Li Yongzhi, He Huan, Gao Yuhan, Ou Zejin, He Wenqiao, Chen Caiyun, Fu Jiaqi, Xiong Husheng, Chen Qing
Guangdong Provincial Key Laboratory of Tropical Disease Research, Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China.
Front Med (Lausanne). 2021 Nov 11;8:733999. doi: 10.3389/fmed.2021.733999. eCollection 2021.
To explore the differences in clinical manifestations and infection marker determination for early diagnosis of coronavirus disease-2019 (COVID-19) and influenza (A and B). A hospital-based retrospective cohort study was designed. Patients with COVID-19 and inpatients with influenza at a sentinel surveillance hospital were recruited. Demographic data, medical history, laboratory findings, and radiographic characteristics were summarized and compared between the two groups. The chi-square test or Fisher's exact test was used for categorical variables, and Kruskal-Wallis -test was used for continuous variables in each group. Receiver operating characteristic curve (ROC) was used to differentiate the intergroup characteristics. The Cox proportional hazards model was used to analyze the predisposing factors. About 23 patients with COVID-19 and 74 patients with influenza were included in this study. Patients with influenza exhibited more symptoms of cough and sputum production than COVID-19 ( < 0.05). CT showed that consolidation and pleural effusion were more common in influenza than COVID-19 ( < 0.05). Subgroup analysis showed that patients with influenza had high values of infection and coagulation function markers, but low values of blood routine and biochemical test markers than patients with COVID-19 (mild or moderate groups) ( < 0.05). In patients with COVID-19, the ROC analysis showed positive predictions of albumin and hematocrit, but negative predictions of C-reactive protein (CRP), procalcitonin (PCT), lactate dehydrogenase (LDH), hydroxybutyrate dehydrogenase (HBDH), and erythrocyte sedimentation rate. Multivariate analysis revealed that influenza might associate with risk of elevated CRP, PCT, and LDH, whereas COVID-19 might associated with high HBDH. Patients with influenza had more obvious clinical symptoms but less common consolidation lesions and pleural effusion than those with COVID-19. These findings suggested that influenza likely presents with stronger inflammatory reactions than COVID-19, which provides some insights into the pathogenesis of these two contagious respiratory illnesses.
为探讨2019冠状病毒病（COVID-19）和流感（甲型和乙型）在临床表现及感染标志物检测方面的差异，以用于早期诊断。设计了一项基于医院的回顾性队列研究。招募了定点监测医院的COVID-19患者和流感住院患者。总结并比较了两组的人口统计学数据、病史、实验室检查结果和影像学特征。分类变量采用卡方检验或Fisher精确检验，每组连续变量采用Kruskal-Wallis检验。采用受试者操作特征曲线（ROC）来区分组间特征。采用Cox比例风险模型分析易感因素。本研究纳入了约23例COVID-19患者和74例流感患者。流感患者咳嗽和咳痰症状比COVID-19患者更常见（<0.05）。CT显示，流感患者实变和胸腔积液比COVID-19患者更常见（<0.05）。亚组分析显示，流感患者感染和凝血功能标志物值较高，但血常规和生化检查标志物值低于COVID-19患者（轻症或中症组）（<0.05）。在COVID-19患者中，ROC分析显示白蛋白和血细胞比容有阳性预测价值，但C反应蛋白（CRP）、降钙素原（PCT）、乳酸脱氢酶（LDH）、羟丁酸脱氢酶（HBDH）和红细胞沉降率有阴性预测价值。多因素分析显示，流感可能与CRP、PCT和LDH升高风险相关，而COVID-19可能与高HBDH相关。流感患者临床症状更明显，但实变病灶和胸腔积液比COVID-19患者少见。这些发现表明，流感可能比COVID-19表现出更强的炎症反应，这为这两种传染性呼吸道疾病的发病机制提供了一些见解。
