Li Jitian, Chen Zhe, Nie Yifei, Ma Yan, Guo Qiaoyun, Dai Xiaofeng
Henan Provincial Orthopedic Institute, Zhengzhou, China.
Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
J Med Internet Res. 2020 Jun 30;22(6):e19636. doi: 10.2196/19636.
The outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease (COVID-19), has been declared a global pandemic. Identifying individuals whose infection can potentially become severe is critical to control the case fatality rate of COVID-19. However, knowledge of symptoms that are prognostic of COVID-19 severity is lacking.
The objective of our study was to identify symptoms prognostic of COVID-19 infection severity.
We analyzed documented symptoms, including fever, cough, fatigue, expectoration, sore throat, chest distress, headache, diarrhea, rhinorrhea, stuffed nose, nausea, vomiting, muscle or joint ache, shortness of breath, and their associations with disease severity using a case series, including 655 confirmed cases from January 23 to February 5, 2020 in Henan Province, China. We also analyzed the influence of individual characteristics, including age, gender, and comorbidities, on symptoms with prognostic value.
Fatigue (95% CI 0.141 to 0.334, P<.001), expectoration (95% CI 0.107 to 0.305, P<.001) and stuffed nose (95% CI -0.499 to -0.082, P=.006) were identified as the prognostic symptoms of COVID-19 patients from the multivariate analysis. Fever occurred in 603/655 (92.1%) of the patients but was not associated with disease severity. Fatigue accounted for 184/655 (28.1%) of the patients and was linearly associated with infection severity with statistical significance. Expectoration occurred in 169/655 (25.8%) patients in the cohort and was the sole prognostic factor for patients with cardiovascular complications, including hypertension. Shortness of breath, chest distress, muscle or joint ache, and dry cough, which occurred in 33 (5%), 83 (12.7%), 78 (11.9%), and 276 (42.1%) of the 655 patients, respectively, were significantly enriched among patients classified as severe. Stuffed nose and nausea were associated with favorable disease severity, especially among male patients. More female than male patients were documented as having muscle or joint ache. Headache was most enriched in patents aged 15 to 39 years, followed by those aged 40 to 64 years, with statistical significance.
Fatigue and expectoration are signs of severe COVID-19 infection. Shortness of breath, chest distress, muscle or joint ache, and dry cough are prevalent in severe patients. Expectoration is commonly present in older individuals and patients with cardiovascular disorders, including hypertension. Shortness of breath is prognostic of severe infection in male patients. Stuffed nose and nausea are favorable prognostic factors of severe infection, especially among male patients.
严重急性呼吸综合征冠状病毒2（SARS-CoV-2）引发冠状病毒病（COVID-19），其爆发已被宣布为全球大流行。识别那些感染后可能病情加重的个体对于控制COVID-19的病死率至关重要。然而，目前尚缺乏关于可预示COVID-19严重程度的症状的认识。
我们研究的目的是识别可预示COVID-19感染严重程度的症状。
我们分析了记录的症状，包括发热、咳嗽、乏力、咳痰、咽痛、胸闷、头痛、腹泻、流涕、鼻塞、恶心、呕吐、肌肉或关节疼痛、气短等，并使用病例系列研究分析了这些症状与疾病严重程度的关联，该病例系列包括2020年1月23日至2月5日在中国河南省的655例确诊病例。我们还分析了个体特征（包括年龄、性别和合并症）对具有预后价值的症状的影响。
多因素分析确定乏力（95%CI 0.141至0.334，P<0.001）、咳痰（95%CI 0.107至0.305，P<0.001）和鼻塞（95%CI -0.499至-0.082，P=0.006）为COVID-19患者的预后症状。603/655（92.1%）的患者出现发热，但发热与疾病严重程度无关。184/655（28.1%）的患者出现乏力，且乏力与感染严重程度呈线性相关，具有统计学意义。队列中169/655（25.8%）的患者出现咳痰，咳痰是包括高血压在内的心血管并发症患者的唯一预后因素。655例患者中分别有33例（5%）、83例（12.7%）、78例（11.9%）和276例（42.1%）出现气短、胸闷、肌肉或关节疼痛以及干咳，这些症状在被分类为重症的患者中显著富集。鼻塞和恶心与较好的疾病严重程度相关，尤其是在男性患者中。记录显示有肌肉或关节疼痛的女性患者多于男性患者。头痛在15至39岁的患者中最为富集，其次是40至64岁的患者，具有统计学意义。
乏力和咳痰是COVID-19严重感染的体征。气短、胸闷、肌肉或关节疼痛以及干咳在重症患者中很常见。咳痰在老年个体和患有包括高血压在内的心血管疾病的患者中普遍存在。气短是男性患者严重感染的预后指标。鼻塞和恶心是严重感染的有利预后因素，尤其是在男性患者中。
