Abstract
Most studies investigating early risk predictors in coronavirus disease 19 (COVID-19) lacked comparison with controls. We aimed to assess and directly compare outcomes and risk predictors at time of emergency department (ED) presentation in COVID-19 and controls. Consecutive patients presenting to the ED with suspected COVID-19 were prospectively enrolled. COVID-19-patients were compared with (i) patients tested negative (overall controls) and (ii) patients tested negative, who had a respiratory infection (respiratory controls). Primary outcome was the composite of intensive care unit (ICU) admission and death at 30 days. Among 1081 consecutive cases, 191 (18%) were tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and 890 (82%) were tested negative (overall controls), of which 323 (30%) had a respiratory infection (respiratory controls). Incidence of the composite outcome was significantly higher in COVID-19 (23%) as compared with the overall control group (10%, adjusted-HR 2.45 (95%CI, 1.61–3.74), p < 0.001) or the respiratory control group (10%, adjusted-HR 2.93 (95%CI, 1.66–5.17), p < 0.001). Blood oxygen saturation, age, high-sensitivity troponin, c-reactive protein, and lactate dehydrogenase were identified as the strongest predictors of poor outcome available at time of ED presentation in COVID-19 with highly comparable prognostic utility in overall and respiratory controls. In conclusion, patients presenting to the ED with COVID-19 have a worse outcome than controls, even after adjustment for differences in baseline characteristics. Most predictors of poor outcome in COVID-19 were not restricted to COVID-19, but of comparable prognostic utility in controls and therefore generalizable to unselected patients with suspected COVID-19.
Highlights
Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a global pandemic with a massive burden on healthcare systems worldwide
Studies from China, Italy, and the USA analyzed characteristics and the predictive value of clinical parameters [4,5,6,7,8,9,10,11]. Various laboratory parameters such as high c-reactive protein (CRP), low albumin and leukocyte levels were found characteristic for COVID-19 [8], whereas higher age, obesity, hypertension, and high CRP concentrations were associated with poor outcome [10,12,13,14,15,16,17,18]
Prevalence of most comorbidities and cardiovascular risk factors did not differ between the three groups, except for cardiac disease, atrial fibrillation, pneumopathy, overweight, and smoking, which were less frequent in COVID-19
Summary
Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a global pandemic with a massive burden on healthcare systems worldwide. Studies from China, Italy, and the USA analyzed characteristics and the predictive value of clinical parameters [4,5,6,7,8,9,10,11] Various laboratory parameters such as high c-reactive protein (CRP), low albumin and leukocyte levels were found characteristic for COVID-19 [8], whereas higher age, obesity, hypertension, and high CRP concentrations were associated with poor outcome [10,12,13,14,15,16,17,18]. During the early phase of the COVID-19 pandemic, data on outcomes and predictive value of clinical characteristics were mainly reported from heavily affected regions. This data may not be generalizable to less affected regions such as Central Europe or Japan. Most of the existing data was derived from retrospective registries enrolling exclusively patients with confirmed
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