Abstract
BackgroundClinically most apparent symptoms of COVID-19 include fever and cough, which in some patients show a worsening trend but are completely non-apparent in patients who present with an asymptomatic course of the disease. The aim of this study was to identify clinical and biochemical differences among polymerase chain reaction (PCR) positive patients who are either febrile or afebrile.MethodsThis study was conducted in Rawalpindi Medical University and Allied Hospitals between September and December 2020. All patients who tested positive for reverse transcription polymerase chain reaction (RT-PCR) COVID-19 were included in the study. After evaluation of 146 patients, 100 were selected, and with a response rate of 97%, a total of 97 patients were included in the final analysis. Depending on the presence of fever, the participants were divided into two groups. Both groups were then compared for baselines vitals and laboratory investigations. Data was entered and analyzed in SPSS v23.0 (IBM Inc., Armonk, New York).ResultsAmong the 97 patients, 66 (68%) of the participants were male, and 31 (32%) were females. The mean age of the study participants was 45.23±18.08 years. Fever was present in 39 (40.2%) of the participants. When compared with patients with no fever, the patients with fever had greater severity of disease (p<0.001), higher heart rate (p<0.001), decreased oxygen saturation (p<0.001). Among the laboratory investigations, the fever group had a greater tendency of having deranged alanine aminotransferase (ALT) (70.82±29.23 vs. 32.83±16.22, p=0.010), Lymphocytes (1.56±0.54 vs. 2.12±0.94, p=0.003) and serum total bilirubin (1.06±0.36 vs. 0.55±0.21, p=0.009). Based on multiple regression analysis, the presence of fever is a predictor of derangement in ALT (OR=1.034, CI=1.001-1.068 p=0.025) and total bilirubin (OR=4.38, CI=2.14-6.78, p=0.021).ConclusionFever may not be present among all patients presenting with COVID-19 infection, but those who have a fever have a greater risk of having deranged liver function tests. Hence, it is important to monitor liver function tests (LFTs) in COVID-19 patients presenting with fever.
Highlights
Coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome virus 2 (SARSCov-2)
The hospital protocol included all the following patients who were eligible for reverse transcription polymerase chain reaction (RTPCR): 1) patients presenting with any two of the following symptoms: non-productive cough, fever, body aches; 2) COVID-19 suspect based on radiological assessment; 3) exposure to a COVID-19 positive patient in the past seven days; and 4) patients being prepared for surgical procedures
This is because our study included patients who consecutively had sampling done for RT-polymerase chain reaction (PCR) whether they had symptoms or not, while the studies above reported fever in patients who presented with a suspicion of COVID-19 on the basis of symptoms
Summary
Coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome virus 2 (SARSCov-2). It manifests symptomatically in multiple ways, including fever, dry cough, dyspnea, fatigue, myalgias, and loss of appetite [1]. The patient presents with flu-like illness having fever, cough, and myalgia most commonly, but as the adaptive phase begins, the patient starts to deteriorate clinically. The viral load reduces considerably over time, the inflammatory cascade builds up and develops into a tornado of inflammatory cytokine responses This leads to multi-organ dysfunction [4]. Most apparent symptoms of COVID-19 include fever and cough, which in some patients show a worsening trend but are completely non-apparent in patients who present with an asymptomatic course of the disease. The aim of this study was to identify clinical and biochemical differences among polymerase chain reaction (PCR) positive patients who are either febrile or afebrile
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