Risk stratification of hospitalized COVID-19 patients through comparative studies of laboratory results with influenza.

BACKGROUND

The outbreak of coronavirus disease 2019 (COVID-19) in December 2019 overlaps with the flu season.

METHODS

We compared clinical and laboratory results from 719 influenza and 973 COVID-19 patients from January to April 2020. We compiled laboratory results from the first 14 days of the hospitalized patients using parameters that are most significantly different between COVID-19 and influenza and hierarchically clustered COVID-19 patients.

FINDINGS

Compared to influenza, patients with COVID-19 exhibited a continued increase in white blood cell count, rapid decline of hemoglobin, more rapid increase in blood urea nitrogen (BUN) and D-dimer, and higher level of alanine transaminase, C-reactive protein, ferritin, and fibrinogen. COVID-19 patients were sub-classified into 5 clusters through a hierarchical clustering analysis. Medical records were reviewed and patients were risk stratified based on the clinical outcomes. The cluster with the highest risk showed 27·8% fatality, 94% ICU admission, 94% intubation, and 28% discharge rates compared to 0%, 38%, 22%, and 88% in the lowest risk cluster, respectively. Patients in the highest risk cluster had leukocytosis including neutrophilia and monocytosis, severe anemia, increased red blood cell distribution width, higher BUN, creatinine, D-dimer, alkaline phosphatase, bilirubin, and troponin.

INTERPRETATION

There are significant differences in the clinical and laboratory courses between COVID-19 and influenza. Risk stratification in hospitalized COVID-19 patients using laboratory data could be useful to predict clinical outcomes and pathophysiology of these patients.

FUNDING

National Institute of Diabetes and Digestive and Kidney Disease, Department of Defense, and National Heart, Lung, and Blood Institute.