Pablo Sieber1, Domenica Flury1, Sabine Güsewell2, Werner C Albrich1, Katia Boggian1, Céline Gardiol3, Matthias Schlegel1, Robert Sieber4, Pietro Vernazza1, Philipp Kohler5. 1. Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, Rorschacher Strasse 95, 9007, St. Gallen, Switzerland. 2. Clinical Trial Unit, Cantonal Hospital St. Gallen, St. Gallen, Switzerland. 3. Federal Office of Public Health, Berne, Switzerland. 4. Emergency Department, Cantonal Hospital St. Gallen, St. Gallen, Switzerland. 5. Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, Rorschacher Strasse 95, 9007, St. Gallen, Switzerland. philipp.kohler@kssg.ch.
Abstract
BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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.
BACKGROUND: In the future, co-circulation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and influenza virusesA/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 influenzapatients at time of hospital admission. METHODS: 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 influenzapatients 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 influenzapatients. RESULTS: We included 96 COVID-19 and 96 influenzapatients. 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 influenzapatients, respectively. Time from symptom onset to hospital admission was longer for COVID-19 (median 7 days, IQR 3-10) than for influenzapatients (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-19patients (16% vs. 5%, p = 0.018). CONCLUSION: Discriminating COVID-19 from influenzapatients based on clinical presentation is challenging. Time from symptom onset to hospital admission is considerably longer in COVID-19 than in influenzapatients and showed the strongest discriminatory power in our classification tree. Although they had fewer comorbidities, in-hospital mortality was higher for COVID-19patients.
Authors: W S Lim; M M van der Eerden; R Laing; W G Boersma; N Karalus; G I Town; S A Lewis; J T Macfarlane Journal: Thorax Date: 2003-05 Impact factor: 9.139
Authors: Alexander E Merkler; Neal S Parikh; Saad Mir; Ajay Gupta; Hooman Kamel; Eaton Lin; Joshua Lantos; Edward J Schenck; Parag Goyal; Samuel S Bruce; Joshua Kahan; Kelsey N Lansdale; Natalie M LeMoss; Santosh B Murthy; Philip E Stieg; Matthew E Fink; Costantino Iadecola; Alan Z Segal; Marika Cusick; Thomas R Campion; Ivan Diaz; Cenai Zhang; Babak B Navi Journal: JAMA Neurol Date: 2020-07-02 Impact factor: 18.302
Authors: Florian Krammer; Gavin J D Smith; Ron A M Fouchier; Malik Peiris; Katherine Kedzierska; Peter C Doherty; Peter Palese; Megan L Shaw; John Treanor; Robert G Webster; Adolfo García-Sastre Journal: Nat Rev Dis Primers Date: 2018-06-28 Impact factor: 52.329