Symptoms associated with severe disease

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The following symptoms are significantly associated with increased risk of severe disease, hospitalisation or mortality.

See the table in the full review here.  

Altered consciousness

One large cohort study identified altered consciousness or confusion as a symptom associated with increased risk of mortality.12

Altered mental status

One meta-analysis reported an increased risk of mortality in patients with COVID-19 and altered mental status (odds ratio (OR) 4.38, 95% confidence interval (CI) 2.53 to 7.58).13

Anorexia

Anorexia as a symptom of COVID-19 is associated with increased risk of mortality and severe disease.12,6,13 Odds ratios for mortality ranged from 1.13 (95% CI 0.9 to 1.36)6 to 1.54 (0.92 to 2.58)13, and there was a significant association with severe disease (OR 3.13, 95% CI 2.69 to 3.57).6

Chest pain

One meta-analysis found chest pain as a symptom of COVID-19 to be significantly associated with severe disease (OR 3.13 2.69 to 3.57),6 however, other studies did not find the association with ICU admission to be statistically significant, and one found a decreased risk of mortality.13,12

Cough

One large cohort study reported an increased risk of mortality with cough as a symptom of COVID-19.12 However, findings from other studies found no statistically significant association for mortality, ICU admission, hospital admission or severe disease.13,14,6

Dizziness

Dizziness was associated with increased risk of severe disease in one meta-analysis (OR 6.15, 95% CI 5.36 to 6.93).6

Dyspnoea

Dyspnoea as a symptom of COVID-19 has been found to be associated with increased risk of severe disease and mortality across several meta-analyses:6,12-14

Mortality: OR 2.70, 95% CI 2.16 to 3.39;13 3.21, 95% CI 2.04 to 4.37;6 3.47, 95% CI 1.67 to 7.1814

Severe disease: OR 6.28, 95% CI 3.10 to 12.7;14 7.32, 95% CI 1.06 to 13.57.6

Fatigue

A large cohort study and a meta-analysis reported an increased risk of mortality with fatigue as a symptom of COVID-19 (OR 1.33, 95% CI 1.04 to 1.33).6,12 Risk for severe disease was OR 1.74, 95% CI 1.26 to 2.21.6  Two other meta-analyses did not find the association to be statistically significant for mortality, severe disease or hospital admission.13,14

Fever

Fever as a symptom of COVID-19 was found to be significantly associated with increased risk of mortality in one large cohort study, but not in meta-analyses.12,6,13 There was, however, a significant association with hospital admission (OR 2.10, 95% CI 1.53 to 2.88)13 and severe disease (OR 1.98, 95% CI 1.05 to 2.91).6

Heart rate >100bpm

One meta-analysis identified heart rate >100 bpm as a symptom of COVID-19 associated with risk of mortality (OR 1.81, 95% CI 1.24 to 2.65).13

See the section on Clinical Signs for more information on heart rate

Inability to walk

Inability to walk was identified by one large cohort study as a symptom of COVID-19 associated with increased risk of mortality.12

Oxygen saturation <90%

One meta-analysis identified oxygen saturation <90% as a symptom of COVID-19 associated with risk of mortality (OR 4.37, 95% CI 2.98 to 6.42).13

See the section on Clinical Signs for more information on oxygen saturation measures.

Respiratory rate >24 bpm

One meta-analysis identified a respiratory rate >24 bpm as a symptom of COVID-19 associated with risk of mortality (OR 4.50, 95% CI 2.38 to 8.54).13

See the section on Clinical Signs for more information on oxygen saturation measures.

Severe dehydration

Severe dehydration was identified by one large cohort study as a symptom of COVID-19 associated with increased risk of mortality.12

Skin rash

Skin rash was identified by one large cohort study as a symptom of COVID-19 associated with increased risk of mortality.12

Sputum production

One meta-analysis identified sputum production as a symptom of COVID-19 associated with risk of mortality (OR 1.25, 95% CI 1.03 to 1.53).13

Vomiting

Vomiting was found to be associated with increased hospital admission in one meta-analysis (OR 1.58, 1.15 to 2.19).14 Another meta-analysis did not find a statistically significant risk for mortality or admission to an intensive care unit, and a large cohort study found a decreased risk of mortality in patients with COVID-19 who experienced vomiting.13,12

Wheeze

Wheeze was identified by one large cohort study as a symptom of COVID-19 associated with increased risk of mortality.12