Development and validation of an early warning score (EWAS) for predicting clinical deterioration in patients with coronavirus disease 2019 (preprint)

Background: Since the pandemic outbreak of coronavirus disease 2019 (COVID-19), the health system capacity in highly endemic areas has been overwhelmed. Approaches to efficient management are urgently needed. We aimed to develop and validate a score for early prediction of clinical deterioration of COVID-19 patients. Methods: In this retrospective multicenter cohort study, we included 1138 mild to moderate COVID-19 patients admitted to 33 hospitals in Guangdong Province from December 27, 2019 to March 4, 2020 (N =818; training cohort), as well as two hospitals in Hubei Province from January 21 to February 22, 2020 (N =320; validation cohort) in the analysis. Results: The 14-day cumulative incidences of clinical deterioration were 7.9% and 12.1% in the training and validation cohorts, respectively. An Early WArning Score (EWAS) (ranging from 0 to 4.5), comprising of age, underlying chronic disease, neutrophil to lymphocyte ratio, C-reactive protein, and D-dimer levels, was developed (AUROC: 0.857). By applying the EWAS, patients were categorized into low-, medium-, and high risk groups (cut-off values: two and three). The 14-day cumulative incidence of clinical deterioration in the low-risk group was 1.8%, which was significantly lower than the incidence rates in the medium- (14.4%) and high-risk (40.9%) groups (P

Diagnosis challenge of suspected COVID-19 pneumonia in cancer patients with radiation-induced pneumonitis (preprint)

Background During the outbreak period of COVID-19 pneumonia, cancer patients have been neglected and in greater danger. Furthermore, the differential diagnosis between COVID-19 pneumonia and radiation pneumonitis in caner patients remains a challenge. The study aimed to determine their clinical presentations and radiological features to familiarize radiologists and clinical teams with them in order to early diagnosis and prompt early patient isolation.Methods From January 21, 2019 to February 18, 2020, the patients selected consecutively met the following criteria: (i) presumed COVID-19 pneumonia; (ii) patients with a history of malignancy and lung exposure to ionizing radiation. A retrospective analysis including all patients’ presenting was performed.Results 4 patients from 112 suspected individals were selected, including 2 males and 2 females with a median age of 54 years (39–64 years). After repeated pharyngeal swab nucleic acid tests, 1 case was confirmed and 3 cases were excluded from COVID-19 pneumonia.Conclusions Despite the comparable morphologic characteristics of lung CT imaging, the location, extent, and distribution of lung lesions between COVID-19 pneumonia and radiation pneumonitis differ significantly, further combined with clinical and laboratory findings that could facilitate early diagnosis and appropriate management.