Department of Emergency and Critical Care Medicine, Nippon Medical School.
Self-Defense Forces Central Hospital.
J Nippon Med Sch. 2021 Mar 11;88(1):80-86. doi: 10.1272/jnms.JNMS.2021_88-107. Epub 2020 Aug 31.
Coronavirus disease 2019 (COVID-19) and heat-related illness are systemic febrile diseases. These illnesses must be differentiated during a COVID-19 pandemic in summer. However, no studies have compared and distinguished heat-related illness and COVID-19. We compared data from patients with early heat-related illness and those with COVID-19.
This retrospective observational study included 90 patients with early heat-related illness selected from the Heatstroke STUDY 2017-2019 (nationwide registries of heat-related illness in Japan) and 86 patients with laboratory-confirmed COVID-19 who had fever or fatigue and were admitted to one of two hospitals in Tokyo, Japan.
Among vital signs, systolic blood pressure (119 vs. 125 mm Hg, p = 0.02), oxygen saturation (98% vs. 97%, p < 0.001), and body temperature (36.6°C vs. 37.6°C, p<0.001) showed significant between-group differences in the heatstroke and COVID-19 groups, respectively. The numerous intergroup differences in laboratory findings included disparities in white blood cell count (10.8 × 10/μL vs. 5.2 × 10/μL, p<0.001), creatinine (2.2 vs. 0.85 mg/dL, p<0.001), and C-reactive protein (0.2 vs. 2.8 mg/dL, p<0.001), although a logistic regression model achieved an area under the curve (AUC) of 0.966 using these three factors. A Random Forest machine learning model achieved an accuracy, precision, recall, and AUC of 0.908, 0.976, 0.842, and 0.978, respectively. Creatinine was the most important feature of this model.
Acute kidney injury was associated with heat-related illness, which could be essential in distinguishing or evaluating patients with fever in the summer during a COVID-19 pandemic.
2019 年冠状病毒病（COVID-19）和与热相关的疾病是全身性发热性疾病。在夏季 COVID-19 大流行期间，必须对这些疾病进行区分。但是，尚无研究比较和区分与热相关的疾病和 COVID-19。我们比较了早期与热相关的疾病患者和 COVID-19 患者的数据。
这项回顾性观察性研究包括从日本全国性的与热相关疾病登记册（2017-2019 年的 Heatstroke STUDY）中选择的 90 名早期与热相关疾病患者，以及 86 名在日本东京的两家医院住院且有发热或疲劳的 COVID-19 患者。
在生命体征方面，收缩压（119 与 125mmHg，p=0.02）、血氧饱和度（98%与 97%，p<0.001）和体温（36.6°C 与 37.6°C，p<0.001）在两组之间有显著差异。实验室检查结果也存在许多组间差异，包括白细胞计数（10.8×10/μL 与 5.2×10/μL，p<0.001）、肌酐（2.2 与 0.85mg/dL，p<0.001）和 C 反应蛋白（0.2 与 2.8mg/dL，p<0.001）的差异。尽管使用这三个因素建立的逻辑回归模型曲线下面积（AUC）为 0.966，但随机森林机器学习模型的准确性、精密度、召回率和 AUC 分别为 0.908、0.976、0.842 和 0.978。肌酐是该模型最重要的特征。
急性肾损伤与与热相关的疾病有关，这在 COVID-19 大流行期间夏季鉴别或评估发热患者时可能很重要。
