Impact of upper and lower respiratory symptoms on COVID-19 outcomes: a multicenter retrospective cohort study

• Published in: Respiratory research Vol. 23; no. 1; pp. 315 - 14
• Main Authors: Nakagawara, Kensuke, Chubachi, Shotaro, Namkoong, Ho, Tanaka, Hiromu, Lee, Ho, Azekawa, Shuhei, Otake, Shiro, Fukushima, Takahiro, Morita, Atsuho, Watase, Mayuko, Sakurai, Kaori, Kusumoto, Tatsuya, Asakura, Takanori, Masaki, Katsunori, Kamata, Hirofumi, Ishii, Makoto, Hasegawa, Naoki, Harada, Norihiro, Ueda, Tetsuya, Ueda, Soichiro, Ishiguro, Takashi, Arimura, Ken, Saito, Fukuki, Yoshiyama, Takashi, Nakano, Yasushi, Mutoh, Yoshikazu, Suzuki, Yusuke, Edahiro, Ryuya, Murakami, Koji, Sato, Yasunori, Okada, Yukinori, Koike, Ryuji, Kitagawa, Yuko, Tokunaga, Katsushi, Kimura, Akinori, Imoto, Seiya, Miyano, Satoru, Ogawa, Seishi, Kanai, Takanori, Fukunaga, Koichi
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 15.11.2022; BioMed Central; BMC
• Subjects: Body mass index; Care and treatment; Clinical outcomes; Cohort analysis; Complications; Coronaviruses; COVID-19; COVID-19 - therapy; Diabetes; Diagnosis; Dyspnea; Hospitalization; Humans; Hypertension; Kidney diseases; Laboratories; Lower respiratory tract symptoms; Mechanical ventilation; Medicin och hälsovetenskap; Oxygen; Oxygen Inhalation Therapy; Oxygenation; Patients; Primary care; Pulmonary manifestations of general diseases; Respiration, Artificial; Respiratory tract; Retrospective Studies; SARS-CoV-2; SARS-CoV-2 infection; Severe acute respiratory syndrome coronavirus 2; Signs and symptoms; Statistical significance; Supplements; Task forces; Thromboembolism; Thrombosis; Upper respiratory tract symptoms; Viral diseases; Japan; COVID-19; Upper respiratory tract symptoms; SARS-CoV-2 infection; Lower respiratory tract symptoms; Primary care
• DOI: 10.1186/s12931-022-02222-3
• ISSN: 1465-993X; 1465-9921

Respiratory symptoms are associated with coronavirus disease 2019 (COVID-19) outcomes. However, the impacts of upper and lower respiratory symptoms on COVID-19 outcomes in the same population have not been compared. The objective of this study was to characterize upper and lower respiratory symptoms and compare their impacts on outcomes of hospitalized COVID-19 patients. This was a multicenter, retrospective cohort study; the database from the Japan COVID-19 Task Force was used. A total of 3314 COVID-19 patients were included in the study, and the data on respiratory symptoms were collected. The participants were classified according to their respiratory symptoms (Group 1: no respiratory symptoms, Group 2: only upper respiratory symptoms, Group 3: only lower respiratory symptoms, and Group 4: both upper and lower respiratory symptoms). The impacts of upper and lower respiratory symptoms on the clinical outcomes were compared. The primary outcome was the percentage of patients with poor clinical outcomes, including the need for oxygen supplementation via high-flow oxygen therapy, mechanical ventilation, and extracorporeal membrane oxygenation or death. Of the 3314 COVID-19 patients, 605, 1331, 1229, and 1149 were classified as Group 1, Group 2, Group 3, and Group 4, respectively. In univariate analysis, patients in Group 2 had the best clinical outcomes among all groups (odds ratio [OR]: 0.21, 95% confidence interval [CI]: 0.11-0.39), while patients in Group 3 had the worst outcomes (OR: 3.27, 95% CI: 2.43-4.40). Group 3 patients had the highest incidence of pneumonia, other complications due to secondary infections, and thrombosis during the clinical course. Upper and lower respiratory tract symptoms had vastly different impacts on the clinical outcomes of COVID-19.