# Association Between Initial Symptoms and Clinical Outcomes in COVID-19

## TL;DR

This study found that initial symptoms of COVID-19, whether localized respiratory or systemic, did not predict more severe disease outcomes.

## Contribution

The study is the first to compare severe disease risk based on localized respiratory versus systemic initial symptoms in COVID-19.

## Key findings

- No significant differences in clinical outcomes were found between localized respiratory and systemic symptom groups.
- Mortality rates were 0.0% in the localized group and 4.6% in the systemic group.
- Inflammatory and oxidative stress biomarkers were similar between the two groups.

## Abstract

Background: The clinical presentation of coronavirus disease 2019 (COVID-19) ranges from localized respiratory symptoms such as cough and sore throat to systemic symptoms such as fever and fatigue. To our knowledge, no study has assessed severe disease risk by dividing onset symptoms into localized respiratory and other symptoms. We aimed to determine whether the risk of severe COVID-19 differs depending on whether the symptoms at onset are limited to local respiratory symptoms.

Method: This was a multicenter prospective cohort study. The patients were classified into localized respiratory or systemic symptom groups based on the symptoms at onset. Demographic data, blood biomarkers, and clinical outcomes, including mortality, intubation, admission to the intensive care unit, and time to discharge, were compared. This study included 100 adult patients diagnosed with COVID-19 between July 2020 and August 2021.

Result: Twelve patients were classified into the localized respiratory symptom group and the remaining 88 into the systemic symptom group. No significant differences between the groups were observed in the baseline characteristics, blood biomarkers, or clinical outcomes. The mortality rates were 0.0% and 4.6%, respectively. The median durations to discharge were 11 and 10 days, respectively (p=0.512). The levels of inflammatory and oxidative stress biomarkers, including interleukin-6 and hydroperoxides, were similar between the groups.

Conclusion: The symptom type at disease onset was not significantly associated with differences in clinical outcomes. Comprehensive assessments beyond initial symptoms are crucial for predicting disease progression and optimizing management strategies.