الفهرس 
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Abstract
This is a prospective observational study to identify different extrapulmonary clinical manifestations of SARS-COV-2 and its correlations with the disease severity grades. The study enrolled patients from emergency room, isolation unit, chest outpatient clinics at Assiut University hospitals on a series of COVID-19 patients who were treated from April 1st, 2021, to June 5th, 2022. All patients were diagnosed positive with Covid-19 based on PCR test. The study participants were recruited after written consent by patients or their relatives.
It included 445 participants (208 females and 237 males), who were categorized into four groups according to severity of illness.; mild group (n=255), moderate group (n=60), severe group (n= 58), and critical group (n=29). All patients were subjected to full medical history including patients’ demographic data, clinical pulmonary and extrapulmonary symptoms based on the affected body systems were all included. Laboratory tests included complete blood picture (CBC), C-reactive protein (CRP), Ferritin, D dimer, lactate dehydrogenase, coagulation times, liver functions tests, kidney function test. In addition to any investigations were reported; according to each case when needed.
The mild group had the lowest mean age (50.20±17.4 years) compared to other groups. The highest covid infection rates were found in the age group of 70 to 80 years, where they reached (19.60%). The age range of 80 to 89 years had the higher critical severity of the Covid infection observed in 14 cases (48.3 percent). Moreover, the higher COVID-19 infection was seen in males, where they were 237 (53.30%).
Smokers were (32.8%) in COVID-19 patients, the critical and severe illness had higher smoking rates (65.6 percent and 60.3 percent, respectively) than other severity levels. The three main comorbid conditions linked to COVID-19 were diabetes (23.8%), hypertension (14.4%), and ischemic heart disease (12.80%).
The most common extrapulmonary manifestations of COVID-19 were the following, and they were all significantly increased with the disease’s severity:
• Neurological and psychiatric: headache (57.3), smell impairment (17.8),
• Gastrointestinal: nausea/vomiting (40.9%),and abdominal pain (31.3 %)
• Hematological Raised C-Reactive Protein (53.9%), lymphopenia (36%) , anemia (36%), leukocytosis (26.7 %), lymphocytosis (25.70 percent) thrombocytopenia (17.3%)
• Urological: hematuria (18.7%), albuminuria (15.7)
• Cardiovascular: heart failure (14.8%),
• Endocrinal: Ketoacidosis (8.8%) and Thyrotoxicosis (2.7%).
While data indicate that musculoskeletal, ocular, and dermatological symptoms were uncommon and have no relation with the COVID-19 severity.
Limitations
The impact of vaccination on patient outcomes whether they were better or worse was not examined.