{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T14:24:50Z","timestamp":1774362290555,"version":"3.50.1"},"reference-count":33,"publisher":"Springer Science and Business Media LLC","issue":"5","license":[{"start":{"date-parts":[[2021,6,25]],"date-time":"2021-06-25T00:00:00Z","timestamp":1624579200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,6,25]],"date-time":"2021-06-25T00:00:00Z","timestamp":1624579200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Infection"],"published-print":{"date-parts":[[2021,10]]},"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n International, prospective observational study of 60\u2009109 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.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n \u2018Typical\u2019 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 (\u2264\u200918\u00a0years: 69, 48, 23; 85%), older adults (\u2265\u200970\u00a0years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each\n P<\/jats:italic>\n \u2009<\u20090.001). The most common atypical presentations under 60\u00a0years of age were nausea and vomiting and abdominal pain, and over 60\u00a0years was confusion. Regression models showed significant differences in symptoms with sex, age and country.\n <\/jats:p>\n <\/jats:sec>\n \n Interpretation<\/jats:title>\n 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\u00a0years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60\u00a0years. Women are less likely to experience typical symptoms than men.<\/jats:p>\n <\/jats:sec>","DOI":"10.1007\/s15010-021-01599-5","type":"journal-article","created":{"date-parts":[[2021,6,25]],"date-time":"2021-06-25T11:03:16Z","timestamp":1624618996000},"page":"889-905","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":59,"title":["COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study"],"prefix":"10.1007","volume":"49","author":[{"name":"ISARIC Clinical Characterisation Group","sequence":"first","affiliation":[]},{"given":"Sheryl Ann","family":"Abdukahil","sequence":"additional","affiliation":[]},{"given":"Ryuzo","family":"Abe","sequence":"additional","affiliation":[]},{"given":"Laurent","family":"Abel","sequence":"additional","affiliation":[]},{"given":"Lara","family":"Absil","sequence":"additional","affiliation":[]},{"given":"Andrew","family":"Acker","sequence":"additional","affiliation":[]},{"given":"Shingo","family":"Adachi","sequence":"additional","affiliation":[]},{"given":"Elisabeth","family":"Adam","sequence":"additional","affiliation":[]},{"given":"Diana","family":"Adri\u00e3o","sequence":"additional","affiliation":[]},{"given":"Kate","family":"Ainscough","sequence":"additional","affiliation":[]},{"given":"Ali Ait","family":"Hssain","sequence":"additional","affiliation":[]},{"given":"Younes Ait","family":"Tamlihat","sequence":"additional","affiliation":[]},{"given":"Takako","family":"Akimoto","sequence":"additional","affiliation":[]},{"given":"Tala","family":"Al-Dabbous","sequence":"additional","affiliation":[]},{"given":"Abdulrahman","family":"Al-Fares","sequence":"additional","affiliation":[]},{"given":"Eman","family":"Al Qasim","sequence":"additional","affiliation":[]},{"given":"Razi","family":"Alalqam","sequence":"additional","affiliation":[]},{"given":"Beatrice","family":"Alex","sequence":"additional","affiliation":[]},{"given":"K\u00e9vin","family":"Alexandre","sequence":"additional","affiliation":[]},{"given":"Huda","family":"Alfoudri","sequence":"additional","affiliation":[]},{"given":"Kazali Enagnon","family":"Alidjnou","sequence":"additional","affiliation":[]},{"given":"Jeffrey","family":"Aliudin","sequence":"additional","affiliation":[]},{"given":"Clotilde","family":"Allavena","sequence":"additional","affiliation":[]},{"given":"Nathalie","family":"Allou","sequence":"additional","affiliation":[]},{"given":"Jo\u00e3o","family":"Alves","sequence":"additional","affiliation":[]},{"given":"Rita","family":"Alves","sequence":"additional","affiliation":[]},{"given":"Maria","family":"Amaral","sequence":"additional","affiliation":[]},{"given":"Heidi","family":"Ammerlaan","sequence":"additional","affiliation":[]},{"given":"Phoebe","family":"Ampaw","sequence":"additional","affiliation":[]},{"given":"Roberto","family":"Andini","sequence":"additional","affiliation":[]},{"given":"Claire","family":"Andrejak","sequence":"additional","affiliation":[]},{"given":"Andrea","family":"Angheben","sequence":"additional","affiliation":[]},{"given":"Fran\u00e7ois","family":"Angoulvant","sequence":"additional","affiliation":[]},{"given":"S\u00e9verine","family":"Ansart","sequence":"additional","affiliation":[]},{"given":"Massimo","family":"Antonelli","sequence":"additional","affiliation":[]},{"given":"Carlos Alexandre Antunes","family":"De Brito","sequence":"additional","affiliation":[]},{"given":"Yaseen","family":"Arabi","sequence":"additional","affiliation":[]},{"given":"Irene","family":"Aragao","sequence":"additional","affiliation":[]},{"given":"Antonio","family":"Arcadipane","sequence":"additional","affiliation":[]},{"given":"Lukas","family":"Arenz","sequence":"additional","affiliation":[]},{"given":"Jean-Beno\u00eet","family":"Arlet","sequence":"additional","affiliation":[]},{"given":"Christel","family":"Arnold-Day","sequence":"additional","affiliation":[]},{"given":"Lovkesh","family":"Arora","sequence":"additional","affiliation":[]},{"given":"Elise","family":"Artaud-Macari","sequence":"additional","affiliation":[]},{"given":"Angel","family":"Asensio","sequence":"additional","affiliation":[]},{"given":"Jean Baptiste","family":"Assie","sequence":"additional","affiliation":[]},{"given":"Anika","family":"Atique","sequence":"additional","affiliation":[]},{"given":"Johann","family":"Auchabie","sequence":"additional","affiliation":[]},{"given":"Hugues","family":"Aumaitre","sequence":"additional","affiliation":[]},{"given":"Laur\u00e8ne","family":"Azemar","sequence":"additional","affiliation":[]},{"given":"C\u00e9cile","family":"Azoulay","sequence":"additional","affiliation":[]},{"given":"Benjamin","family":"Bach","sequence":"additional","affiliation":[]},{"given":"Delphine","family":"Bachelet","sequence":"additional","affiliation":[]},{"given":"J. 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Cheng declares grants from McGill Interdisciplinary Initiative in Infection and Immunity, and Canadian Institutes of Health Research; and personal fees from GEn1E Lifesciences (as a member of the scientific advisory board) and nplex biosciences (as a member of the scientific advisory board); M. Cummings and M. O'Donnell participated as investigators for completed and ongoing clinical trials evaluating the efficacy and safety of remdesivir (sponsored by Gilead Sciences) and convalescent plasma (sponsored by Amazon), in hospitalized patients with COVID-19\u2014support for this work is paid to Columbia University; J. C. Holter declared grants from Research Council of Norway [grant 312780], and Vivaldi Invest A\/S owned by Jon Stephenson von Tetzchner, during the conduct of the study; A.Kimmoun declared personal fees (payment for lectures) from Baxter, Aguettant, Aspen; D. Kumar declared grants and personal fees from Roche, GSK and Merck, and personal fees from Pfizer and Sanofi; F.X. Lescure declared personal fees (payment for lectures) from Gilead, MSD; and travel\/accommodation\/meeting expenses from Astellas, Eumedica, MSD; A. Pesenti declared personal fees from Maquet, Novalung\/Xenios, Baxter, and Boehringer Ingelheim; S. Shrapnel reported grants from Prince Charles Hospital Foundation during the conduct of the study, and concurrently performed data analytics for the COVID-19 Critical Care Consortium; R. Tedder reports grants from MRC\/UKRI during the conduct of the study, and has a patent United Kingdom Patent Application No. 2014047.1 \u201cSARS-CoV-2 antibody detection assay\u201d issued; J. Troost declared personal fees from General Electric and Procter and Gamble.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"This observational study required no change to clinical management and permitted enrolment in other research. The study was approved by the World Health Organization Ethics Review Committee (RPC571 and RPC572). Local ethics approval was obtained for each participating country and site according to local requirements.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"Informed consent was sought where required by local ethics committees. In many jurisdictions, ethics committees and public health authorities approved a waiver of consent to collect anonymised clinical data in the context of this public health emergency.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"Not applicable.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}}]}}