Differential Diagnosis Of COVID-19 Research Articles

Causes of digestive symptoms in patients with COVID-19

This literature review discusses the problem of the causes of digestive symptoms in COVID-19 patients, examining papers in which SARS-CoV-2 gastrointestinal infection was the underlying cause of symptoms and papers in which the occurrence of such symptoms was associated with exacerbation of pre-existing, including previously undiagnosed GI diseases.
 Objective: to identify the most likely underlying cause of digestive symptoms in COVID-19 patients. Materials and Methods. We searched 59 literature sources from eLibrary, PubMed, Scopus, and Google scholar databases. All papers were published in the last 4 years.
 Results. The resulting digestive symptoms in coronavirus lesions are caused by direct disruption of the intestinal barrier; also, these symptoms may be a manifestation of exacerbation or debut of chronic digestive diseases on the background of COVID-19, and exacerbate the course of infection; or a result of COVID-19 therapy. A differential diagnosis of COVID-19 with inflammatory bowel diseases, chronic liver diseases, chronic and acute biliary pancreatitis is required in patients with diarrhea, abdominal pain, elevated blood liver and pancreatic enzymes. The correlation of gastroenterological symptoms with the direct COVID-19 lesion can be established by comparing the clinical picture with the detection of RNA virus in stool, histologic specimens, but sometimes there may be no unambiguous answer. Specific changes on computed tomography with angiography of the abdominal cavity organs (peri-intestinal fatty tissue strands against the background of intestinal wall thickening) are described only in the initial stage of COVID-19, at later stages the changes are nonspecific. Data from endoscopic studies in patients with COVID-19 are limited to single clinical cases or case series describing nonspecific findings and suggesting that the virus directly damages GI mucosal surfaces. This calls into question the results of the studies that have been conducted, most of which were retrospective and did not evaluate the baseline presence of gastrointestinal symptoms prior to COVID-19. Due to the peculiarities of the virus interaction with body cells and the diversity of clinical manifestations of the disease, a combined approach in the diagnosis of GI diseases in COVID-19 is necessary.

A comprehensive analysis of gene expression profiling data in COVID-19 patients for discovery of specific and differential blood biomarker signatures

COVID-19 is a newly recognized illness with a predominantly respiratory presentation. Although initial analyses have identified groups of candidate gene biomarkers for the diagnosis of COVID-19, they have yet to identify clinically applicable biomarkers, so we need disease-specific diagnostic biomarkers in biofluid and differential diagnosis in comparison with other infectious diseases. This can further increase knowledge of pathogenesis and help guide treatment. Eight transcriptomic profiles of COVID-19 infected versus control samples from peripheral blood (PB), lung tissue, nasopharyngeal swab and bronchoalveolar lavage fluid (BALF) were considered. In order to find COVID-19 potential Specific Blood Differentially expressed genes (SpeBDs), we implemented a strategy based on finding shared pathways of peripheral blood and the most involved tissues in COVID-19 patients. This step was performed to filter blood DEGs with a role in the shared pathways. Furthermore, nine datasets of the three types of Influenza (H1N1, H3N2, and B) were used for the second step. Potential Differential Blood DEGs of COVID-19 versus Influenza (DifBDs) were found by extracting DEGs involved in only enriched pathways by SpeBDs and not by Influenza DEGs. Then in the third step, a machine learning method (a wrapper feature selection approach supervised by four classifiers of k-NN, Random Forest, SVM, Naïve Bayes) was utilized to narrow down the number of SpeBDs and DifBDs and find the most predictive combination of them to select COVID-19 potential Specific Blood Biomarker Signatures (SpeBBSs) and COVID-19 versus influenza Differential Blood Biomarker Signatures (DifBBSs), respectively. After that, models based on SpeBBSs and DifBBSs and the corresponding algorithms were built to assess their performance on an external dataset. Among all the extracted DEGs from the PB dataset (from common PB pathways with BALF, Lung and Swab), 108 unique SpeBD were obtained. Feature selection using Random Forest outperformed its counterparts and selected IGKC, IGLV3-16 and SRP9 among SpeBDs as SpeBBSs. Validation of the constructed model based on these genes and Random Forest on an external dataset resulted in 93.09% Accuracy. Eighty-three pathways enriched by SpeBDs and not by any of the influenza strains were identified, including 87 DifBDs. Using feature selection by Naive Bayes classifier on DifBDs, FMNL2, IGHV3-23, IGLV2-11 and RPL31 were selected as the most predictable DifBBSs. The constructed model based on these genes and Naive Bayes on an external dataset was validated with 87.2% accuracy. Our study identified several candidate blood biomarkers for a potential specific and differential diagnosis of COVID-19. The proposed biomarkers could be valuable targets for practical investigations to validate their potential.

Differential diagnosis of COVID-19 and influenza.

This study uses two existing data sources to examine how patients' symptoms can be used to differentiate COVID-19 from other respiratory diseases. One dataset consisted of 839,288 laboratory-confirmed, symptomatic, COVID-19 positive cases reported to the Centers for Disease Control and Prevention (CDC) from March 1, 2019, to September 30, 2020. The second dataset provided the controls and included 1,814 laboratory-confirmed influenza positive, symptomatic cases, and 812 cases with symptomatic influenza-like-illnesses. The controls were reported to the Influenza Research Database of the National Institute of Allergy and Infectious Diseases (NIAID) between January 1, 2000, and December 30, 2018. Data were analyzed using case-control study design. The comparisons were done using 45 scenarios, with each scenario making different assumptions regarding prevalence of COVID-19 (2%, 4%, and 6%), influenza (0.01%, 3%, 6%, 9%, 12%) and influenza-like-illnesses (1%, 3.5% and 7%). For each scenario, a logistic regression model was used to predict COVID-19 from 2 demographic variables (age, gender) and 10 symptoms (cough, fever, chills, diarrhea, nausea and vomiting, shortness of breath, runny nose, sore throat, myalgia, and headache). The 5-fold cross-validated Area under the Receiver Operating Curves (AROC) was used to report the accuracy of these regression models. The value of various symptoms in differentiating COVID-19 from influenza depended on a variety of factors, including (1) prevalence of pathogens that cause COVID-19, influenza, and influenza-like-illness; (2) age of the patient, and (3) presence of other symptoms. The model that relied on 5-way combination of symptoms and demographic variables, age and gender, had a cross-validated AROC of 90%, suggesting that it could accurately differentiate influenza from COVID-19. This model, however, is too complex to be used in clinical practice without relying on computer-based decision aid. Study results encourage development of web-based, stand-alone, artificial Intelligence model that can interview patients and help clinicians make quarantine and triage decisions.

Особенности течения острого коронарного синдрома у пациентов с новой коронавирусной инфекцией COVID-19

INTRODUCTION: Coronary heart disease (CHD) is an important medical and social problem. It occupies one of the leading positions in the structure of morbidity, temporary and permanent disability and mortality. The peculiarities of the course of acute coronary syndrome (ACS) in patients with new coronavirus infection COVID-19 are of great clinical interest. Studies have shown that the effect of COVID-19 on the cardiovascular system consists not only the in direct cardiotoxic effect of the virus, but also in myocardial damage due to hemodynamic disorders, systemic hypoxia, destabilization of atherosclerotic plaques due to endothelial dysfunction, increased myocardial oxygen demand as a response to systemic inflammation, coagulopathy and others. An important role is played by the involvement of the vascular endothelium in the pathological process. There is extensive evidence of SARS-CoV-2 directly infecting endothelial cells because of the high level of expression of angiotensin-converting enzyme 2. The combination of ACS and new coronavirus infection is a frequent event in both infectious disease units and specialized coronary centers. However, many questions of pathogenesis, clinical presentation, diagnosis and management tactics of such patients are not clear enough. There are data on the manifestation of cardiovascular diseases against the background COVID-19. The difficulty is that clinical presentation of acute coronary syndrome in COVID-19 patients can be masked by peculiarities of the course of infectious disease itself. CONCLUSION: Differential diagnosis of COVID-19 and ACS has also become a problem for clinicians due to the fact that symptoms of chest pain or chest tightness are common in patients with new coronavirus infection. Myocardial damage in coronavirus infection can impair interpretation of the results of some clinical diagnostic tools. A complex disputable problem is assessment of prognosis in ACS combined with COVID-19. Most patients with COVID-19 have disorders of the clotting system, the severity of which determines the probability of adverse outcomes, above all, the risk of death.

Development of specific immunity in laboratory animals after co-immunization against seasonal influenza and COVID-19

Introduction. In clinical practice, the differential diagnosis of COVID-19 can be challenging during the flu season, entailing serious consequences such as delays in appropriate control measures against the SARS-CoV-2 pandemic. Another problem is posed by co-infection of SARS-CoV-2 and influenza virus (IV), which significantly contributes to the severity of the COVID-19 disease. This study was aimed to explore the cross-impact of co-administration of Russian influenza and COVID-19 vaccines on development of specific immunity in laboratory animals.Materials and methods. The study was conducted on BALB/c mice. The animals were inoculated intramuscularly with the vaccine for COVID-19 prevention (CoviVac) and the vaccine for influenza prevention (Flu-M). The sera from the immunized animals were examined separately. Three IV strains were used in the hemagglutination inhibition assay. Antibodies (Abs) against SARS-CoV-2 were detected by an enzyme-linked immunosorbent assay (ELISA). The neutralization test was performed to detect virus neutralizing antibodies against SARS-CoV-2 and IV.Results. Relatively high titers of specific Abs were found in the groups of animals inoculated with one vaccine and with two vaccines concurrently. In the groups of animals inoculated with CoviVac and with two vaccines concurrently, both in the ELISA test and in the neutralization test, the average titers of specific Abs against SARSCoV- 2 did not demonstrate any statistical difference. The group of animals inoculated concurrently with two vaccines demonstrated statistically higher titers of Abs against IV after the second immunization compared to the group of animals inoculated with Flu-M.Discussion. The study has shown that post-vaccination immunity both to IV and to SARS-CoV-2 develops after co-vaccination with two vaccines. The observed enhanced post-vaccination immune response to IV in the coimmunized laboratory animals needs further research.Conclusion. The performed studies suggest the possibility of co-administration of two vaccines to prevent influenza and COVID-19.

Methanol Intoxication in the Differential Diagnosis of COVID-19

Methanol Intoxication in the Differential Diagnosis of COVID-19

What about the others: differential diagnosis of COVID-19 in a German emergency department

BackgroundThe ongoing COVID-19 pandemic remains a major challenge for worldwide health care systems and in particular emergency medicine. An early and safe triage in the emergency department (ED) is especially crucial for proper therapy. Clinical symptoms of COVID-19 comprise those of many common diseases; thus, differential diagnosis remains challenging.MethodWe performed a retrospective study of 314 ED patients presenting with conceivable COVID-19 symptoms during the first wave in Germany. All were tested for COVID-19 with SARS-Cov-2-nasopharyngeal swabs. Forty-seven patients were positive. We analyzed the 267 COVID-19 negative patients for their main diagnosis and compared COVID-19 patients with COVID-19 negative respiratory infections for differences in laboratory parameters, symptoms, and vital signs.ResultsAmong the 267 COVID-19 negative patients, 42.7% had respiratory, 14.2% had other infectious, and 11.2% had cardiovascular diseases. Further, 9.0% and 6.7% had oncological and gastroenterological diagnoses, respectively. Compared to COVID-19 negative airway infections, COVID-19 patients showed less dyspnea (OR 0.440; p = 0.024) but more dysgeusia (OR 7.631; p = 0.005). Their hospital stay was significantly longer (9.0 vs. 5.6 days; p = 0.014), and their mortality significantly higher (OR 3.979; p = 0.014).ConclusionFor many common ED diagnoses, COVID-19 should be considered a differential diagnosis. COVID-19 cannot be distinguished from COVID-19 negative respiratory infections by clinical signs, symptoms, or laboratory results. When hospitalization is necessary, the clinical course of COVID-19 airway infections seems to be more severe compared to other respiratory infections.Trial registration: German Clinical Trial Registry DRKS, DRKS-ID of the study: DRKS00021675 date of registration: May 8th, 2020, retrospectively registered.

Differential diagnosis of COVID-19 at the chest computed tomography scan: A review with special focus on cancer patients.

BACKGROUNDGiven the several radiological features shared by coronavirus disease 2019 pneumonia and other infective or non-infective diseases with lung involvement, the differential diagnosis is often tricky, and no unequivocal tool exists to help the radiologist in the proper diagnosis. Computed tomography is considered the gold standard in detecting pulmonary illness caused by severe acute respiratory syndrome coronavirus 2.AIMTo conduct a systematic review including the available studies evaluating computed tomography similarities and discrepancies between coronavirus disease 2019 pneumonia and other pulmonary illness, then providing a discussion focus on cancer patients.METHODSUsing pertinent keywords, we performed a systematic review using PubMed to select relevant studies published until October 30, 2020.RESULTSOf the identified 133 studies, 18 were eligible and included in this review. CONCLUSIONGround-glass opacity and consolidations are the most common computed tomography lesions in coronavirus disease 2019 pneumonia and other respiratory diseases. Only two studies included cancer patients, and the differential diagnosis with early lung cancer and radiation pneumonitis was performed. A single lesion associated with pleural effusion and lymphadenopathies in lung cancer and the onset of the lesions in the radiation field in the case of radiation pneumonitis allowed the differential diagnosis. Nevertheless, the studies were heterogeneous, and the type and prevalence of lesions, distributions, morphology, evolution, and additional signs, together with epidemiological, clinical, and laboratory findings, are crucial to help in the differential diagnosis.

Diagnostic comparison of biochemical profile in patients with Covid-19, dengue and Acute Febrile illness: Implications for patient management

PurposeAlthough there are specific laboratory tests available for the diagnosis of Covid-19 and dengue, during the present pandemic era of prioritized focus on Covid-19 assessment, there are possibilities that persons with dengue may remain undiagnosed. The present study explores the role of biochemical markers in the differential diagnosis of Covid-19 and dengue. MethodsA total of 212 participants with Acute Febrile Illness were tested for Covid-19 and dengue at the secondary care hospital, Civil Hospital Narwana, Haryana, India. The Covid-19 and dengue diagnosis were performed using standard tests followed by hematological profiling which included neutrophil lymphocyte ratio (NLR), platelet count, Vitamin D3 assessment, SGOT, SGPT, and SPO2 concentration levels. ResultsOut of 212 participants, 118 were diagnosed with Covid-19 positive only, 18 dengue positive only, 5 co-infected with Covid-19 and dengue, and 71 persons with Acute Febrile Illness (control group). ANOVA revealed that mean SPO2 was significantly lower in Covid-19 and dengue than control, while SGPT and SGOT levels of Covid-19 and dengue patients were significantly higher than the control group. The mean NLR was significantly higher in Covid-19 and dengue than control and Vitamin D3 levels were significantly reduced for Covid-19 patients. Besides, thrombocytopenia was observed only in dengue patients. ConclusionThe results advocate the potential use of combinations of these makers in differential diagnosis of these two fatal viral conditions and can help by enabling the adaptation of the therapeutic conduct to the needs of individual patients.

Management of Patients with Connective Tissue Disease-associated Interstitial Lung Diseases During the COVID-19 Pandemic.

The novel coronavirus disease (COVID-19) is similar to connective tissue disease-associated interstitial lung diseases (CTD-ILD) in many aspects. However, patients with CTD-ILD have required particular attention during the pandemic since they are at high risk due to -immunosuppressive treatments. Thus, prompt decisions for diagnosis and treatment initiation have become more important than earlier for these patients during the pandemic. Radiological perspectives have become inevitable for the differential diagnosis of this group ¬during the pandemic, particularly to obtain rapid and accurate results that allow the physicians to start treatment immediately. However, in addition to radiological images, a definitive diagnosis also requires access to extensive information regarding patient history, including characteristics of comorbidities, and clinical and serological findings. Consequently, the differential diagnosis of COVID-19 and CTD-ILD can yield accurate treatment regimens that differ greatly between the 2 diseases, and also prevent the spread of the outbreak with COVID-19 patients treated under isolation.

Significance of peripheral blood indexes in differential diagnoses of SARS-CoV-2 and New Bunia virus

We aimed to provide a laboratory basis for differential diagnosis of COVID-19 and severe fever with thrombocytopenia syndrome (SFTS). Clinical data were collected from 32 COVID-19 patients (2019-nCoV group), 31 SFTS patients (SFTS group) and 30 healthy controls (control group). For each group of hospitalized patients, a retrospective analysis was performed on specific indices, including cytokines, T-lymphocyte subsets, routine blood parameters, C-reactive protein (CRP) and procalcitonin (PCT), and receiver operating characteristic (ROC) curves for the indices revealed the differences among groups. Compared with the 2019-nCoV group, the SFTS group had a significantly and greatly decreased counts of WBC, absolute lymphocyte, PLT and absolute CD4+ T lymphocyte (P < 0.05); the IL-6, TNF-α, D-D and PCT levels of the SFTS group were higher than those of the 2019-nCoV group (P < 0.05). Compared with those of the SFTS group, the CRP and FIB levels of the 2019-nCoV group were greatly increased (P < 0.05). The ROC curves showed that area under the curves (AUCs) for FIB, PLT and TNF-α were greater than 0.85, demonstrating high diagnostic value. At the initial stage of SARS-CoV-2 or SFTS virus infection, PLT, FIB and TNF-α have definitive clinical value for the early and differential diagnosis of these two infections.

COVID-19 и грипп: основные отличия между клиническими симптомами

Данный обзор посвящен анализу клинических симптомов, дифференциальной диагностике COVID-19 и гриппа для облегчения установления клинического диагноза при обоих заболеваниях. Развитие эпидемии COVID-19 проходило по экспоненциальному росту заболеваемости из-за высокой контагиозности вируса, бессимптомного носительства. Ситуация осложнялась контагиозностью больного в последние 2–3 суток инкубационного периода, что затрудняло своевременную изоляцию пациентов и контактных лиц. По мере более детального изучения клинического течения COVID-19 спектр поражения органов и систем постоянно расширяется. Иногда проявления COVID-19 продолжаются даже в периоде реконвалесценции, что довольно часто приводит к снижению работоспособности и качества жизни пациентов. В статье рассматриваются неврологические проявления, симптомы со стороны желудочно-кишечного тракта и особенности пневмонии при COVID-19. Также продемонстрированы клинические особенности гриппа и основные отличия в клиническом течении от COVID-19.

CT findings and dynamic imaging changes of COVID-19 in 2908 patients: a systematic review and meta-analysis.

Quick screening patients with COVID-19 is the most important way of controlling transmission by isolation and medical treatment. Chest computed tomography (CT) has been widely used during the initial screening process, including pneumonia diagnosis, severity assessment, and differential diagnosis of COVID-19. The course of COVID-19 changes rapidly. Serial CT imaging could observe the distribution, density, and range of lesions dynamically, monitor the changes, and then guide towards appropriate treatment. The aim of the review was to explore the chest CT findings and dynamic CT changes of COVID-19 using systematic evaluation methods, instructing the clinical imaging diagnosis. A systematic literature search was performed. The quality of included literature was evaluated with a quality assessment tool, followed by data extraction and meta-analysis. Homogeneity and publishing bias were analyzed. A total of 109 articles were included, involving 2908 adults with COVID-19. The lesions often occurred in bilateral lungs (74%) and were multifocal (77%) with subpleural distribution (81%). Lesions often showed ground-glass opacity (GGO) (68%), followed by GGO with consolidation (48%). The thickening of small vessels (70%) and thickening of intralobular septum (53%) were also common. The dynamic changes of chest CT manifestations showed that lesions were absorbed and improved gradually after reaching the peak (80%), had progressive deterioration (55%), were absorbed and improved gradually (46%), fluctuated (22%), or remained stable (26%). The review showed the common and key CT features and the dynamic imaging change patterns of COVID-19, helping with timely management during COVID-19 pandemic.

Human Metapneumovirus Infection in Adults as the Differential Diagnosis of COVID-19

Human metapneumovirus (HMPV) is a respiratory tract virus identified 18 years prior to severe acute respiratory syndrome coronavirus-2. Both viruses cause acute respiratory failure characterised by a rapid onset of widespread inflammation in the lungs with clinical symptoms similar to those reported for other viral respiratory lung infections. HMPV, more generally known as childhood viral infection, causes mild and self-limiting infections in the majority of adults, but clinical courses can be complicated in risky groups and associated morbidity and mortality are considerable. Moreover, adults are not regularly screened for HMPV and the prevalence of adult HMPV infections in Turkey is unknown, with previous reports in the paediatric population. This should always be kept in mind during the coronavirus disease-2019 pandemic, particularly when neurological complications are added to respiratory findings. In our study, two adult cases of HMPV pneumonia and encephalitis have been recorded.

Human metapneumovirus-associated community-acquired pneumonia in adults during the first wave of COVID-19.

Objective: The clinical course of human metapneumovirus (hMPV) infection is similar to that of coronavirus 2019 disease (COVID-19). However, community-acquired hMPV infections in adults have not yet been sufficiently investigated. We examined the detection status of hMPV antigens and the clinical features of positive patients during the first wave of COVID-19, which coincided with the epidemic season of hMPV infection in Japan.Methods: In this cross-sectional, observational, and single-center study, we recruited consecutive individuals who visited the Japan Agricultural Cooperatives Kochi Hospital due to fever, respiratory symptoms, or close contact with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infected persons during the period from January to May 2020.Results: The positive rate of immunochromatography for hMPV antigens from nasopharyngeal swabs was 9.5% (4/42), and four positive cases were community-acquired pneumonia (CAP) (5.3% of all CAP). The positive rate of hMPV antigens in the CAP group (30.8%, 4/13) was higher than that in the non-pneumonia group (0.0%, 0/19) (p < 0.05). The average age of the four adult patients with CAP was 69.8 years (range 35–93). Mean white blood cell counts and C-reactive protein blood levels were 6,250 cells/μL (3,500–12,180) and 4.30 mg/dL (4.05–7.04), respectively. Chest computed tomography images were diverse and two patients showed dense consolidation. No multi-organ disorder was noted during the clinical course in any of the four cases, and their prognoses were good.Conclusion: hMPV infection may be considered in the differential diagnosis of COVID-19 and CAP in Japan under the preventive measures for SARS-CoV-2 infection, at least during the epidemic season of hMPV infection.

A Case of Vasculitis Delayed Due to COVID-19 Differential Diagnosis

The COVID-19 disease - which emerged in Wuhan, China in December 2019 - has had a significant effect on the whole world having developed into a pandemic, with a wide range of symptoms ranging from asymptomatic carrier to mortality. The focus on COVID-19 diagnosis for these reasons has led to difficulties in the diagnosis and treatment of other diseases. Vasculitis is a very difficult disease group due to its multi-organ involvement and different clinical courses. Due to its radiological properties, there the differential diagnosis of COVID-19 can be difficult. A 65-year-old female patient was admitted with a complaint of dry cough, shortness of breath when walking and chest pain. The patient was examined many times for COVID-19, both in our hospital and in other clinics, and for this reason, the diagnosis of vasculitis was delayed. A diagnosis of vasculitis should be kept in mind in patients with prolonged and multi-systemic symptoms when examined with a pre-diagnosis of COVID-19.

COVID-19 и внебольничная пневмония

The article is devoted to the diagnosis and differential diagnosis of COVID-19 and community-acquired pneumonia. It provides a comparative analysis of clinical, laboratory and computed tomographic signs of diseases. The issues of rational antibiotic therapy for COVID-19 and community-acquired pneumonia are discussed.

Clinical and Laboratory Comparison of Covid-19 and Influenza A/B in Children.

The clinical picture of COVID-19 shows significant similarity with influenza. In this study, it was aimed to compare the clinical and laboratory findings between pediatric patients diagnosed with COVID-19 and those with influenza A or B, and to obtain data on the differential diagnosis of COVID-19 from influenza in children. The study included 104 patients with COVID-19, 140 patients with influenza A and 135 patients with in-fluenza B (379 patients in total) who were admitted to our tertiary hospital with symptoms of acute respiratory tract infection. Fever, cough, runny nose, and pharyngeal hyperemia rates were significantly lower in patients with COVID-19 than in those with influenza A/B. The highest leukocytosis and lymphocytosis rates were seen in influenza A patients. Eosinophil levels were found significantly lower in the influenza A/B patients compared to the COVID-19 group. C-reactive protein levels were significantly higher in the influenza A/B group when compared with the COVID-19 group. The mean PDW value was significantly higher in the COVID-19 patients compared to influenza A/B. Our study data show that low body temperature and loss of taste and smell support the diagnosis of COVID-19, and fever, cough, pharyngeal hyperemia, and runny nose support the diagnosis of influenza. While leukocytosis and increased C-reactive protein suggest influenza, high PDW and eosinophil levels support COVID-19.

Pulmonary vascular enlargement on thoracic CT for diagnosis and differential diagnosis of COVID-19: a systematic review and meta-analysis.

The 2019 coronavirus disease (COVID-19) has become a global pandemic. To date, although many studies have reported on the computed tomography (CT) manifestations of COVID-19, the vascular enlargement sign (VES) of COVID-19 has not been deeply examined, with the few available studies reporting an inconsistent prevalence. We thus performed a systematic review and meta-analysis based on the best available studies to estimate the prevalence and identify the underlying differential diagnostic value of VES. We searched nine English and Chinese language databases up to April 23, 2020. Studies that evaluated CT features of COVID-19 patients and reported VES, with or without comparison with other pneumonia were included. The methodologic quality was assessed using Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). Meta-analyses with random effects models were performed to calculate the aggregate prevalence and pooled odds ratios (ORs) of VES. We also conducted meta-regression and subgroup analyses to analyze heterogeneity. VES findings from a total of 1969 patients were summarized and pooled across 22 studies. Our analysis demonstrated that the prevalence of VES among COVID-19 patients was 69.37% [95% confidence interval (CI): 57.40-79.20%]. Compared with non-COVID-19 patients, VES manifestation was more frequently observed in confirmed COVID-19 patients (OR =6.43, 95% CI: 3.39-12.22). Studies that explicitly defined distribution of VES in the lesion area demonstrated a significantly higher prevalence (P=0.03). Subgroup analyses also revealed a relatively higher VES rate in studies with a sample size larger than 50, but the difference was not statistically significant. No significant difference in VES rates was found between different countries (China/Italy), regions (Hubei/outside Hubei), average age groups (over/less than 50-year-old), or slice thicknesses of CT scan. Extensive heterogeneity was identified across most estimates (I2>80%). Some of the variations (R2=19.73%) could be explained by VES distribution, and sample size. No significant publication bias was seen (P=0.29). VES on thoracic CT was found in almost two-thirds of COVID-19 patients, and was more prevalent compared with that of the non-COVID-19 patients, supporting a promising role for VES in identifying pneumonia caused by coronavirus.

Early chest computed tomography to diagnose COVID-19 from suspected patients: A multicenter retrospective study.

ObjectiveThe purpose of this study was to distinguish the imaging features of COVID-19 from those of other infectious pulmonary diseases and evaluate the diagnostic value of chest CT for suspected COVID-19 patients.MethodsAdult patients suspected of COVID-19 aged >18 years who underwent chest CT scans and reverse-transcription polymerase chain reaction (RT-PCR) tests within 14 days of symptom onset were enrolled. The enrolled patients were confirmed and grouped according to the results of the RT-PCR tests. The basic demographics, single chest CT features, and combined chest CT features were analyzed for the confirmed and nonconfirmed groups.ResultsA total of 130 patients were enrolled, with 54 testing positive and 76 testing negative. The typical CT imaging features of the positive group were ground glass opacities (GGOs), the crazy-paving pattern and air bronchogram. The lesions were mostly distributed bilaterally and close to the lower lungs or the pleura. When features were combined, GGOs with bilateral pulmonary distribution and GGOs with pleural distribution were more common among the positive patients, found in 31 (57.4%) and 30 patients (55.6%), respectively. The combinations were almost all statistically significant (P < .05), except for the combination of GGOs with consolidation. Most combinations presented relatively low sensitivity but extremely high specificity. The average specificity of these combinations was approximately 90%.ConclusionsThe combinations with GGOs could be useful in the identification and differential diagnosis of COVID-19, alerting clinicians to isolate patients for prompt treatment and repeat RT-PCR tests until the end of incubation.