ABSTRACT
Introduction: The spread of COVID-19 imposed a re-organization of healthcare services. The increased circulation of the virus among the population and the need for a quick diagnosis suggest the identification of new decisionmaking actions. Aim(s): We aimed to determine whether clinical, laboratory and imaging characteristics can reliably differentiate suspected COVID from positives tested with nasal-pharyngeal(N-P)swab. Method(s): This is a retrospective, cross-sectional study on data collected(March-May 2020)at the Lung Unit, University of Pavia(confirmed cases=50)and at the Emergency Unit, University of Palermo(suspected cases=103). COVID-19 was confirmed by positive N-P swab. Suspected were tested negative. We recorded clinical, laboratory and radiological variables and compared them by Chi-squared or t-test. Logistic regression estimated which variables increased the risk of COVID-19 in both groups. A prediction model and derived ROC-AUCcurve, assessed the accuracy. P<0.05 was considered significant. Result(s): High ReactiveC-Protein, suggestive CTimages, dyspnea and respiratory failure increased the risk of COVID-19, whereas pleural effusion decreased the risk(table). ROC confirmed the discriminative role of these variables between suspected and confirmed COVID-19(AUC 0.91). Conclusion(s): Clinical, laboratory and imaging features predict the diagnosis of COVID-19, independently of the N-P swab result. We suggest the inclusion of these elements in the decision-making to facilitate the management of suspected COVID.
ABSTRACT
The COVID-19 epidemic is currently spreading worldwide;Italy and Lombardy region have been facing the largest European outbreak since February 2020. In Pneumology Unit in San Matteo Hospital more than 121 COVID-19 positive patients have been followed and treated. For 97 of them (68 males, 29 females) we were able to collect exhaustive demographic and clinic data. An exhaustive database has been constructed. Data were processed according to partitioning method and clustering analysis by using JMP software tool. Overall, the 42% of male patients older than 73 years deceased whereas the percentage decreases to 20.8% in younger patients. Among this subgroup, survival is conditioned by the occurrence of pulmonary embolism, being the 100% of patients without embolism alive whereas 14.5% of death occurred in patients who developed embolism. In those male patients older than 73, survival was mainly influenced by infections and 80% of survivors were treated with antibiotics. Among females, survival was associated to smoking habit and 100% of never smoker patients are alive, whereas 19% of past smokers deceased. Notably, we do not observe current smoker female patients. Secondarily, survival was affected by the occurrence of endocrinologic (diabetes) and rheumatic comorbidities. Interestingly neoplastic condition did not affect outcome both in male and female patients.