Extra pulmonary versus pulmonary presentation of COVID-19 patients: comparative study

Abstract

The respiratory system is the most frequently affected system by COVID-19. However, a variety of extra-pulmonary systems can be influenced by COVID-19 with subsequent morbidity and mortality. This study aim is to report the most frequent extra pulmonary presentations of COVID-19 with comparison to patients with primary pulmonary presentation. Risk factors for ICU admission in both groups were examined. In this prospective comparative cross-sectional study, detailed demographics, medical history, clinical assessment, and computed tomography (CT) scan of the chest were done to all recruited patients with COVID-19. This study included a total of 1664 confirmed COVID-19 patients. The patients were categorized into two groups. Patients with pulmonary manifestations included 716 patients while 948 patients presented with extrapulmonary manifestations. Patients in the extrapulmonary group were older. The prevalence of certain chronic comorbid conditions was higher in the extra pulmonary group as cardiac, CNS, hepatic, and renal diseases, while chronic respiratory disorders were more prevalent in the pulmonary group (P value: < 0.0001). No significant difference in CT severity score between both groups. CORAD 5 was predominant in the pulmonary group (P value: < 0.0001). Most cases in both groups required hospital admission either inward or in ICU with higher frequency of ICU admission was observed in the pulmonary group. The significant risk factors for ICU admission in both groups were critically ill category of patients, CT severity, low oxygen saturation level, and the presence of comorbid chronic disease (P < 0.0001 with adjusted Odds ratio). CNS, cardiac, renal, and metabolic dysfunctions exert significant risk for ICU admission in the extrapulmonary group. Atypical or non-respiratory manifestations could be the presentation of a respiratory pathogen as reported in COVID-19. Our work highlights the extrapulmonary presentation of COVID-19. Older male patients were more prone to present with extra pulmonary symptoms. CNS, cardiac, renal, and metabolic dysfunctions were the most affected systems. This could impact the level of care required for patient management and the extent of resource utility.