Department of Geriatric Medicine, Elisabeth-TweeSteden Hospital, Location ETZ Elisabeth, Post Office Box 90151, 5000 LC, Tilburg, The Netherlands.
Department of Geriatric Medicine and Centre of Excellence for Old Age Medicine, Gelre Hospitals, Apeldoorn and Zutphen, The Netherlands.
Eur Geriatr Med. 2023 Apr;14(2):333-343. doi: 10.1007/s41999-022-00736-z. Epub 2023 Feb 7.
Older patients with COVID-19 can present with atypical complaints, such as falls or delirium. In other diseases, such an atypical presentation is associated with worse clinical outcomes. However, it is not known whether this extends to COVID-19. We aimed to study the association between atypical presentation of COVID-19, frailty and adverse outcomes, as well as the incidence of atypical presentation.
We conducted a retrospective observational multi-center cohort study in eight hospitals in the Netherlands. We included patients aged ≥ 70 years hospitalized with COVID-19 between February 2020 until May 2020. Atypical presentation of COVID-19 was defined as presentation without fever, cough and/or dyspnea. We collected data concerning symptoms on admission, demographics and frailty parameters [e.g., Charlson Comorbidity Index (CCI) and Clinical Frailty Scale (CFS)]. Outcome data included Intensive Care Unit (ICU) admission, discharge destination and 30-day mortality.
We included 780 patients, 9.5% (n = 74) of those patients had an atypical presentation. Patients with an atypical presentation were older (80 years, IQR 76-86 years; versus 79 years, IQR 74-84, p = 0.044) and were more often classified as severely frail (CFS 6-9) compared to patients with a typical presentation (47.6% vs 28.7%, p = 0.004). Overall, there was no significant difference in 30-day mortality between the two groups in univariate analysis (32.4% vs 41.5%; p = 0.173) or in multivariate analysis [OR 0.59 (95% CI 0.34-1.0); p = 0.058].
In this study, patients with an atypical presentation of COVID-19 were more frail compared to patients with a typical presentation. Contrary to our expectations, an atypical presentation was not associated with worse outcomes.
患有 COVID-19 的老年患者可能表现出非典型症状，如跌倒或意识混乱。在其他疾病中，这种非典型表现与更差的临床结局相关。然而，目前尚不清楚这是否适用于 COVID-19。我们旨在研究 COVID-19 的非典型表现、虚弱与不良结局之间的关系，以及非典型表现的发生率。
我们在荷兰的 8 家医院进行了一项回顾性、多中心队列研究。我们纳入了 2020 年 2 月至 2020 年 5 月期间因 COVID-19 住院的年龄≥70 岁的患者。COVID-19 的非典型表现定义为无发热、咳嗽和/或呼吸困难的表现。我们收集了入院时的症状、人口统计学和虚弱参数（如 Charlson 合并症指数（CCI）和临床虚弱量表（CFS））的数据。结局数据包括重症监护病房（ICU）入院、出院去向和 30 天死亡率。
我们纳入了 780 名患者，其中 9.5%（n=74）的患者表现出非典型症状。与表现出典型症状的患者相比，表现出非典型症状的患者年龄更大（80 岁，IQR 76-86 岁； versus 79 岁，IQR 74-84 岁，p=0.044），且更常被归类为严重虚弱（CFS 6-9）（47.6% vs 28.7%，p=0.004）。总体而言，在单因素分析中，两组间 30 天死亡率无显著差异（32.4% vs 41.5%；p=0.173）或多因素分析中（OR 0.59（95% CI 0.34-1.0）；p=0.058）。
在这项研究中，与表现出典型症状的患者相比，表现出 COVID-19 非典型症状的患者更虚弱。与我们的预期相反，非典型表现与不良结局无关。
