed Mohammed Abodina, the ISARIC Clinical Characterisation Group

^*Corresponding author for this work

Research output: Contribution to journal › Article › Research › peer-review

Abstract

Background: COVID-19 is primarily known as a respiratory illness; however, many patients present to hospital without respiratory symptoms. The association between non-respiratory presentations of COVID-19 and outcomes remains unclear. We investigated risk factors and clinical outcomes in patients with no respiratory symptoms (NRS) and respiratory symptoms (RS) at hospital admission. Methods: This study describes clinical features, physiological parameters, and outcomes of hospitalised COVID-19 patients, stratified by the presence or absence of respiratory symptoms at hospital admission. RS patients had one or more of: cough, shortness of breath, sore throat, runny nose or wheezing; while NRS patients did not. Results: Of 178,640 patients in the study, 86.4 % presented with RS, while 13.6 % had NRS. NRS patients were older (median age: NRS: 74 vs RS: 65) and less likely to be admitted to the ICU (NRS: 36.7 % vs RS: 37.5 %). NRS patients had a higher crude in-hospital case-fatality ratio (NRS 41.1 % vs. RS 32.0 %), but a lower risk of death after adjusting for confounders (HR 0.88 [0.83–0.93]). Conclusion: Approximately one in seven COVID-19 patients presented at hospital admission without respiratory symptoms. These patients were older, had lower ICU admission rates, and had a lower risk of in-hospital mortality after adjusting for confounders.

Original language	English
Article number	e29591
Journal	Heliyon
Volume	10
Issue number	10
DOIs	https://doi.org/10.1016/j.heliyon.2024.e29591
Publication status	Published - 30 May 2024

Keywords

COVID-19
Mortality
Non-respiratory symptoms
Respiratory symptoms
Risk factors

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10.1016/j.heliyon.2024.e29591Licence: CC BY

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Citarella, B. W., Kartsonaki, C., Ibáñez-Prada, E. D., Gonçalves, B. P., Baruch, J., Escher, M., Pritchard, M. G., Wei, J., Philippy, F., Dagens, A., Hall, M., Lee, J., Kutsogiannis, D. J., Wils, E. J., Fernandes, M. A., Tirupakuzhi Vijayaraghavan, B. K., Panda, P. K., Martin-Loeches, I., Ohshimo, S., ... the ISARIC Clinical Characterisation Group (2024). Characteristics and outcomes of COVID-19 patients admitted to hospital with and without respiratory symptoms. Heliyon, 10(10), Article e29591. https://doi.org/10.1016/j.heliyon.2024.e29591

@article{f11e9ded953741b19dedd0b716334ce7,

title = "Characteristics and outcomes of COVID-19 patients admitted to hospital with and without respiratory symptoms",

abstract = "Background: COVID-19 is primarily known as a respiratory illness; however, many patients present to hospital without respiratory symptoms. The association between non-respiratory presentations of COVID-19 and outcomes remains unclear. We investigated risk factors and clinical outcomes in patients with no respiratory symptoms (NRS) and respiratory symptoms (RS) at hospital admission. Methods: This study describes clinical features, physiological parameters, and outcomes of hospitalised COVID-19 patients, stratified by the presence or absence of respiratory symptoms at hospital admission. RS patients had one or more of: cough, shortness of breath, sore throat, runny nose or wheezing; while NRS patients did not. Results: Of 178,640 patients in the study, 86.4 % presented with RS, while 13.6 % had NRS. NRS patients were older (median age: NRS: 74 vs RS: 65) and less likely to be admitted to the ICU (NRS: 36.7 % vs RS: 37.5 %). NRS patients had a higher crude in-hospital case-fatality ratio (NRS 41.1 % vs. RS 32.0 %), but a lower risk of death after adjusting for confounders (HR 0.88 [0.83–0.93]). Conclusion: Approximately one in seven COVID-19 patients presented at hospital admission without respiratory symptoms. These patients were older, had lower ICU admission rates, and had a lower risk of in-hospital mortality after adjusting for confounders.",

keywords = "COVID-19, Mortality, Non-respiratory symptoms, Respiratory symptoms, Risk factors",

author = "Citarella, {Barbara Wanjiru} and Christiana Kartsonaki and Ib{\'a}{\~n}ez-Prada, {Elsa D.} and Gon{\c c}alves, {Bronner P.} and Joaquin Baruch and Martina Escher and Pritchard, {Mark G.} and Jia Wei and Fred Philippy and Andrew Dagens and Matthew Hall and James Lee and Kutsogiannis, {Demetrios James} and Wils, {Evert Jan} and Fernandes, {Mar{\'i}lia Andreia} and {Tirupakuzhi Vijayaraghavan}, {Bharath Kumar} and Panda, {Prasan Kumar} and Ignacio Martin-Loeches and Shinichiro Ohshimo and Fatoni, {Arie Zainul} and Peter Horby and Jake Dunning and Jordi Rello and Laura Merson and Amanda Rojek and Michel Vaillant and Piero Olliaro and Reyes, {Luis Felipe} and Moharam, {S. A.} and Sabriya Abdalasalam and Abdalhadi, {Alaa Abdalfattah} and Abdalla, {Naana Reyam} and Walaa Abdalla and Abdalrheem, {Almthani Hamza} and Ashraf Abdalsalam and Saedah Abdeewi and Abdelgaum, {Esraa Hassan} and Mohamed Abdelhalim and Mohammed Abdelkabir and Israa Abdelrahman and Abdukahil, {Sheryl Ann} and Abdulbaqi, {Lamees Adil} and Salaheddin Abdulhamid and Widyan Abdulhamid and Abdulkadir, {Nurul Najmee} and Eman Abdulwahed and Rawad Abdunabi and Ryuzo Abe and Laurent Abel and Abodina, {Ahmed Mohammed} and {the ISARIC Clinical Characterisation Group}",

note = "Funding: This work was made possible by the UK Foreign, Commonwealth and Development Office and Wellcome [215091/Z/18/Z, 222410/Z/21/Z, 225288/Z/22/Z and 220757/Z/20/Z]; the Bill & Melinda Gates Foundation [OPP1209135]; the philanthropic support of the donors to the University of Oxford{\textquoteright}s COVID-19 Research Response Fund (0009109); grants from the National Institute for Health Research (NIHR; award CO–CIN-01/DH_/Department of Health/United Kingdom), the Medical Research Council (MRC; grant MC_PC_19059), and by the NIHR Health Protection Research Unit (HPRU) in Emerging and Zoonotic Infections at University of Liverpool in partnership with Public Health England (PHE), (award 200907), NIHR HPRU in Respiratory Infections at Imperial College London with PHE (award 200927), Liverpool Experimental Cancer Medicine Centre (grant C18616/A25153), NIHR Biomedical Research Centre at Imperial College London (award ISBRC-1215-20013), and NIHR Clinical Research Network providing infra- structure support; Cambridge NIHR Biomedical Research Centre (award NIHR203312); funding from Medical Research Council (UK Research and Innovation; award number MC_PC_19084) and Medical Research Council (MC_UU_00031/7); the Comprehensive Local Research Networks (CLRNs) of which PJMO is an NIHR Senior Investigator (NIHR201385); CIHR Coronavirus Rapid Research Funding Opportunity OV2170359 and the coordination in Canada by Sunnybrook Research Institute; funding by the Health Research Board of Ireland [CTN-2014-12]; the Rapid European COVID-19 Emergency Response research (RECOVER) [H2020 project 101003589] and European Clinical Research Alliance on Infectious Diseases (ECRAID) [965313]; a Research Council of Norway grant no 312780, and a philanthropic donation from Vivaldi Invest A/S owned by Jon Stephenson von Tetzchner; the South Eastern Norway Health Authority and the Research Council of Norway; Innovative Medicines Initiative Joint Undertaking under Grant Agreement No. 115523 COM- BACTE, resources of which are composed of financial contribution from the European Union{\textquoteright}s Seventh Framework Programme (FP7/ 2007–2013) and EFPIA companies, in-kind contribution; the French COVID cohort (NCT04262921) is sponsored by INSERM and is funded by the REACTing (REsearch & ACtion emergING infectious diseases) consortium and by a grant of the French Ministry of Health (PHRC n◦20–0424); Stiftungsfonds zur F{\" }orderung der Bek{\" }ampfung der Tuberkulose und anderer Lungenkrankheiten of the City of Vienna, Project Number: APCOV22BGM; funding from Medical University of Vienna, Department of Anaesthesia, Intensive Care Medicine and Pain Medicine; Italian Ministry of Health “Fondi Ricerca corrente–L1P6” to IRCCS Ospedale Sacro Cuore–Don Calabria; Australian Department of Health grant (3273191); Gender Equity Strategic Fund at University of Queensland, Artificial Intelligence for Pandemics (A14PAN) at University of Queensland, the Australian Research Council Centre of Excellence for Engineered Quantum Systems (EQUS, CE170100009), the Prince Charles Hospital Foundation, Australia; Australian Department of Health grant (3273191); Brazil, National Council for Scientific and Technological Development Scholarship number 303953/2018- 7; the Firland Foundation, Shoreline, Washington, USA; a grant from foundation Bevordering Onderzoek Franciscus; a grant from foundation Bevordering Onderzoek Franciscus; Institute for Clinical Research (ICR), National Institutes of Health (NIH) supported by the Ministry of Health Malaysia; funding from Saisei Mirai/Saisei Pharma, Japan; the U.S. DoD Armed Forces Health Surveillance Division, Global Emerging Infectious Diseases Branch to the U.S Naval Medical Research Unit No. TWO (NAMRU-2) (Work Unit #: P0153_21_N2). These authors would like to thank Vysnova Partners, Inc. for the management of this research project. The Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit is funded by the Wellcome Trust Publisher Copyright: {\textcopyright} 2024 The Authors",

year = "2024",

month = may,

day = "30",

doi = "10.1016/j.heliyon.2024.e29591",

language = "English",

volume = "10",

journal = "Heliyon",

issn = "2405-8440",

publisher = "Elsevier BV",

number = "10",

}

Citarella, BW, Kartsonaki, C, Ibáñez-Prada, ED, Gonçalves, BP, Baruch, J, Escher, M, Pritchard, MG, Wei, J, Philippy, F, Dagens, A, Hall, M, Lee, J, Kutsogiannis, DJ, Wils, EJ, Fernandes, MA, Tirupakuzhi Vijayaraghavan, BK, Panda, PK, Martin-Loeches, I, Ohshimo, S, Fatoni, AZ, Horby, P, Dunning, J, Rello, J, Merson, L, Rojek, A, Vaillant, M, Olliaro, P, Reyes, LF, Moharam, SA, Abdalasalam, S, Abdalhadi, AA, Abdalla, NR, Abdalla, W, Abdalrheem, AH, Abdalsalam, A, Abdeewi, S, Abdelgaum, EH, Abdelhalim, M, Abdelkabir, M, Abdelrahman, I, Abdukahil, SA, Abdulbaqi, LA, Abdulhamid, S, Abdulhamid, W, Abdulkadir, NN, Abdulwahed, E, Abdunabi, R, Abe, R, Abel, L, Abodina, AM & the ISARIC Clinical Characterisation Group 2024, 'Characteristics and outcomes of COVID-19 patients admitted to hospital with and without respiratory symptoms', Heliyon, vol. 10, no. 10, e29591. https://doi.org/10.1016/j.heliyon.2024.e29591

TY - JOUR

T1 - Characteristics and outcomes of COVID-19 patients admitted to hospital with and without respiratory symptoms

AU - Citarella, Barbara Wanjiru

AU - Kartsonaki, Christiana

AU - Ibáñez-Prada, Elsa D.

AU - Gonçalves, Bronner P.

AU - Baruch, Joaquin

AU - Escher, Martina

AU - Pritchard, Mark G.

AU - Wei, Jia

AU - Philippy, Fred

AU - Dagens, Andrew

AU - Hall, Matthew

AU - Lee, James

AU - Kutsogiannis, Demetrios James

AU - Wils, Evert Jan

AU - Fernandes, Marília Andreia

AU - Tirupakuzhi Vijayaraghavan, Bharath Kumar

AU - Panda, Prasan Kumar

AU - Martin-Loeches, Ignacio

AU - Ohshimo, Shinichiro

AU - Fatoni, Arie Zainul

AU - Horby, Peter

AU - Dunning, Jake

AU - Rello, Jordi

AU - Merson, Laura

AU - Rojek, Amanda

AU - Vaillant, Michel

AU - Olliaro, Piero

AU - Reyes, Luis Felipe

AU - Moharam, S. A.

AU - Abdalasalam, Sabriya

AU - Abdalhadi, Alaa Abdalfattah

AU - Abdalla, Naana Reyam

AU - Abdalla, Walaa

AU - Abdalrheem, Almthani Hamza

AU - Abdalsalam, Ashraf

AU - Abdeewi, Saedah

AU - Abdelgaum, Esraa Hassan

AU - Abdelhalim, Mohamed

AU - Abdelkabir, Mohammed

AU - Abdelrahman, Israa

AU - Abdukahil, Sheryl Ann

AU - Abdulbaqi, Lamees Adil

AU - Abdulhamid, Salaheddin

AU - Abdulhamid, Widyan

AU - Abdulkadir, Nurul Najmee

AU - Abdulwahed, Eman

AU - Abdunabi, Rawad

AU - Abe, Ryuzo

AU - Abel, Laurent

AU - Abodina, Ahmed Mohammed

AU - the ISARIC Clinical Characterisation Group

N1 - Funding: This work was made possible by the UK Foreign, Commonwealth and Development Office and Wellcome [215091/Z/18/Z, 222410/Z/21/Z, 225288/Z/22/Z and 220757/Z/20/Z]; the Bill & Melinda Gates Foundation [OPP1209135]; the philanthropic support of the donors to the University of Oxford’s COVID-19 Research Response Fund (0009109); grants from the National Institute for Health Research (NIHR; award CO–CIN-01/DH_/Department of Health/United Kingdom), the Medical Research Council (MRC; grant MC_PC_19059), and by the NIHR Health Protection Research Unit (HPRU) in Emerging and Zoonotic Infections at University of Liverpool in partnership with Public Health England (PHE), (award 200907), NIHR HPRU in Respiratory Infections at Imperial College London with PHE (award 200927), Liverpool Experimental Cancer Medicine Centre (grant C18616/A25153), NIHR Biomedical Research Centre at Imperial College London (award ISBRC-1215-20013), and NIHR Clinical Research Network providing infra- structure support; Cambridge NIHR Biomedical Research Centre (award NIHR203312); funding from Medical Research Council (UK Research and Innovation; award number MC_PC_19084) and Medical Research Council (MC_UU_00031/7); the Comprehensive Local Research Networks (CLRNs) of which PJMO is an NIHR Senior Investigator (NIHR201385); CIHR Coronavirus Rapid Research Funding Opportunity OV2170359 and the coordination in Canada by Sunnybrook Research Institute; funding by the Health Research Board of Ireland [CTN-2014-12]; the Rapid European COVID-19 Emergency Response research (RECOVER) [H2020 project 101003589] and European Clinical Research Alliance on Infectious Diseases (ECRAID) [965313]; a Research Council of Norway grant no 312780, and a philanthropic donation from Vivaldi Invest A/S owned by Jon Stephenson von Tetzchner; the South Eastern Norway Health Authority and the Research Council of Norway; Innovative Medicines Initiative Joint Undertaking under Grant Agreement No. 115523 COM- BACTE, resources of which are composed of financial contribution from the European Union’s Seventh Framework Programme (FP7/ 2007–2013) and EFPIA companies, in-kind contribution; the French COVID cohort (NCT04262921) is sponsored by INSERM and is funded by the REACTing (REsearch & ACtion emergING infectious diseases) consortium and by a grant of the French Ministry of Health (PHRC n◦20–0424); Stiftungsfonds zur F ̈orderung der Bek ̈ampfung der Tuberkulose und anderer Lungenkrankheiten of the City of Vienna, Project Number: APCOV22BGM; funding from Medical University of Vienna, Department of Anaesthesia, Intensive Care Medicine and Pain Medicine; Italian Ministry of Health “Fondi Ricerca corrente–L1P6” to IRCCS Ospedale Sacro Cuore–Don Calabria; Australian Department of Health grant (3273191); Gender Equity Strategic Fund at University of Queensland, Artificial Intelligence for Pandemics (A14PAN) at University of Queensland, the Australian Research Council Centre of Excellence for Engineered Quantum Systems (EQUS, CE170100009), the Prince Charles Hospital Foundation, Australia; Australian Department of Health grant (3273191); Brazil, National Council for Scientific and Technological Development Scholarship number 303953/2018- 7; the Firland Foundation, Shoreline, Washington, USA; a grant from foundation Bevordering Onderzoek Franciscus; a grant from foundation Bevordering Onderzoek Franciscus; Institute for Clinical Research (ICR), National Institutes of Health (NIH) supported by the Ministry of Health Malaysia; funding from Saisei Mirai/Saisei Pharma, Japan; the U.S. DoD Armed Forces Health Surveillance Division, Global Emerging Infectious Diseases Branch to the U.S Naval Medical Research Unit No. TWO (NAMRU-2) (Work Unit #: P0153_21_N2). These authors would like to thank Vysnova Partners, Inc. for the management of this research project. The Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit is funded by the Wellcome Trust Publisher Copyright: © 2024 The Authors

PY - 2024/5/30

Y1 - 2024/5/30

N2 - Background: COVID-19 is primarily known as a respiratory illness; however, many patients present to hospital without respiratory symptoms. The association between non-respiratory presentations of COVID-19 and outcomes remains unclear. We investigated risk factors and clinical outcomes in patients with no respiratory symptoms (NRS) and respiratory symptoms (RS) at hospital admission. Methods: This study describes clinical features, physiological parameters, and outcomes of hospitalised COVID-19 patients, stratified by the presence or absence of respiratory symptoms at hospital admission. RS patients had one or more of: cough, shortness of breath, sore throat, runny nose or wheezing; while NRS patients did not. Results: Of 178,640 patients in the study, 86.4 % presented with RS, while 13.6 % had NRS. NRS patients were older (median age: NRS: 74 vs RS: 65) and less likely to be admitted to the ICU (NRS: 36.7 % vs RS: 37.5 %). NRS patients had a higher crude in-hospital case-fatality ratio (NRS 41.1 % vs. RS 32.0 %), but a lower risk of death after adjusting for confounders (HR 0.88 [0.83–0.93]). Conclusion: Approximately one in seven COVID-19 patients presented at hospital admission without respiratory symptoms. These patients were older, had lower ICU admission rates, and had a lower risk of in-hospital mortality after adjusting for confounders.

AB - Background: COVID-19 is primarily known as a respiratory illness; however, many patients present to hospital without respiratory symptoms. The association between non-respiratory presentations of COVID-19 and outcomes remains unclear. We investigated risk factors and clinical outcomes in patients with no respiratory symptoms (NRS) and respiratory symptoms (RS) at hospital admission. Methods: This study describes clinical features, physiological parameters, and outcomes of hospitalised COVID-19 patients, stratified by the presence or absence of respiratory symptoms at hospital admission. RS patients had one or more of: cough, shortness of breath, sore throat, runny nose or wheezing; while NRS patients did not. Results: Of 178,640 patients in the study, 86.4 % presented with RS, while 13.6 % had NRS. NRS patients were older (median age: NRS: 74 vs RS: 65) and less likely to be admitted to the ICU (NRS: 36.7 % vs RS: 37.5 %). NRS patients had a higher crude in-hospital case-fatality ratio (NRS 41.1 % vs. RS 32.0 %), but a lower risk of death after adjusting for confounders (HR 0.88 [0.83–0.93]). Conclusion: Approximately one in seven COVID-19 patients presented at hospital admission without respiratory symptoms. These patients were older, had lower ICU admission rates, and had a lower risk of in-hospital mortality after adjusting for confounders.

KW - COVID-19

KW - Mortality

KW - Non-respiratory symptoms

KW - Respiratory symptoms

KW - Risk factors

UR - http://www.scopus.com/inward/record.url?scp=85192803986&partnerID=8YFLogxK

UR - https://pubmed.ncbi.nlm.nih.gov/38779000

U2 - 10.1016/j.heliyon.2024.e29591

DO - 10.1016/j.heliyon.2024.e29591

M3 - Article

C2 - 38779000

AN - SCOPUS:85192803986

SN - 2405-8440

VL - 10

JO - Heliyon

JF - Heliyon

IS - 10

M1 - e29591

ER -

Characteristics and outcomes of COVID-19 patients admitted to hospital with and without respiratory symptoms

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