Comparisons in early and late presentation to Hospital in covid-19 patients

ABSTRACT

Background The clinical presentation and disease severity in SARS-Cov-2 infection ranges from asymptomatic carriage to death. There is little data regarding the timeframe of symptom onset to presentation to hospital, and disease outcomes. Therefore, we aim to investigate differences between 'early presenters' (< 7 days of symptom onset) and 'late presenters' (>7 days) and their clinical and radiological outcomes. Methods In this retrospective cohort study, symptom onset, epidemiological, and clinical characteristics were collected from patient electronic medical records at University Hospital Southampton Foundation Trust with laboratory confirmed SARS-Cov-2 infection. Logistical regression models were used to explore the relationships between these data and time of presentation to hospital. Results Between March and July 2020, symptom onset data was collected for 626 SARS-Cov-2 positive patients, 574 of whom had chest radiographs (CXR). Early presenters comprised 388 (62%) and 238 (38%) were late presenters. Early presenters were significantly older (p<0.001), more likely to have significant comorbidities-hypertension, thromboembolic and renal disease (p<0.001)- A nd also significantly less likely to report cardinal symptoms of Covid-19;fever, cough, SOB, myalgia, fatigue/malaise, headache (p<0.001). In the cohort overall, the presence of infiltrates was not predictive of adverse outcome (ICU admission, ventilation or death) (p=0.214). Although early presenters were less likely to have infiltrates on their CXR (58% vs 76.8%), (p<0.001), the presence of CXR infiltrates in early presenters demonstrated an increased risk of adverse outcome (OR 1.90, 95% CI 1.11, 3.25). Conclusion We have demonstrated that SARS-Cov-2 infection presents in an heterogenous manner that varies with symptom duration. Atypical presentation of SARS-Cov-2 infection is more common earlier on in disease course, where viral shedding is likely to be higher, and this finding is of note in the context of national criteria for self-isolation and testing. Late presentation is more likely to be associated with radiological change, but this does not reflect an increased likelihood of adverse outcome. Patients who present early in their illness with radiological changes are at increased risk of adverse clinical outcome, suggesting that symptom onset and detection of CXR infiltrates are important for clinical assessment of severity at presentation to hospital in Covid-19.