77 - long Term Care Facility Residents Hospitalized with COVID-19 Infection Present with Atypical Symptoms

Background: Fever and cough are frequently reported in COVID-19 infections, although little is known about the subgroup of symptomatic patients who do not manifest these classic symptoms. We aimed to compare clinical manifestations and outcomes for hospitalized COVID-19 patients with typical vs. atypical presentations and identify risk factors for atypical COVID-19 presentations.

Methods: We conducted a retrospective cohort of all patients hospitalized with laboratory-confirmed COVID-19 infections during 3/13- 5/13/2020 at UW Health, a network of 3 acute-care hospitals in Midwest. We defined atypical cases as patients hospitalized for COVID-19 related reasons presenting without fever and cough and compared them in univariate analysis with patients manifesting both symptoms (controls). We identified independent risk factors for atypical COVID-19 presentations by logistic regression.

Results: Among the 163 patients hospitalized during the 60-day study frame, 39 (24%) had atypical presentations. Table 1 shows demographic, clinical manifestations, and outcomes of atypical vs. typical cases. On univariate analysis, atypical cases were more likely to be older, reside in a long-term-care facility (LTCF), have underlying diabetes mellitus, stroke, cardiac disease, and deny myalgias or dyspnea, despite having no significant difference in the prevalence of hypoxia or radiological lung infiltrates.  Atypical cases also had a significantly higher Beta-Natriuretic-Peptide and lower C-Reactive-Protein, although other inflammatory markers were not significantly different. They were less likely to be admitted to the ICU, and more likely to die within 30 days, as older patients with respiratory failure and multiple comorbidities opted for comfort measures and less aggressive care. On multivariate analysis, LTCF residence was the only independent predictor for atypical status (Table 2).Table 1. Characteristics associated with atypical COVID-19 presentation on admission to the hospital (univariate analysis)
Table 2. Independent risk factors/characteristics associated with atypical COVID-19 presentations in hospitalized patients, multivariate analysis


Conclusion: LTCF residents are more likely to experience COVID-19 respiratory illness (hypoxia, pneumonia) without classic symptoms (fever, cough, myalgias, dyspnea). Given the excessive pandemic burden in the LTCF setting, timely recognition and diagnosis of these atypical, more subtle presentations is critical.

Presenting Author(s)

• 

  Aurora E. Pop-Vicas, MD, MPH

  Assistant Professor of Medicine
  University of Wisconsin School of Medcine and Public Health
  Madison, WI

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

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Co-Author(s)

• AH

  Ambar Haleem, MD

  Assistant Professor of Medicine
  University of Wisconsin School of Medicine and Public Health, Madison, WI
  Madison, Wisconsin

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• FO

  Fauzia Osman, MPH

  Researcher, Biostatistics
  University of Wisconsin School of Medicine and Public Health, Madison, WI
  Madison, Wisconsin

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• DS

  Daniel Shirley, MD, MS

  Assistant Professor (CHS)
  University of Wisconsin-Madison School of Medicine and Public Health
  Madison, Wisconsin

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• RS

  Robert Striker, MD

  Associated Professor of Medicine
  University of Wisconsin School of Medicine and Public Health, Madison, WI
  Madison, Wisconsin

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• NS

  Nasia Safdar, MD, PhD

  Professor
  University of Wisconsin-Madison School of Medicine and Public Health
  Madison, Wisconsin

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.