Federica Montseny Primary Care Centre. Av. Albufera 285, 28035, Madrid, Spain.
Accident and Emergency Department, Hospital Infanta Leonor, Av. Gran Vía del Este, 80, 28031, Madrid, Spain.
BMC Fam Pract. 2021 Apr 29;22(1):83. doi: 10.1186/s12875-021-01430-y.
Possible cases of SARS-CoV-2 infection were diagnosed in primary care in Madrid, some of these cases had pneumonia. Most of the SARS-CoV-2 pneumonia published data came from hospitalised patients. This study set out to describe clinical characteristics of patients with SARS-CoV-2 pneumonia diagnosed in primary care across age groups and type of pneumonia.
Observational retrospective study obtaining clinical data from the electronic health records of patients who were followed-up by SARS-CoV-2 possible infection in a primary care practice in Madrid. All the cases were collected by in-person or remote consultation during the 10th March to the 7th of April.
Diagnosis of SARS-CoV-2 pneumonia by chest X-ray ordered by the GP. Main outcomes and measures: Symptoms of SARS-CoV-2 pneumonia, physical examination and diagnostic tests as a blood test, nasopharyngeal swab results for RT-PCR (Reverse transcriptase-polymerase chain reaction) and chest X-ray results.
The overall SARS-CoV-2 pneumonias collected were 172 (female 87 [50.6%], mean age 60.5 years standard deviation [SD] 17.0). Comorbidities were body mass index ≥ 25 kg/m (90 [52.3%]), hypertension (83 [48.3%]), dyslipidaemia (68 [39.5%]) and diabetes (33 [19.2%]). The sample was stratified by age groups (< 50 years, 50-75 years and ≥ 75 years). Clinical manifestations at onset were fever (144 [83.7%]), cough (140 [81.4%]), dyspnoea (103 [59.9%]) and gastrointestinal disturbances (72 [41.9%]). Day 7.8 (SD:4.1) from clinical onset was the mean day of pneumonia diagnosis. Bilateral pneumonia was more prevalent than unilateral (126 [73.3%] and 46 [26.7%]). Patients with unilateral pneumonia were prone to higher pulse oximetry (96% vs 94%, p < 0.001). We found differences between unilateral and bilateral cases in C-reactive protein (29.6 vs 81.5 mg/L, p < 0.001), and lymphocytes (1400.0 vs 1000.0E3/ml, p < 0.001). Complications were registered: 42 (100%) of patients ≥ 75 years were admitted into hospital; pulmonary embolism was only present at bilateral pneumonia (7 patients [5.6%]) and death occurred in 1 patient with unilateral pneumonia (2.2%) vs 10 patients (7.9%) with bilateral pneumonia ( p 0.170).
Clinical manifestations of SARS-CoV-2 pneumonia were fever, cough and dyspnoea; this was especially clear in the elderly. We described different characteristics between unilateral and bilateral pneumonia.
马德里的初级保健机构诊断出了可能的 SARS-CoV-2 感染病例，其中一些病例患有肺炎。大多数发表的 SARS-CoV-2 肺炎数据来自住院患者。本研究旨在描述初级保健机构中通过 SARS-CoV-2 感染可能性筛查出的不同年龄段和肺炎类型的患者的临床特征。
对马德里一家初级保健机构对 SARS-CoV-2 可能感染患者进行随访的电子健康记录中获取临床数据。所有病例均在 3 月 10 日至 4 月 7 日期间通过现场或远程咨询进行收集。
由全科医生通过胸部 X 光检查诊断 SARS-CoV-2 肺炎。主要结局和测量指标：SARS-CoV-2 肺炎的症状、体格检查和诊断检查，包括血液检查、鼻咽拭子 RT-PCR（逆转录酶-聚合酶链反应）结果和胸部 X 光结果。
共收集到 172 例（女性 87 例[50.6%]，平均年龄 60.5 岁，标准差[SD]为 17.0）SARS-CoV-2 肺炎病例。合并症包括体重指数≥25kg/m²（90 例[52.3%]）、高血压（83 例[48.3%]）、血脂异常（68 例[39.5%]）和糖尿病（33 例[19.2%]）。该样本按年龄组（<50 岁、50-75 岁和≥75 岁）分层。发病时的临床症状为发热（144 例[83.7%]）、咳嗽（140 例[81.4%]）、呼吸困难（103 例[59.9%]）和胃肠道紊乱（72 例[41.9%]）。从发病到肺炎诊断的平均时间为第 7.8 天（SD：4.1）。双侧肺炎比单侧肺炎更为常见（126 例[73.3%]和 46 例[26.7%]）。单侧肺炎患者的脉搏血氧饱和度更高（96%比 94%，p<0.001）。我们发现单侧和双侧病例在 C 反应蛋白（29.6 比 81.5mg/L，p<0.001）和淋巴细胞（1400.0 比 1000.0E3/ml，p<0.001）方面存在差异。登记了并发症：≥75 岁的患者中 42 例（100%）住院；肺栓塞仅见于双侧肺炎（7 例[5.6%]），1 例单侧肺炎患者死亡（2.2%），而 10 例双侧肺炎患者死亡（7.9%）（p 0.170）。
SARS-CoV-2 肺炎的临床症状为发热、咳嗽和呼吸困难；这在老年人中更为明显。我们描述了单侧和双侧肺炎之间的不同特征。
