Association of olfactory dysfunction with hospitalization for COVID-19: a multicenter study in Kurdistan

  1. Hosna Zobairy
  2. Erfan Shamsoddin
  3. Mohammad Aziz Rasouli
  4. Nasrollah Veisi Khodlan
  5. Ghobad Moradi
  6. Bushra Zareie
  7. Sara Teymori
  8. Jalal Asadi
  9. Ahmad Sofi-Mahmudi
  10. Ahmad R Sedaghat

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Abstract

Objective

To evaluate the association of olfactory dysfunction (OD) with hospitalization for COVID-19.

Study Design

Multi-center cohort study.

Setting

Emergency departments of thirteen COVID-19-designed hospitals in Kurdistan province, Iran.

Subjects and Methods

Patients presenting with flu-like symptoms who tested positive by RT-PCR for COVID-19 between May 1 st and 31 st , 2020. At the time of presentation and enrollment, patients were asked about the presence of OD, fever, cough, shortness of breath, headache, rhinorrhea and sore throat. The severity of OD was assessed on an 11-point scale from 0 (none) to 10 (anosmia). Patients were either hospitalized or sent home for outpatient care based on standardized criteria.

Results

Of 203 patients, who presented at a mean of 6 days into the COVID-19 disease course, 25 patients (12.3%) had new OD and 138 patients (68.0%) were admitted for their COVID-19. Patients admitted for COVID-19 had a higher prevalence of all symptoms assessed, including OD (p<0.05 in all cases), and OD identified admitted patients with 84.0% sensitivity and 34.3% specificity. On univariate logistic regression, hospitalization was associated with OD (odds ratio [OR] = 2.47, 95%CI: 1.085–6.911, p=0.049). However, hospitalization for COVID-19 was not associated with OD (OR=3.22, 95% CI: 0.57–18.31, p=0.188) after controlling for confounding demographics and comorbidities.

Conclusion

OD may be associated with hospitalization for (and therefore more severe) COVID-19. However, this association between OD and COVID-19 severity is more likely driven by patient characteristics linked to OD, such as greater numbers of COVID-19 symptoms experienced or high-risk comorbidities.

Article activity feed

  1. ScreenIT

    SciScore for 10.1101/2020.07.26.20158550: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: The study protocol was approved by the Ethics Committee of Kurdistan University of Medical Sciences (ref. no. IR.MUK.REC.1399.006).
    Consent: All participants provided informed consent for inclusion in this study.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Statistical analysis: We used Statistical Package for the Social Sciences for Windows (SPSS version 25,0; IBM Corp, Armonk, NY, USA) to perform the statistical analyses.
    Statistical Package for the Social Sciences
    suggested: (SPSS, RRID:SCR_002865)
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Our study should be interpreted within the constraints of its limitations. First, although this was a multicenter study, all participants were from the Kurdistan province of Iran and subjective OD may be differentially reported than in other parts of the world. All of the patients who participated in our study also were presenting to an emergency department, which suggests that these patients were experiencing more severe symptoms in general, in contrast to other studies that have reported findings for COVID-19 patients with mild to moderate symptoms. Finally, we did not use objective assessment of OD due to limitations of practicality in the setting of emergency department treatment. As reported by Moein et al, who also studied Iranian COVID-19 patients, the subjectively reported prevalence of OD may be significantly lower than OD determined by objective testing.20

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. ScreenIT

    SciScore for 10.1101/2020.07.26.20158550: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementThe study protocol was approved by the Ethics Committee of Kurdistan University of Medical Sciences (ref. no. IR.MUK.REC.1399.006).Randomizationnot detected.Blindingnot detected.Power Analysisnot detected.Sex as a biological variableThere were 91 females (44.8%) and 112 males (55.2%).

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Statistical analysis We used Statistical Package for the Social Sciences for Windows (SPSS version 25,0; IBM Corp, Armonk, NY, USA) to perform the statistical analyses.
    Statistical Package for the Social Sciences
    suggested: (SPSS, RRID:SCR_002865)
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:

    Our study should be interpreted within the constraints of its limitations. First, although this was a multicenter study, all participants were from the Kurdistan province of Iran and subjective OD may be differentially reported than in other parts of the world. All of the patients who participated in our study also were presenting to an emergency department, which suggests that these patients were experiencing more severe symptoms in general, in contrast to other studies that have reported findings for COVID-19 patients with mild to moderate symptoms. Finally, we did not use objective assessment of OD due to limitations of practicality in the setting of emergency department treatment. As reported by Moein et al, who also studied Iranian COVID-19 patients, the subjectively reported prevalence of OD may be significantly lower than OD determined by objective testing.20 Conclusion Amongst patients presenting to emergency departments for COVID-19, patient-reported OD was more prevalent in those needing hospitalization for COVID-19. However, patientreported OD was a component of a generally higher prevalence of COVID-19 symptoms— including a greater prevalence of symptoms such as cough, fever, shortness of breath, headache, rhinorrhea and sore throat—as well as other high-risk comorbidities. Patient-reported OD in isolation may be a predictor of more severe COVID-19 and the need for hospitalization, but this association may be driven by other underlying risk factors for more severe disease.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore is not a substitute for expert review. SciScore checks for the presence and correctness of RRIDs (research resource identifiers) in the manuscript, and detects sentences that appear to be missing RRIDs. SciScore also checks to make sure that rigor criteria are addressed by authors. It does this by detecting sentences that discuss criteria such as blinding or power analysis. SciScore does not guarantee that the rigor criteria that it detects are appropriate for the particular study. Instead it assists authors, editors, and reviewers by drawing attention to sections of the manuscript that contain or should contain various rigor criteria and key resources. For details on the results shown here, including references cited, please follow this link.

  3. ScreenIT

    SciScore for 10.1101/2020.07.26.20158550: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementThe study protocol was approved by the Ethics Committee of Kurdistan University of Medical Sciences (ref. no. IR.MUK.REC.1399.006).Randomizationnot detected.Blindingnot detected.Power Analysisnot detected.Sex as a biological variableThere were 91 females (44.8%) and 112 males (55.2%).

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Statistical analysis We used Statistical Package for the Social Sciences for Windows (SPSS version 25,0; IBM Corp, Armonk, NY, USA) to perform the statistical analyses.
    Statistical Package for the Social Sciences
    suggested: (SPSS, RRID:SCR_002865)
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:

    Our study should be interpreted within the constraints of its limitations. First, although this was a multicenter study, all participants were from the Kurdistan province of Iran and subjective OD may be differentially reported than in other parts of the world. All of the patients who participated in our study also were presenting to an emergency department, which suggests that these patients were experiencing more severe symptoms in general, in contrast to other studies that have reported findings for COVID-19 patients with mild to moderate symptoms. Finally, we did not use objective assessment of OD due to limitations of practicality in the setting of emergency department treatment. As reported by Moein et al, who also studied Iranian COVID-19 patients, the subjectively reported prevalence of OD may be significantly lower than OD determined by objective testing.20 Conclusion Amongst patients presenting to emergency departments for COVID-19, patient-reported OD was more prevalent in those needing hospitalization for COVID-19. However, patientreported OD was a component of a generally higher prevalence of COVID-19 symptoms— including a greater prevalence of symptoms such as cough, fever, shortness of breath, headache, rhinorrhea and sore throat—as well as other high-risk comorbidities. Patient-reported OD in isolation may be a predictor of more severe COVID-19 and the need for hospitalization, but this association may be driven by other underlying risk factors for more severe disease.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore is not a substitute for expert review. SciScore checks for the presence and correctness of RRIDs (research resource identifiers) in the manuscript, and detects sentences that appear to be missing RRIDs. SciScore also checks to make sure that rigor criteria are addressed by authors. It does this by detecting sentences that discuss criteria such as blinding or power analysis. SciScore does not guarantee that the rigor criteria that it detects are appropriate for the particular study. Instead it assists authors, editors, and reviewers by drawing attention to sections of the manuscript that contain or should contain various rigor criteria and key resources. For details on the results shown here, including references cited, please follow this link.

  4. ScreenIT

    SciScore for 10.1101/2020.07.26.20158550: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementThe study protocol was approved by the Ethics Committee of Kurdistan University of Medical Sciences (ref. no. IR.MUK.REC.1399.006).Randomizationnot detected.Blindingnot detected.Power Analysisnot detected.Sex as a biological variableThere were 91 females (44.8%) and 112 males (55.2%).

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Statistical analysis We used Statistical Package for the Social Sciences for Windows (SPSS version 25,0; IBM Corp, Armonk, NY, USA) to perform the statistical analyses.
    Statistical Package for the Social Sciences
    suggested: (SPSS, SCR_002865)
          <div style="margin-bottom:8px">
        <div><b>SPSS</b></div>
        <div>suggested: (SPSS, <a href="https://scicrunch.org/resources/Any/search?q=SCR_002865">SCR_002865</a>)</div>
      </div>
    </td></tr></table>

    Data from additional tools added to each annotation on a weekly basis.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore is not a substitute for expert review. SciScore checks for the presence and correctness of RRIDs (research resource identifiers) in the manuscript, and detects sentences that appear to be missing RRIDs. SciScore also checks to make sure that rigor criteria are addressed by authors. It does this by detecting sentences that discuss criteria such as blinding or power analysis. SciScore does not guarantee that the rigor criteria that it detects are appropriate for the particular study. Instead it assists authors, editors, and reviewers by drawing attention to sections of the manuscript that contain or should contain various rigor criteria and key resources. For details on the results shown here, including references cited, please follow this link.

  5. Version published to 10.1101/2020.07.26.20158550v1 on medRxiv