Abstract
IntroductionAsymptomatic coronavirus disease 2019 (COVID-19) and moderate COVID-19 may be the most common COVID-19 cases. This study was designed to develop a diagnostic model for patients with asymptomatic and moderate COVID-19 based on demographic, clinical, and laboratory variables.MethodsThis retrospective study divided the subjects into 2 groups: asymptomatic COVID-19 (without symptoms, n = 15) and moderate COVID-19 (with symptoms, n = 57). Demographic characteristics, clinical data, routine blood tests, other laboratory tests, and inpatient data were collected and analyzed to compare patients with asymptomatic COVID-19 and moderate COVID-19.ResultsComparison of the asymptomatic COVID-19 group with the moderate COVID-19 group yielded the following results: the patients were younger (P = 0.045); the cluster of differentiation (CD)8+ (cytotoxic) T cell level was higher (P = 0.017); the C-reactive protein (CRP) level was lower (P = 0.001); the white blood cell (WBC, P < 0.001), neutrophil (NEU, P = 0.036), lymphocyte (LYM, P = 0.009), and eosinophil (EOS, P = 0.036) counts were higher; and the serum iron level (P = 0.049) was higher in the asymptomatic COVID-19 group. The multivariate analysis showed that the NEU count (odds ratio [OR] = 2.007, 95% confidence interval (CI): 1.162 - 3.715, P = 0.014) and LYM count (OR = 9.380, 95% CI: 2.382 - 36.934, P = 0.001) were independent factors for the presence of clinical symptoms after COVID-19 infection. The NEU count and LYM count were diagnostic predictors of asymptomatic COVID-19. This diagnostic prediction model showed high discriminatory power, consistency, and net clinical benefits.ConclusionsThe proposed model can distinguish asymptomatic COVID-19 from moderate COVID-19, thereby helping clinicians identify and distinguish patients with potential asymptomatic COVID-19 from those with moderate COVID-19.
Highlights
Asymptomatic coronavirus disease 2019 (COVID-19) and moderate COVID-19 may be the most common COVID-19 cases
The multivariate analysis showed that the NEU count (odds ratio [OR] = 2.007, 95% confidence interval (CI): 1.162 - 3.715, P = 0.014) and LYM count (OR = 9.380, 95% CI: 2.382 - 36.934, P = 0.001) were independent factors for the presence of clinical symptoms after COVID-19 infection
The characteristics of patients with moderate and asymptomatic COVID-19 were analyzed, and the results showed that age, cluster of differentiation (CD)8+ T cells, C-reactive protein (CRP), white blood cell (WBC) count, neutrophil (NEU) count, lymphocyte (LYM) count, eosinophil (EOS) count, and serum iron were important factors that distinguished patients with asymptomatic COVID19 from those with moderate COVID-19
Summary
Asymptomatic coronavirus disease 2019 (COVID-19) and moderate COVID-19 may be the most common COVID-19 cases. A growing body of evidence shows that many individuals with COVID-19 present no symptoms or only mild symptoms but can spread SARS-CoV-2 (Rivett et al, 2020; Gao et al, 2021). These individuals may have been missed during screening in the early stage of the pandemic due to the limited testing capacity and the nature of asymptomatic infection. Previous studies show that asymptomatic cases account for approximately 9.8% of all cases of Middle East respiratory syndrome coronavirus (MERS-CoV) (Al-Tawfiq and Gautret, 2019). A simulation study estimated that 17.9% of all infected patients may be truly asymptomatic (Mizumoto et al, 2020)
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