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

BACKGROUND: Severe Acute Respiratory Syndrome Coronavirus 2 infection (SARS-CoV-2) outbreak had been declared a global pandemic. Identifying individuals potentially become severe is critical to control the case-fatality rate of coronavirus disease 2019 (COVID-19). Yet, knowledge on symptoms 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, stuffy nose, nausea, vomiting, muscle or joint ache, shortness of breath, and their associations with patient 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=0.141-0.334, P<.001), 'Expectoration' (95%CI=0.107-0.305, P<.001) and 'Stuffy nose' (95%CI=-0.499- -0.082, P=0.006) were identified as the prognostic symptoms of COVID-19 patients from the multivariate analysis. 'Fever' occurred in 92.1% of the patients, but was not associated with patient severity. 'Fatigue' accounted for 28.1% of the patients, and was linearly associated with infection severity with statistical significance. 'Expectoration' took 25.8% of the cohort size and was the sole prognostic factor for patients carrying cardiovascular complications including hypertension. 'Shortness of breath', 'chest distress', 'muscle or joint ache' and 'dry cough', each representing 5%, 12.7%, 11.9%, 42.1% of the patients, were significantly enriched in the 'severe' group. 'Stuffy nose' and 'nausea' were associated with favorable patient severity especially among males. More females than males were documented with 'Muscle or joint ache'. 'Headache' was enriched in the '15 to 39' age group followed by the '40 to 64' age group 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 elder individuals and patients carrying cardiovascular disorders including hypertension. 'Shortness of breath' is prognostic of severe infection in males. 'Stuffy nose' and 'nausea' are favorable factors especially among males. CLINICALTRIAL: