Abstract
Background and Objectives: During the coronavirus disease 2019 (COVID-19) pandemic, patients with chronic diseases suffering exacerbations have required acute medical care. The purpose of our study was to determine useful criteria for the differentiation of patients with acute clinical syndromes and suspicion of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Materials and Methods: This was an observational retrospective study, conducted in an internal medicine clinic from April to May 2020. We collected clinical, biological, and computed tomography (CT) data on patients with exacerbations of chronic diseases and clinical suspicion of SARS-CoV-2 infection. Patients with an already-positive real-time reverse-transcription polymerase chain reaction (RT-PCR) test for SARS-CoV-2 on presentation at the emergency department were excluded from our study. Results: Of 253 suspected cases, 20 were laboratory-confirmed as having SARS-CoV-2 infection by RT-PCR, whereas COVID-19 diagnosis was ruled out in the remaining 233. Venous thromboembolism (VTE) correlated significantly with COVID-19 diagnosis in suspected patients, while laboratory markers were not significantly different between the two groups. Of the suspected patients, significantly higher percentages of dry cough, fever, myalgias, sore throat, loss of smell and appetite, and ground-glass opacities (GGOs) on CT were found in SARS-CoV-2-positive individuals. Conclusions: The study demonstrated that, until receiving the result of an RT-PCR test for SARS-CoV-2 (usually 12–24 h), association with VTE as a comorbidity, fever, dry cough, and myalgia as clinical features, and GGO on CT are the main markers for the identification of COVID-19 patients among those suspected with acute clinical syndromes. Our results also provide evidence for doctors not to rely solely on biological markers in the case of suspected SARS-CoV-2 infection in patients with exacerbations of chronic diseases. These data are useful for faster decision-making with regard to suspected COVID-19 patients before receiving RT-PCR test results, thus avoiding keeping patients in crowded emergency departments.
Highlights
In December 2019, the novel severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) was identified in relation to a newly emerging type of viral pneumonia, which was subsequently named coronavirus disease 2019 (COVID-19)
Of the 253 patients included in the study, 236 patients were admitted to the clinic and 17 patients were admitted to the intensive care unit (ICU) department
Our clinic was mainly responsible for the admission and differential diagnosis of patients with acute illnesses and symptoms suggestive of COVID-19 who were admitted to our hospital; the patients with confirmed SARS-CoV-2 infection by reverse-transcription polymerase chain reaction (RT-PCR) tests were transferred to an infectious disease hospital for specialized treatment
Summary
In December 2019, the novel severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) was identified in relation to a newly emerging type of viral pneumonia, which was subsequently named coronavirus disease 2019 (COVID-19). Thousands of articles have reported the characteristics and changes in COVID-19 patients with respect to clinical, biological, or radiological features, as well as treatment options related to guidelines [1,2,4,5,6,7], with the majority of these studies focused strictly on the disease and its complications. It is a reality that the clinical signs and symptoms and the biological or radiological changes of COVID-19 can overlap with those of other acute diseases or the exacerbations of chronic ones. There are few studies related to the differentiation of confirmed COVID-19 from suspected but confirmed SARS-CoV-2-negative patients, as the differentiation of suspected SARS-CoV-2 infection and acute diseases is difficult in terms of clinical, biological, and/or radiological criteria [8,9]
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