Abstract
BackgroundLittle is known in distinguishing clinical features and outcomes between coronavirus disease-19 (COVID-19) and influenza (FLU).Materials/methods Retrospective, single-centre study including patients with COVID-19 or FLU pneumonia admitted to the Intensive care Unit (ICU) of Policlinico Umberto I (Rome). Aims were: (1) to assess clinical features and differences of patients with COVID-19 and FLU, (2) to identify clinical and/or laboratory factors associated with FLU or COVID-19 and (3) to evaluate 30-day mortality, bacterial superinfections, thrombotic events and invasive pulmonary aspergillosis (IPA) in patients with FLU versus COVID-19.ResultsOverall, 74 patients were included (19, 25.7%, FLU and 55, 74.3%, COVID-19), median age 67 years (58–76). COVID-19 patients were more male (p = 0.013), with a lower percentage of COPD (Chronic Obstructive Pulmonary Disease) and chronic kidney disease (CKD) (p = 0.001 and p = 0.037, respectively) than FLU. SOFA score was higher (p = 0.020) and lymphocytes were significantly lower in FLU than in COVID-19 [395.5 vs 770.0 cells/mmc, p = 0.005]. At multivariable analysis, male sex (OR 6.1, p < 0.002), age > 65 years (OR 2.4, p = 0.024) and lymphocyte count > 725 cells/mmc at ICU admission (OR 5.1, p = 0.024) were significantly associated with COVID-19, whereas CKD and COPD were associated with FLU (OR 0.1 and OR 0.16, p = 0.020 and p < 0.001, respectively). No differences in mortality, bacterial superinfections and thrombotic events were observed, whereas IPA was mostly associated with FLU (31.5% vs 3.6%, p = 0.0029).ConclusionsIn critically ill patients, male sex, age > 65 years and lymphocytes > 725 cells/mmc are related to COVID-19. FLU is associated with a significantly higher risk of IPA than COVID-19.
Highlights
The novel β-coronavirus, named Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), due to the similarity with the virus that caused the SARS outbreak in 2002–2004, emerged in Wuhan, China, in December 2019 and has rapidly spread through the world causing the ongoing pandemic [1]
No differences in the Charlson Comorbidity Index were found between the 2 groups (p = 0.102), with a lower percentage of smoke, COPD (Chronic Obstructive Pulmonary Disease) and chronic kidney disease (CKD) in patients with COVID-19 than those with FLU (25% vs 63.1%, p = 0.004, 20% vs 57.8%, p = 0.003 and 4% vs 26.3%, p = 0.010, respectively)
At Intensive care Unit (ICU) admission, severity of infection was higher in FLU than in COVID-19 patients (Fig. 2a)
Summary
The novel β-coronavirus, named Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), due to the similarity with the virus that caused the SARS outbreak in 2002–2004, emerged in Wuhan, China, in December 2019 and has rapidly spread through the world causing the ongoing pandemic [1]. SARS-CoV-2 and influenza viruses share similar aspects, from their ease of transmission from person-to-person through the respiratory droplet route to their clinical presentation Both viruses can cause acute respiratory failure that might require hospitalization in ICU, might be complicated by bacterial and fungal superinfections and might predispose subjects to the development of thrombosis [4,5,6,7,8,9,10,11]. Little is known in distinguishing clinical features and outcomes in critically ill patients with coronavirus disease-19 (COVID-19) and influenza (FLU) requiring ICU admission. FLU is associated with a significantly higher risk of IPA than COVID-19
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