key: cord-0702968-uzxmcofk
authors: Russo, Alessandro; Bellelli, Valeria; Ceccarelli, Giancarlo; Marincola Cattaneo, Federica; Bianchi, Luigi; Pierro, Roberto; Russo, Roberta; Steffanina, Alessia; Pugliese, Francesco; Mastroianni, Claudio Maria; d'Ettorre, Gabriella; Sabetta, Francesco
title: Comparison between hospitalized patients affected or not by COVID-19 (RESILIENCY study)
date: 2020-11-18
journal: Clin Infect Dis
DOI: 10.1093/cid/ciaa1745
sha: 694159827ab6081a1fe217f3c7e2b8b489278d88
doc_id: 702968
cord_uid: uzxmcofk

nan

M a n u s c r i p t 2 Dear Editor, in the recent report of Munblit and coworkers [1] , authors observed that the combination of clinical features was sufficient to diagnose COVID-19 indicating that laboratory testing is not critical in real-life clinical practice. To date, all patients admitted to Emergency Department with acute respiratory failure and/or fever should be considered as a suspected SARS-CoV-2 infection [2] [3] , and an early recognition of etiology and the prompt therapeutic management are crucial to improve survival [4] [5] .

From March to July 2020, we performed a prospective, multicenter study (RESILIENCY study). During the study period, all patients hospitalized for suspected or confirmed COVID-19 were prospectively recruited in 3 large hospitals in Rome, Italy. All patients with suspected SARS-CoV-2 infection, admitted to the hospital in case of fever and/or hypoxemic respiratory failure (PaO 2 <60 mmHg at rest in ambient air) or of exacerbation of underlying diseases or severe symptoms not manageable outside the hospital, were evaluated according to a predefined protocol (see Figure 1 ). The findings of the present study can be summarized as follows:1) the prompt identification of specific clinical characteristics (like dry cough or duration of fever>3 days), and laboratory findings (like lymphocytopenia, PaO2/FiO2 ratio<250, procalcitonin value>1 ng/ mL, and lactate>2 mmol/L) can help physicians to distinguish rapidly between COVID-19 or other etiologies [6] ; 2) the application of a standard approach to management of patients with acute respiratory failure and/or fever associated with the knowledge of clinical and laboratory characteristics of COVID-19 can early drive physicians to therapeutic choices; and 3) age, cardiovascular disease, and ICU admission show an independent association with all-cause 30-day mortality [7] , while the use of low-molecular-weight heparin was associated with survival [8] .

In conclusion, COVID-19 syndrome is characterized by a heterogeneous clinical, laboratoristic, and radiological presentation, especially at its onset [9] . However, the application of a standard approach to management of patients with acute respiratory failure and/or fever and the knowledge of clinical and laboratory characteristics of COVID-19 can early drive therapeutic choices [10] . A c c e p t e d M a n u s c r i p t

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