Identification of Symptoms Prognostic of COVID-19 Severity: Multivariate Data Analysis of a Case Series in Henan Province

Background: 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. Objective: The objective of our study was to identify
symptoms prognostic of COVID-19 infection severity. Methods: 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. Results: 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. Conclusions: 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.

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Identification of Symptoms Prognostic of COVID-19 Severity:
Multivariate Data Analysis of a Case Series in Henan
Province