COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Correction to: Surgery and outcome of infective endocarditis in octogenarians: prospective data from the ESC EORP EURO-ENDO registry (Infection, (2022), 50, 5, (1191-1202), 10.1007/s15010-022-01792-0)

In this article the “EURO-ENDO Investigators group” member U. Y. Sinan was incorrectly written as U.S. Yasar. The original article has been corrected

Surgery and outcome of infective endocarditis in octogenarians: prospective data from the ESC EORP EURO-ENDO registry

none912Purpose: High mortality and a limited performance of valvular surgery are typical features of infective endocarditis (IE) in octogenarians, even though surgical treatment is a major determinant of a successful outcome in IE. Methods: Data from the prospective multicentre ESC EORP EURO-ENDO registry were used to assess the prognostic role of valvular surgery depending on age. Results: As compared to < 80 yo patients, ≥ 80 yo had lower rates of theoretical indication for valvular surgery (49.1% vs. 60.3%, p < 0.001), of surgery performed (37.0% vs. 75.5%, p < 0.001), and a higher in-hospital (25.9% vs. 15.8%, p < 0.001) and 1-year mortality (41.3% vs. 22.2%, p < 0.001). By multivariable analysis, age per se was not predictive of 1-year mortality, but lack of surgical procedures when indicated was strongly predictive (HR 2.98 [2.43-3.66]). By propensity analysis, 304 ≥ 80 yo were matched to 608 < 80 yo patients. Propensity analysis confirmed the lower rate of indication for valvular surgery (51.3% vs. 57.2%, p = 0.031) and of surgery performed (35.3% vs. 68.4%, p < 0.0001) in ≥ 80 yo. Overall mortality remained higher in ≥ 80 yo (in-hospital: HR 1.50[1.06-2.13], p = 0.0210; 1-yr: HR 1.58[1.21-2.05], p = 0.0006), but was not different from that of < 80 yo among those who had surgery (in-hospital: 19.7% vs. 20.0%, p = 0.4236; 1-year: 27.3% vs. 25.5%, p = 0.7176). Conclusion: Although mortality rates are consistently higher in ≥ 80 yo patients than in < 80 yo patients in the general population, mortality of surgery in ≥ 80 yo is similar to < 80 yo after matching patients. These results confirm the importance of a better recognition of surgical indication and of an increased performance of surgery in ≥ 80 yo patients.nonePazdernik, Michal; Iung, Bernard; Mutlu, Bulent; Alla, François; Riezebos, Robert; Kong, William; Nunes, Maria Carmo Pereira; Pierard, Luc; Srdanovic, Ilija; Yamada, Hirotsugu; De Martino, Andrea; Miglioranza, Marcelo Haertel; Magne, Julien; Piper, Cornelia; Laroche, Cécile; Maggioni, Aldo P; Lancellotti, Patrizio; Habib, Gilbert; Selton-Suty, Christine, EURO-ENDO Investigators group: R Ronderos, G Avegliano, P Fernandez Oses, E Filipini, I Granada, A Iribarren, M Mahia, F Nacinovich, S Ressi, R Obregon, M Bangher, J Dho, L Cartasegna, M L Plastino, V Novas, C Shigel, G Reyes, M De Santos, N Gastaldello, M Granillo Fernandez, M Potito, G Streitenberger, P Velazco, J H Casabé, C Cortes, E Guevara, F Salmo, M Seijo, F Weidinger, M Heger, R Brooks, C Stöllberger, C-Y Ho, L Perschy, L Puskas, G Goliasch, C Binder, R Rosenhek, M Schneider, 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T Staub, L Jacobs-Orazi, C Mallia Azzopardi, R G Xuereb, T Piscopo, D Borg, R Casha, J Farrugia, M Fenech, E Pllaha, C Vella, K Yamagata, L Grib, E Raevschi, A Grejdieru, G Balan, I Cardaniuc, L Cardaniuc, V Corcea, A Feodorovici, V Gaina, L Girbu, P Jimbei, D Kravcenco, E Panfile, E Prisacari, E Samohvalov, S Samohvalov, N Sceglova, I Benesco, V Marian, N Sumarga, M Mirocevic, B Bozovic, N Bulatovic, P Lakovic, L Music, J Roos-Hesselink, R Budde, T Gamela, A Wahadat, O Kamp, T Meijers, J P Van Melle, V M Deursen, H Crijns, S Bekkers, E Cheriex, M Gilbers, B Kietselaer, C Knackstedt, R Lorusso, S Schalla, S Streukens, S Chamuleau, M-J Cramer, A Teske, T Van der Spoel, A Wind, O Liesbek, J Lokhorst, H Van Heusden, W Tanis, I Van der Bilt, J Vriend, H De Lange-van Bruggen, E Karijodikoro, R Riezebos, E van Dongen, J Schoep, V Stolk, O Axler, F Baumann, S Lebras, T Edvardsen, J T Offstad, J O Beitnes, T Helle-Valle, H Skulstad, R Skardal, N Qamar, S Furnaz, B Ahmed, M H Butt, M F Khanzada, T Saghir, A Wahid, T Hryniewiecki, P Szymanski, K Marzec, M Misztal-Ogonowska, W Kosmala, M Przewlocka-Kosmala, A Rojek, K Woznicka, J Zachwyc, A Lisowska, M Kaminska, J Kasprzak, E Kowalczyk, D F Strzecka, P Wejner-Mik, M Trabulo, P Freitas, S Ranchordas, G Rodrigues, P Pinto, C Queiros, J Azevedo, L Marques, D Seabra, L Branco, J Abreu, M Cruz, A Galrinho, R Moreira, P Rio, A T Timoteo, M Selas, N M Cardim, V Carmelo, B Duque Neves, H Pereira, I Cruz, A Guerra, A Marques, I Pintassilgo, M C Tomescu, N-M Trofenciuc, M Andor, A Bordejevic, H S Branea, F Caruntu, L Cirin, I M Citu, C A Cotoraci, D Darabantiu, R Farcas, I Marincu, A Mavrea, M F Onel, T Parvanescu, D Pop, A L Pop-Moldovan, M I Puticiu, L A Velcean, A Ionac, D Cozma, C Mornos, F Goanta, I Popescu, R Beyer, R Mada, R Rancea, H Rosianu, R Tomoaia, C Stanescu, Z Kobalava, J Karaulova, E Kotova, A Milto, A Pisaryuk, N Povalyaev, M Sorokina, J Alrahimi, A Elshiekh, A Jamiel, A Ahmed, M Al-Mallah, N Attia, B 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C Farinas Alvarez, J Aguero Balbin, C Arminanzas, F Arnaiz de Las Revillas, A Arnaiz Garcia, M Cobo Belaustegui, M Fernandez Sampedro, M Gutierrez Cuadra, J F Gutierrez-Diez, J Zarauza, L Garcia Cuello, C Gonzalez Rico, R Rodriguez-Alvarez, J Goikoetxea, M Montejo, J Miro, M Almela, J Ambrosioni, C Falces, D Fuster, C Garcia-de-la-Maria, M Hernandez-Meneses, J Llopis, F Marco, A Moreno, E Quintana, E Sandoval, A Tellez, J M Tolosana, B Vidal, I Ruiz-Zamora, A Bardaji Ruiz, E Sanz Girgas, G Garcia-Pardo, M Guillen Marzo, A Rodriguez Oviedo, A Villares Jimenez, L Abid, R Hammami, S Kammoun, M S Mourali, F Mghaieth Zghal, M Ben Hlima, S Boudiche, S Ouali, L Zakhama, S Antit, I Slama, O Gulel, M Sahin, L E Sade, E Karacaglar, S Kucukoglu, O Cetinarslan, U S Yasar, U Canpolat, B Mutlu, H Atas, R Dervishova, C Ileri, H Zaky, J Alhashmi, F Baslib, J Tahir, P Zarger, S Woldman, L Menezes, C Primus, R Uppal, I Bvekerwa, B Chandrasekaran, A Kopanska, B Prendergast, S Cannata, J Chambers, J Hancock, J Klein, R Rajani, M P Ursi, R Dworakowski, A Fife, J Breeze, M Browne-Morgan, M Gunning, S Streather, F Asch, M Zemedkun, B Alyavi, J UzokovMichal, Pazdernik; Bernard, Iung; Bulent, Mutlu; François, Alla; Robert, Riezebos; William, Kong; Maria Carmo Pereira, Nunes; Luc, Pierard; Ilija, Srdanovic; Hirotsugu, Yamada; Andrea, De Martino; Marcelo Haertel, Miglioranza; Julien, Magne; Cornelia, Piper; Cécile, Laroche; Aldo P, Maggioni; Patrizio, Lancellotti; Gilbert, Habib; Christine, Selton-Suty; R Ronderos, EURO-ENDO Investigators group:; Avegliano, G; Fernandez Oses, P; Filipini, E; Granada, I; Iribarren, A; Mahia, M; Nacinovich, F; Ressi, S; Obregon, R; Bangher, M; Dho, J; Cartasegna, L; L Plastino, M; Novas, V; Shigel, C; Reyes, G; De Santos, M; Gastaldello, N; Granillo Fernandez, M; Potito, M; Streitenberger, G; Velazco, P; H Casabé, J; Cortes, C; Guevara, E; Salmo, F; Seijo, M; Weidinger, F; Heger, M; Brooks, R; Stöllberger, C; Ho, C-Y; Perschy, L; Puskas, L; Goliasch, G; Binder, C; Rosenhek, R; Schneider, M; Winter, M-P; Hoffer, E; Melissopoulou, M; Lecoq, E; Legrand, D; Jacquet, S; Massoz, M; Lancellotti, P; Pierard, L; Dulgheru, R; Marchetta, S; D Emal, C; Oury, C; Cosyns, B; Droogmans, S; Kerkhove, D; Motoc, A; Plein, D; Roosens, B; Soens, L; Weytjens, C; Lemoine, I; Rodrigus, I; Paelinck, B; Amsel, B; Unger, P; Konopnicki, D; Beauloye, C; Pasquet, A; Pierard, S; Vancraeynest, D; L Vanoverschelde, J; Sinnaeve, F; L Andrade, J; C Tude Rodrigues, A; Staszko, K; Dos Santos Monteiro, R; H Miglioranza, M; L Shuha, D; Alcantara, M; Cravo, V; Fazzio, L; Felix, A; Iso, M; Musa, C; P Siciliano, A; Villaca Filho, F; Braga, J; Rodrigues, A; Silva, R; Vilela, F; Rodrigues, D; Silva, L; Morhy, S; Fischer, C; Silva, R; Vieira, M; Afonso, T; Abreu, J; N Falcao, S; Moises, V; Gouvea, A; João, G; Mancuso, F; Silva, C; C Souza, A; S Abboud, C; Bellio de Mattos Barretto, R; Ramos, A; Arnoni, R; E Assef, J; J Della Togna, D; Le Bihan, D; Miglioli, L; P Romero Oliveira, A; Tadeu Magro Kroll, R; Cortez, D; L Gelape, C; C Peirira Nunes, M D; C De Abreu Ferrari, T; Chan, K-L; Hay, K; Le, V; Page, M; Poulin, F; Sauve, C; Serri, K; Mercure, C; Beaudoin, J; Pibarot, P; Sebag, I; Rudski, L; Ricafort, G; Barsic, B; Krajinovic, V; Vargovic, M; Separovic-Hanzevacki, J; Lovric, D; Reskovic-Luksic, V; Vincelj, J; Jaksic Jurinjak, S; Yiannikourides, V; Ioannides, M; Kyriakou, C; Pofaides, C; Masoura, V; Yiangou, K; Pudich, J; Linhart, A; Siranec, M; Marek, J; Blechova, K; Kamenik, M; Pazdernik, M; Pelouch, R; Coufal, Z; Mikulica, M; Griva, M; Jancova, E; Mikulcova, M; Taborsky, M; Precek, J; Jecmenova, M; Latal, J; Widimsky, J; Butta, T; Machacek, S; Vancata, R; Spinar, J; Holicka, M; Pow Chon Long, F; Anzules, N; Bajana Carpio, A; Largacha, G; Penaherrera, E; Moreira, D; Mahfouz, E; Elsafty, E; Soliman, A; Zayed, Y; Aboulenein, J; Abdel-Hay, M; Almaghraby, A; Abdelnaby, M; Ahmed, M; Hammad, B; Saleh, Y; Zahran, H; Elgebaly, O; Saad, A; Ali, M; Zeid, A; El 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Seabra, D; Branco, L; Abreu, J; Cruz, M; Galrinho, A; Moreira, R; Rio, P; T Timoteo, A; Selas, M; M Cardim, N; Carmelo, V; Duque Neves, B; Pereira, H; Cruz, I; Guerra, A; Marques, A; Pintassilg

Surgery and outcome of infective endocarditis in octogenarians: prospective data from the ESC EORP EURO-ENDO registry

Purpose: High mortality and a limited performance of valvular surgery are typical features of infective endocarditis (IE) in octogenarians, even though surgical treatment is a major determinant of a successful outcome in IE. Methods: Data from the prospective multicentre ESC EORP EURO-ENDO registry were used to assess the prognostic role of valvular surgery depending on age. Results: As compared to < 80 yo patients, ≥ 80 yo had lower rates of theoretical indication for valvular surgery (49.1% vs. 60.3%, p < 0.001), of surgery performed (37.0% vs. 75.5%, p < 0.001), and a higher in-hospital (25.9% vs. 15.8%, p < 0.001) and 1-year mortality (41.3% vs. 22.2%, p < 0.001). By multivariable analysis, age per se was not predictive of 1-year mortality, but lack of surgical procedures when indicated was strongly predictive (HR 2.98 [2.43–3.66]). By propensity analysis, 304 ≥ 80 yo were matched to 608 < 80 yo patients. Propensity analysis confirmed the lower rate of indication for valvular surgery (51.3% vs. 57.2%, p = 0.031) and of surgery performed (35.3% vs. 68.4%, p < 0.0001) in ≥ 80 yo. Overall mortality remained higher in ≥ 80 yo (in-hospital: HR 1.50[1.06–2.13], p = 0.0210; 1-yr: HR 1.58[1.21–2.05], p = 0.0006), but was not different from that of < 80 yo among those who had surgery (in-hospital: 19.7% vs. 20.0%, p = 0.4236; 1-year: 27.3% vs. 25.5%, p = 0.7176). Conclusion: Although mortality rates are consistently higher in ≥ 80 yo patients than in < 80 yo patients in the general population, mortality of surgery in ≥ 80 yo is similar to < 80 yo after matching patients. These results confirm the importance of a better recognition of surgical indication and of an increased performance of surgery in ≥ 80 yo patients