key: cord-0691495-skzughd1
authors: Xing, Li-Hong; Xie, Ru-Ming; Ni, Zhi-Yu; Yin, Xiao-Ping
title: Clinical and imaging features of adult COVID-19 patients with and without comorbidities
date: 2021-12-21
journal: Asian J Surg
DOI: 10.1016/j.asjsur.2021.12.010
sha: e42983e20e227c7bcface0cfa3e8bb9ae0990a4a
doc_id: 691495
cord_uid: skzughd1

OBJECTIVE: To investigate clinical and computed tomography (CT) imaging features of COVID-19 patients with and without comorbidities. METHODS: One hundred forty-one patients with COVID-19 were enrolled, including 60 patients without comorbidities and 81 with comorbidities. The clinical characteristics and CT imaging presentations were compared. RESULTS: The most common comorbidity was hypertension (51.8%), followed by diabetes (22.22%) and cardiovascular disease (17.28%). Patients without comorbidities were significantly younger (mean 43 years) than those with comorbidities (mean 61 years) (P < 0.001). Significantly more patients with comorbidities (P < 0.05) had fatigue (P = 0.001), dyspnea (P = 0.024), and increased C-reactive protein (P = 0.002). Patients with comorbidities had significantly more severe diseases and a greater duration of hospitalization (24.96 ± 10.34 vs. 17.48 ± 7.93 days) than those without (P < 0.001). At the early stages, significantly more patients with comorbidities had fibrous stripes on CT imaging (P = 0.02). At the progression stage, 76 patients with comorbidities and 53 without had CT scanning. Significantly more patients with comorbidities (P < 0.05) had thickened intralobular septa (P = 0.026), thickened interlobular septa (P < 0.001), fibrous stripes (P = 0.007), pleural effusion (P < 0.001), over three lobes involved (P < 0.001), and bilateral upper lobes involved (P = 0.008). The disease was significantly improved (P < 0.001) with a shorter duration from onset to improvement in those without than those with comorbidities.

To the editor,

The coronavirus disease (COVID-19) caused by the SARS-CoV-2 virus is currently spreading all over the world. Epidemiology studies have revealed that 25.2% of COVID-19 patients had at least one comorbidity [1] . Currently, most research on COVID-19 focuses on epidemiology [2, 3] , comprehensive analysis [1, 4] , comparative analysis between children and adults, and comparative studies on clinical classification and imaging staging [5] . No comparative studies have been performed between COVID-19 patients with and without comorbidities. This study united multiple medical imaging centers in China to perform a comprehensive analysis on COVID-19 patients with comorbidities to understand the specific epidemiology, clinical and imaging presentations, present the difference between those with and without comorbidities, and provide valuable guidelines for clinical diagnoses, treatments, and prognoses.

It was performed between January and February 2020 with patients admitted to six hospitals in China. One hundred forty-one patients with COVID-19 were enrolled, including 60 patients without comorbidities and 81 with comorbidities. The clinical characteristics and CT imaging presentations were compared. Patients without comorbidities were significantly younger (mean 43 years) than those with comorbidities (mean 61 years) (P < 0.001). Patients with comorbidities had significantly more severe diseases and a greater duration of hospitalization (24.96 ± 10.34 vs. 17.48 ± 7.93 days) than those without (P < 0.001). Significantly more patients with comorbidities (P < 0.05) had fatigue (P = 0.001), dyspnea (P = 0.024), J o u r n a l P r e -p r o o f and increased C-reactive protein (P = 0.002) ( Table 1) . At Early-stage, significantly more patients with comorbidities had fibrous stripes in CT imaging (P = 0.02). At the progression stage, significantly more patients with comorbidities (P < 0.05) had thickened intralobular septa (P = 0.026), thickened interlobular septa (P < 0.001), fibrous stripes (P = 0.007), pleural effusion (P < 0.001), over three lobes involved (P < 0.001), and bilateral upper lobes involved (P = 0.008). No significant difference was observed in the presentations of ground-glass opacity, consolidation, ground-glass opacity mixed with consolidation, or enlarged mediastinal lymph nodes (P > 0.05).

The disease entered the progression stage more quickly in the group with comorbidities but without a significant difference in the duration from onset to progression compared with those without underlying conditions (P > 0.05). The disease was significantly improved with a shorter duration from onset to improvement in those without than those with comorbidities (P < 0.001).

COVID-19 patients may have one or more comorbidities with hypertension the most typical type, followed by diabetes and cardiovascular diseases. Compared with patients without comorbidities, patients with comorbidities were older at onset, 

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The authors declare that they have no competing interests.