Self-Reported Symptoms of SARS-CoV-2 Infection in a Nonhospitalized Population in Italy: Cross-Sectional Study of the EPICOVID19 Web-Based Survey.
Self-Reported Symptoms of SARS-CoV-2 Infection in a Nonhospitalized Population in Italy: Cross-Sectional Study of the EPICOVID19 Web-Based Survey.
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DOI：
10.2196/21866
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发表时间：
2020-09-18
影响因子：
8.5
通讯作者：
Galli M
中科院分区：
文献类型：
--
作者：
Adorni F;Prinelli F;Bianchi F;Giacomelli A;Pagani G;Bernacchia D;Rusconi S;Maggi S;Trevisan C;Noale M;Molinaro S;Bastiani L;Fortunato L;Jesuthasan N;Sojic A;Pettenati C;Tavio M;Andreoni M;Mastroianni C;Antonelli Incalzi R;Galli M
了解意大利流行高峰期大量非住院人群中出现的与严重急性呼吸综合征冠状病毒2型（SARS-CoV-2）相似的症状至关重要;然而，目前数据不足。本研究的目的是评估非住院个体自我报告的症状与SARS-CoV-2鼻咽拭子（SARS-CoV-2）检测结果的相关性，并估计更大规模非检测人群中冠状病毒疾病（COVID-19）相关症状的发生率。EPICOVID 19是一项针对意大利成年人的自填式横断面自愿网络调查，他们在2020年4月13日至21日期间完成了一份匿名问卷。通过控制年龄、性别、教育、吸烟习惯和合并症数量的多元logistic回归分析，计算可能与SARS-CoV-2感染相关的症状和SARS结果之间的相关性，作为校正的比值比（aOR）和95% CI。此后，对于每种症状和症状组合，我们计算了受试者工作特征（ROC）分析中的灵敏度、特异性、准确性和曲线下面积（AUC），以估计非测试人群中COVID-19样感染的发生率。共有171 310人对调查作出了答复，其中102 543人（59.9%）是妇女;平均年龄47.4岁。在4785名有已知的HIV检测结果的受访者中，有4392人没有住院。在4392名未住院的受访者中，最常报告肌痛（527人，61.6%）、嗅觉和味觉障碍（507人，59.2%）、咳嗽（466人，54.4%）和发热（444人，51.9%）的患者中，有856人（19.5%）的尿液检测呈阳性，而7.7%的患者无症状。多元回归分析显示，嗅觉和味觉障碍（aOR 10.3，95%CI 8.4-12.7）、发烧（aOR 2.5，95%CI 2.0-3.1）、肌痛（aOR 1.5，95%CI 1.2-1.8）和咳嗽（aOR 1.3，95%CI 1.0-1.6）与NPS阳性相关。出现2 - 4个这些症状使aOR从7.4（95% CI 5.6-9.7）增加至35.5（95% CI 24.6-52.2）。四种症状的组合显示在分类阳性抗真菌药敏试验结果时的AUC为0.810（95% CI 0.795-0.825），然后应用于非住院和非检测样本（n= 165，782）。我们发现，在这165，782名受访者中，有7739至20，103人（4.4%至12.1%）出现了疑似COVID-19感染的症状。我们的研究结果表明，自我报告的症状是SARS-CoV-2感染在大流行背景下的可靠指标。不可忽略的有症状的受访者（高达12.1%）未被诊断，并可能导致感染的传播。ClinicalTrials.gov NCT 04471701; https://clinicaltrials.gov/ct2/show/NCT04471701
Understanding the occurrence of symptoms resembling those of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a large nonhospitalized population at the peak of the epidemic in Italy is of paramount importance; however, data are currently scarce. The aims of this study were to evaluate the association of self-reported symptoms with SARS-CoV-2 nasopharyngeal swab (NPS) test results in nonhospitalized individuals and to estimate the occurrence of symptoms associated with coronavirus disease (COVID-19) in a larger nontested population. EPICOVID19 is a self-administered cross-sectional voluntary web-based survey of adults throughout Italy who completed an anonymous questionnaire in the period of April 13 to 21, 2020. The associations between symptoms potentially related to SARS-CoV-2 infection and NPS results were calculated as adjusted odds ratios (aORs) with 95% CIs by multiple logistic regression analysis controlling for age, sex, education, smoking habits, and number of comorbidities. Thereafter, for each symptom and for combinations of the symptoms, we calculated the sensitivity, specificity, accuracy, and areas under the curve (AUCs) in a receiver operating characteristic (ROC) analysis to estimate the occurrence of COVID-19–like infection in the nontested population. A total of 171,310 people responded to the survey, of whom 102,543 (59.9%) were women; mean age 47.4 years. Out of the 4785 respondents with known NPS test results, 4392 were not hospitalized. Among the 4392 nonhospitalized respondents, those with positive NPS tests (856, 19.5%) most frequently reported myalgia (527, 61.6%), olfactory and taste disorders (507, 59.2%), cough (466, 54.4%), and fever (444, 51.9%), whereas 7.7% were asymptomatic. Multiple regression analysis showed that olfactory and taste disorders (aOR 10.3, 95% CI 8.4-12.7), fever (aOR 2.5, 95% CI 2.0-3.1), myalgia (aOR 1.5, 95% CI 1.2-1.8), and cough (aOR 1.3, 95% CI 1.0-1.6) were associated with NPS positivity. Having two to four of these symptoms increased the aOR from 7.4 (95% CI 5.6-9.7) to 35.5 (95% CI 24.6-52.2). The combination of the four symptoms showed an AUC of 0.810 (95% CI 0.795-0.825) in classifying positive NPS test results and then was applied to the nonhospitalized and nontested sample (n=165,782). We found that 7739 to 20,103 of these 165,782 respondents (4.4% to 12.1%) had experienced symptoms suggestive of COVID-19 infection. Our results suggest that self-reported symptoms are reliable indicators of SARS-CoV-2 infection in a pandemic context. A nonnegligible number of symptomatic respondents (up to 12.1%) were undiagnosed and potentially contributed to the spread of the infection. ClinicalTrials.gov NCT04471701; https://clinicaltrials.gov/ct2/show/NCT04471701
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