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Inicio Medicina Clínica (English Edition) Clinical characteristics of confirmed and clinically diagnosed patients with 201...
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Vol. 155. Issue 8.
Pages 327-334 (October 2020)
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Vol. 155. Issue 8.
Pages 327-334 (October 2020)
Original
DOI: 10.1016/j.medcle.2020.06.022
Clinical characteristics of confirmed and clinically diagnosed patients with 2019 novel coronavirus pneumonia: a single-center, retrospective, case-control study
Características clínicas de pacientes confirmados y diagnosticados clínicamente con neumonía por el nuevo coronavirus 2019: Un estudio de control de casos, retrospectivo y unicéntrico
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Chunjin Kea,1, Chong Yub,1, Daoyuan Yuec, Xing Zenga, Zhiquan Hua,
, Chunguang Yanga,**
a Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
b Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
c Department of Clinical Laboratory, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Tables (5)
Table 1. Baseline characteristics of patients included in the study.
Table 2. Laboratory findings of patients with COVID-19 pneumonia.
Table 3. Comparison of related parameters between survival and died group.
Table 4. Prognostic value of the clinical parameters.
Table 5. Multivariate logistic regression of independent prognostic factors for mortality.
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Additional material (1)
Abstract
Background

Novel coronavirus disease 2019 (COVID-19) is an emerging infectious disease caused by SARS-CoV-2. At the peak of the outbreak in Wuhan (January and February), there are two types of COVID-19 patients: laboratory confirmation and clinical diagnosis. This study aims to compare and analyze the clinical outcomes and characteristics of confirmed and clinically diagnosed COVID-19 patients to determine whether they are of the same type and require equal treatment. More importantly, the prognostic factors of COVID-19 patients are explored.

Methods

A total of 194 hospitalized patients with COVID-19 pneumonia were retrospectively studied. Demographic data, clinical characteristcs, laboratory results and prognostic information were collected by electronic medical record system and analyzed.

Results

Among 194 subjects included, 173 were confirmed and 21 were clinically diagnosed. There were no significant differences in clinical outcomes (mortality rate 39[22.54%] vs 7[33.33%], P=0.272) and hospital stay (19.00 vs 16.90 days, P=0.411) between the confirmed and clinically diagnosed group, and prognostic factors were similar between them. Older age, lower albumin levels, higher serum Lactate dehydrogenase (LDH) levels, higher D-D levels, longer prothrombin time (PT), higher IL-6 levels, lower T cells indicated poor prognosis in patients with COVID-19 pneumonia. NK cell has the highest AUC among all measured indicators (NK AUC=0.926, P<0.001).

Conclusion

Laboratory-confirmed and clinically diagnosed COVID-19 patients are similar in clinical outcomes and most clinical characteristics. They are of the same type and require equal treatment. Age, AST, LDH, BUN, PT, D-D, IL6, white blood cell and neutrophil counts, T cell and T cell subset counts can efficiently predict clinical outcomes.

Keywords:
SARS-CoV-2
COVID-19
Confirmed
Clinically diagnose
Coronavirus
Clinical Characteristics
Prognosis
Leucocyte
Cytokine
Resumen
Antecedentes

El nuevo coronavirus 2019 (COVID-19) es una nueva enfermedad infecciosa causada por el virus SARS-CoV-2. Durante el pico del brote en Wuhan (enero y febrero 2020), se detectaron dos tipos de pacientes portadores del COVID-19: pacientes confirmados a través de pruebas de laboratorio y pacientes confirmados por diagnóstico clínico. El objetivo de este estudio es comparar y analizar los resultados clínicos y las características de los pacientes con COVID-19 confirmados y clínicamente diagnosticados para determinar si son del mismo tipo y si necesitan el mismo tratamiento. El estudio es importante también para explorar los factores pronósticos de los pacientes con COVID-19.

Métodos

Un total de 194 pacientes hospitalizados con neumonía COVID-19 fueron estudiados retrospectivamente. Se utilizó un sistema de registro médico electrónico para recopilar los datos demográficos, las características clínicas, los resultados de laboratorio y la información pronóstica, para luego ser analizada.

Resultados

De los 194 pacientes incluidos, 173 dieron positivo y 21 fueron diagnosticados clínicamente. No se presentaron diferencias significativas en los resultados clínicos (tasa de mortalidad 39 [22,54%] vs. 7 [33,33%], p = 0,272) y la estancia hospitalaria (19,00 vs. 16,90 días, p = 0,411) entre el grupo de confirmados y el grupo diagnosticado clínicamente, y los factores pronósticos fueron similares entre ellos. Edad avanzada, niveles más bajos de albúmina, niveles más altos de lactato deshidrogenasa (LDH) en suero, niveles más altos de D-D, mayor tiempo de protrombina (PT), altos niveles de IL-6, células T más bajas indicaban mal pronóstico en pacientes con neumonía por COVID-19. La célula NK tiene el AUC más alto entre todos los indicadores medidos (NK AUC = 0,926, p < 0,001).

Conclusión

Los grupos de pacientes COVID-19 confirmados en laboratorio y diagnosticados clínicamente arrojan resultados clínicos similares y tienen la mayoría de las características clínicas. Son del mismo tipo y requieren el mismo tratamiento. La edad, AST, LDH, BUN, PT, D-D, IL6, los recuentos de glóbulos blancos y neutrófilos, recuentos de subgrupos de células T y células T pueden predecir los resultados clínicos de forma eficaz.

Palabras clave:
SARS-CoV-2
COVID-19
Confirmado
Diagnóstico clínico
Coronavirus
Características clínicas
Pronóstico
Leucocito
Citocina

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