Clinical Characteristics and Outcome of Patients with Suspected COVID-19 in Emergency Department (RESILIENCY Study II).

Alessandro Russo,Gabriella D’Ettorre,Tommaso Bucci,Francesco Vullo,Elio Gentilini Cacciola,Giancarlo Ceccarelli,Maria Alessandroni,Erica Binetti,Luigi Battistini,Cristian Borrazzo,Gioacchino Galardo,Luigi Celani,Valeria Filippi,Claudio Maria Mastroianni

doi:10.3390/diagnostics11081368

Alessandro Russo, Gabriella D’Ettorre + Show 12 more

Open Access

https://doi.org/10.3390/diagnostics11081368

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Abstract

Objectives: COVID-19 may show no peculiar signs and symptoms that may differentiate it from other infective or non-infective etiologies; thus, early recognition and prompt management are crucial to improve survival. The aim of this study was to describe clinical, laboratory, and radiological characteristics and outcomes of hospitalized COVID-19 patients compared to those with other infective or non-infective etiologies. Methods: We performed a prospective study from March 2020 to February 2021. All patients hospitalized for suspected or confirmed COVID-19 were prospectively recruited. All patients were evaluated according to a predefined protocol for diagnosis of suspected SARS-CoV-2 infection. The primary endpoint was evaluation of clinical, laboratory, and radiological characteristics associated or not with COVID-19 etiology at time of hospitalization in an emergency department. Results: A total of 1036 patients were included in the study: 717 (69%) patients with confirmed COVID-19 and 319 (31%) without COVID-19, hospitalized for other causes. The main causes of hospitalization among non-COVID-19 patients were acute heart failure (44%) and bacterial pneumonia (45.8%). Overall, 30-day mortality was 9% among the COVID-19 group and 35% in the non-COVID-19 group. Multivariate analysis showed variables (fever > 3 days, dry cough, acute dyspnea, lymphocytes < 1000 × 103/µL, and ferritin > 250 ng/mL) independently associated with COVID-19 etiology. A decision tree was elaborated to early detect COVID-19 patients in the emergency department. Finally, Kaplan–Meier curves on 30-day survival in COVID-19 patients during the first wave (March–May 2020, n = 289 patients) and the second wave (October–February 2021, n = 428 patients) showed differences between the two study periods (p = 0.021). Conclusions: Patients with confirmed diagnosis of COVID-19 may show peculiar characteristics at time of hospitalization that could help physicians to distinguish from other infective or non-infective etiologies. Finally, a different 30-day mortality rate was observed during different periods of the pandemic.

Highlights

Infection caused by severe acute respiratory coronavirus-2 (SARS-CoV-2) in humans was first described in Wuhan, China, in December 2019 [1,2]
Patients with suspected COVID-19 were admitted to the hospital in case of fever and/or hypoxemic respiratory failure (PaO2 < 60 mmHg at rest in ambient air) or of exacerbation of underlying diseases or severe symptoms not manageable outside the hospital
No difference was reported about male sex, while higher age (75.3 vs. 64.1 years, p < 0.001), procalcitonin value (2.6 vs. 0.9 ng/mL, p = 0.002), and bacterial co-infection (28% vs. 20%, p = 0.004) were more frequently observed in non-COVID-19 group

Summary

Introduction

Infection caused by severe acute respiratory coronavirus-2 (SARS-CoV-2) in humans was first described in Wuhan, China, in December 2019 [1,2]. A huge number of experiences have been published, but despite this, still a large amount of information about this serious disease is missing. All patients admitted to emergency departments with acute respiratory failure and/or fever should be considered as a suspected SARS-CoV-2 infection [4,5,6,7]. A previous experience about the first months of pandemic was already reported (RESILIENCY study I) [8]; the 653 patients from RESILIENCY I have been included in this analysis

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