Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.
Department of Infectious Diseases and Immunity, Jessa Hospital, Hasselt, Belgium.
Eur J Clin Microbiol Infect Dis. 2021 May;40(5):987-995. doi: 10.1007/s10096-020-04109-x. Epub 2020 Dec 3.
There is a need for a quick assessment of severely ill patients presenting to the hospital. The objectives of this study were to identify clinical, laboratory and imaging parameters that could differentiate between influenza and COVID-19 and to assess the frequency and impact of early bacterial co-infection. A prospective observational cohort study was performed between February 2019 and April 2020. A retrospective cohort was studied early in the COVID-19 pandemic. Patients suspected of sepsis with PCR-confirmed influenza or SARS-CoV-2 were included. A multivariable logistic regression model was built to differentiate COVID-19 from influenza. In total, 103 patients tested positive for influenza and 110 patients for SARS-CoV-2, respectively. Hypertension (OR 6.550), both unilateral (OR 4.764) and bilateral (OR 7.916), chest X-ray abnormalities, lower temperature (OR 0.535), lower absolute leukocyte count (OR 0.857), lower AST levels (OR 0.946), higher LDH (OR 1.008), higher ALT (OR 1.044) and higher ferritin (OR 1.001) were predictive of COVID-19. Early bacterial co-infection was more frequent in patients with influenza (10.7% vs. 2.7%). Empiric antibiotic usage was high (76.7% vs. 84.5%). Several factors determined at presentation to the hospital can differentiate between influenza and COVID-19. In the future, this could help in triage, diagnosis and early management. Clinicaltrial.gov Identifier: NCT03841162.
需要快速评估因重病而到医院就诊的患者。本研究的目的是确定可区分流感和 COVID-19 的临床、实验室和影像学参数，并评估早期细菌合并感染的频率和影响。进行了一项 2019 年 2 月至 2020 年 4 月之间的前瞻性观察性队列研究。在 COVID-19 大流行早期对回顾性队列进行了研究。纳入了经 PCR 确诊为流感或 SARS-CoV-2 的疑似败血症患者。建立了一个多变量逻辑回归模型，以区分 COVID-19 和流感。共有 103 例患者的流感 PCR 检测结果呈阳性，110 例患者的 SARS-CoV-2 PCR 检测结果呈阳性。高血压（OR6.550）、单侧（OR4.764）和双侧（OR7.916）、胸部 X 线异常、较低的体温（OR0.535）、较低的绝对白细胞计数（OR0.857）、较低的 AST 水平（OR0.946）、较高的 LDH（OR1.008）、较高的 ALT（OR1.044）和较高的铁蛋白（OR1.001）与 COVID-19 相关。流感患者早期细菌合并感染更常见（10.7% vs. 2.7%）。经验性使用抗生素的情况较为普遍（76.7% vs. 84.5%）。在医院就诊时确定的几个因素可以区分流感和 COVID-19。在未来，这可能有助于分诊、诊断和早期管理。Clinicaltrial.gov 标识符：NCT03841162。
