Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, Rorschacher Strasse 95, 9007, St. Gallen, Switzerland.
Clinical Trial Unit, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
BMC Infect Dis. 2021 Mar 17;21(1):271. doi: 10.1186/s12879-021-05957-4.
In the future, co-circulation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and influenza viruses A/B is likely. From a clinical point of view, differentiation of the two disease entities is crucial for patient management. We therefore aim to detect clinical differences between Coronavirus Disease 2019 (COVID-19) and seasonal influenza patients at time of hospital admission.
In this single-center observational study, we included all consecutive patients hospitalized for COVID-19 or influenza between November 2019 and May 2020. Data were extracted from a nationwide surveillance program and from electronic health records. COVID-19 and influenza patients were compared in terms of baseline characteristics, clinical presentation and outcome. We used recursive partitioning to generate a classification tree to discriminate COVID-19 from influenza patients.
We included 96 COVID-19 and 96 influenza patients. Median age was 68 vs. 70 years (p = 0.90), 72% vs. 56% (p = 0.024) were males, and median Charlson Comorbidity Index (CCI) was 1 vs. 2 (p = 0.027) in COVID-19 and influenza patients, respectively. Time from symptom onset to hospital admission was longer for COVID-19 (median 7 days, IQR 3-10) than for influenza patients (median 3 days, IQR 2-5, p < 0.001). Other variables favoring a diagnosis of COVID-19 in the classification tree were higher systolic blood pressure, lack of productive sputum, and lack of headache. The tree classified 86/192 patients (45%) into two subsets with ≥80% of patients having influenza or COVID-19, respectively. In-hospital mortality was higher for COVID-19 patients (16% vs. 5%, p = 0.018).
Discriminating COVID-19 from influenza patients based on clinical presentation is challenging. Time from symptom onset to hospital admission is considerably longer in COVID-19 than in influenza patients and showed the strongest discriminatory power in our classification tree. Although they had fewer comorbidities, in-hospital mortality was higher for COVID-19 patients.
未来，严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) 和流感病毒 A/B 可能会同时流行。从临床角度来看，区分这两种疾病实体对于患者管理至关重要。因此，我们旨在检测入院时 2019 年冠状病毒病 (COVID-19) 和季节性流感患者之间的临床差异。
在这项单中心观察性研究中，我们纳入了 2019 年 11 月至 2020 年 5 月期间因 COVID-19 或流感住院的所有连续患者。数据从全国监测计划和电子健康记录中提取。比较 COVID-19 和流感患者的基线特征、临床表现和结局。我们使用递归分区生成分类树来区分 COVID-19 和流感患者。
我们纳入了 96 例 COVID-19 和 96 例流感患者。中位年龄分别为 68 岁和 70 岁（p=0.90），72%和 56%为男性（p=0.024），COVID-19 和流感患者的中位 Charlson 合并症指数 (CCI) 分别为 1 和 2（p=0.027）。COVID-19 患者从症状发作到住院的时间中位数为 7 天（IQR 3-10），长于流感患者（中位数 3 天，IQR 2-5，p<0.001）。有利于分类树中 COVID-19 诊断的其他变量包括较高的收缩压、无痰、无头痛。该树将 192 例患者中的 86 例（45%）分为两个亚组，分别有≥80%的患者患有流感或 COVID-19。COVID-19 患者的住院死亡率较高（16%比 5%，p=0.018）。
根据临床表现区分 COVID-19 和流感患者具有挑战性。COVID-19 患者从症状发作到住院的时间明显长于流感患者，并且在我们的分类树中显示出最强的区分能力。尽管 COVID-19 患者的合并症较少，但住院死亡率较高。
