Analysis of risk factors and presentation of symptoms among groups at risk of SARS-CoV-2 infection


The emergence of a new coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) led to a group of cases of pneumonia in Wuhan, China, in late 2019. SARS-CoV-2 causes coronavirus disease 2019 (COVID-19), leading to an epidemic in China, followed by a global pandemic.

Recent reports show that SARS-CoV-2 has infected more than 266 million people worldwide and claimed the lives of more than 5.26 million. COVID-19 is characterized by a high degree of transmission, variable clinical picture and severity of symptoms. Estimates range from 33 to 77 percent of those infected asymptomatic. However, it has also been reported that few asymptomatic individuals may consist of unnoticed clinical abnormalities.

Reports also show that among patients who test positive for COVID-19, 80 percent have mild illness, 15 percent have severe illness, and 5 percent have critical illness. In addition, the overall mortality rate was found to be 2 percent, while the death rate among hospitalized people was 10 to 20 percent.

A new study by researchers from Northeastern University focuses only on patients with COVID-19 with type 1 diabetes, alopecia and vitiligo. Alopecia is an autoimmune disease that targets hair follicles, vitiligo an autoimmune / inflammatory disease that attacks the pigment cells of the epidermal layer, and diabetes affects the pancreas.

The study published on the prepress server medRxiv*, analyzed the specific relationships between patients with COVID-19 belonging to the three risk groups with the general patients with COVID-19 and compared the symptoms between and within the risk groups.

The study also aimed to determine whether autoimmunity / inflammatory action had any effect on the severity of SARS-CoV-2 infections.

Study: Assessment of the correlations between risk factors and the presentation of symptoms among certain risk groups after a confirmed diagnosis of COVID-19.  Image credit: GoodStudio / Shutterstock
Study: Assessment of the correlations between risk factors and the presentation of symptoms among certain risk groups after a confirmed diagnosis of COVID-19. Image credit: GoodStudio / Shutterstock

About the study

The study was conducted in two phases. Phase I included determining whether there was a significant difference between the onset of a specific symptom compared to all other symptoms studied in patients with COVID-19 who belonged to the general group and the risk group. Phase II helped determine whether there were significant differences in symptom presentation in patients with COVID-19 with comorbid autoimmune diseases of varying severity and location.

The study analyzed three experimental groups, patients with type 1 diabetes, vitiligo and alopecia, and one control group. All groups had to test positive for SARS-CoV-2 infection. The survey data were obtained from the N3C Enclave, an initiative led by the National Center for the Advancement of Translational Sciences (NCATS).

In addition, concept kits were developed and used for the fourteen most common symptoms associated with COVID-19 infection. The study also determined the positivity of COVID-19 through laboratory tests and determined the occurrence of symptoms in all patients who have at least one symptom defined in the concept.

Survey results

The results of the study did not reveal a significant difference between the presentation of symptoms in the risk groups compared to the general groups. However, the results show a higher percentage of COVID-19 symptoms in all immune groups except type 1 diabetes, where the percentages are slightly lower than in the whole group. It was also found that 0 percent of patients fall into the rash group, with the exception of the alopecia group, where less than 1 percent of patients were found to develop alopecia within one month of symptoms.

Heat chart of p-values ​​in a set of All COVID positive patients to compare all symptoms with each other symptom and compare with each of the three immune groups (alopecia, vitiligo and type 1 diabetes);  the intensity of the color increases with decreasing value;  the following abbreviations are used: breathing (respiratory abnormalities), loss (loss of taste / smell), chest (chest pain / pressure), mental (impaired consciousness)
Heat chart of p-values ​​in a set of All COVID positive patients to compare all symptoms with each other symptom and compare with each of the three immune groups (alopecia, vitiligo and type 1 diabetes); the intensity of the color increases with decreasing value; the following abbreviations are used: breathing (respiratory abnormalities), loss (loss of taste / smell), chest (chest pain / pressure), mental (impaired consciousness)

The results also show a significant association between the three immune groups and the fourteen symptoms included in the concept. However, there were some exceptions, such as the group with alopecia did not matter for the group with mental (impaired consciousness) symptoms, the group with type 1 diabetes did not matter for rash, congestion, sore throat and loss of smell / taste, and the group with vitiligo did not matter for the rash group. In addition, the interactions of symptoms between the three immune groups were found to be less significant than in the whole group.

Therefore, from the present study, it can be concluded that patients belonging to the three immune groups are more likely to be symptomatic than patients belonging to the whole group. However, no variations in severity or symptoms were observed in the three immune groups. Also, fewer associations between symptoms were observed in the three immune groups. Thus, more care should be taken when generating models and building diagnostic tools for COVID in people with pre-existing immune conditions. This study also calls for a more targeted assessment and treatment process for patients with COVID-19 with immune comorbidities.

*Important message

medRxiv publishes preliminary scientific reports that are not reviewed by partners and therefore should not be considered convincing, guiding clinical practice / health-related behavior, or treated as established information.



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