key: cord-0974480-xindgvlk authors: Lv, Ding‐feng; Ying, Qi‐ming; He, Yi‐wen; Liang, Jun; Zhang, Ji‐hong; Lu, Bei‐bei; Qian, Guo‐qing; Chu, Jin‐guo; Weng, Xing‐bei; Chen, Xue‐qin; Mu, Qi‐tian title: Differential diagnosis of coronavirus disease 2019 pneumonia or influenza A pneumonia by clinical characteristics and laboratory findings date: 2021-02-12 journal: J Clin Lab Anal DOI: 10.1002/jcla.23685 sha: 17fad0eafed67a464ce4308f80d8e61a5f3b5ac7 doc_id: 974480 cord_uid: xindgvlk BACKGROUND: Pneumonia caused by the 2019 novel Coronavirus (COVID‐2019) shares overlapping signs and symptoms, laboratory findings, imaging features with influenza A pneumonia. We aimed to identify their clinical characteristics to help early diagnosis. METHODS: We retrospectively retrieved data for laboratory‐confirmed patients admitted with COVID‐19–induced or influenza A–induced pneumonia from electronic medical records in Ningbo First Hospital, China. We recorded patients' epidemiological and clinical features, as well as radiologic and laboratory findings. RESULTS: The median age of influenza A cohort was higher and it exhibited higher temperature and higher proportion of pleural effusion. COVID‐19 cohort exhibited higher proportions of fatigue, diarrhea and ground‐glass opacity and higher levels of lymphocyte percentage, absolute lymphocyte count, red‐cell count, hemoglobin and albumin and presented lower levels of monocytes, c‐reactive protein, aspartate aminotransferase, alkaline phosphatase, serum creatinine. Multivariate logistic regression analyses showed that fatigue, ground‐glass opacity, and higher level of albumin were independent risk factors for COVID‐19 pneumonia, while older age, higher temperature, and higher level of monocyte count were independent risk factors for influenza A pneumonia. CONCLUSIONS: In terms of COVID‐19 pneumonia and influenza A pneumonia, fatigue, ground‐glass opacity, and higher level of albumin tend to be helpful for diagnosis of COVID‐19 pneumonia, while older age, higher temperature, and higher level of monocyte count tend to be helpful for the diagnosis of influenza A pneumonia. This was a retrospective cross-sectional observational study. All of the COVID-19 pneumonia and influenza A pneumonia subjects were confirmed by laboratory tests and were admitted to Ningbo First Hospital. COVID-19 pneumonia patients were hospitalized between January 1 and March 31, 2020, while influenza A pneumonia patients were hospitalized at the same period: All of the patients met the criteria to diagnose pneumonia as an acute respiratory disorder characterized by the presence of cough and at least one of the new-onset focal chest signs, fever for more than 4 days or dyspnea/ tachypnea. 12 Following fulfillment of these criteria, all of the patients with COVID-19-induced or influenza A-induced pneumonia were included in this study. The study has been reviewed and approved by the Medical Ethical Committee of Ningbo First Hospital (2020-R037). The requirement for written informed consent was waived for the urgent need to collect clinical data according to the policy for public-health-outbreak investigation of emerging infectious diseases issued by the National Health Commission of the People's Republic of China, and no potential harm could be done to patients in light of retrospective study. Only hospitalized patients with laboratory-confirmed pneumonia cases were included the analysis. A laboratory-confirmed case with COVID-19 or influenza A is defined as a positive result of the respiratory tract specimens by real-time RT-PCR assay. Outpatients, nonlaboratory-confirmed cases, not manifesting as pneumonia patients, or ones with pneumonia caused by mycoplasma, chlamydia, bacteria, and other pathogens were excluded the analysis. The recent exposure histories, clinical symptoms or signs, and laboratory findings on admission were extracted from electronic medical records. Radiologic assessments included chest radiography or computed tomography (CT). We determined the presence of a radiologic abnormality on the basis of the documentation or description in medical reports. Laboratory assessments consisted of blood routine, infection-related biomarkers, and blood chemical analysis. All data were checked by at least two experienced specialists. Data analysis was performed using SPSS 17.0 (IBM Corp., Armonk, NY) software. Categorical variables were summarized using frequencies and percentages, and continuous data are presented as the medians (interquartile ranges [IQRs]). Chi-square test was used for categorical variables, and nonparametric rank sum test of independent samples was used for continuous variables. Variables with a p value <0.05 in chi-square test and rank sum test were entered into multivariate logistic regression analysis to identify independent risk factors associated with COVID-19 or influenza A. All of the p values less than 0.05 were considered to be statistically significant. The median age of influenza A pneumonia cohort was 62 years old, which was significantly higher than that of COVID-19 pneumonia cohort (54 years old, p = 0.037). There was no significant difference in gender ratio and underlying diseases (including hypertension, type 2 diabetes, cardiovascular and cerebrovascular diseases, tumor, hepatitis, and autoimmune diseases) between the two cohorts. The median value of highest temperature of influenza A pneumonia cohort was 38.8°C, significantly higher than that of COVID-19 pneumonia cohort (37.9°C, p < 0.001), but there was no significant difference in admission temperature between the two cohorts. The proportion of pleural effusion in influenza A pneumonia cohort was significantly higher than that of COVID-19 pneumonia cohort (18.75% vs. 2.94%, p = 0.031) ( Table 1 ). Both of COVID-19 and influenza A pneumonia cohorts presented high proportions of cough, but there was no significant difference between two groups. However, the proportions of fatigue (67.65%), diarrhea (32.35%) in pneumonia patients with COVID-19 were higher than those of influenza A cohort (9.09%, p < 0.001; 3.64%, p < 0.001, respectively) ( Table 1 ). In terms of radiologic characteristics, ground-glass opacity was a characteristic representation of COVID-19 pneumonia (73.53%) ( Table 2 ) ( Figure 1A ,B), while few influenza A pneumonia patients presented ground-glass opacity (6.25%, p < 0.001 Figure 1D ). In addition, two cohorts were prone to harbor bilateral patchy shadowing, but there was no significant difference (82.35% vs. 77.08%, p > 0.05). As far as complete blood count (CBC) was concerned, lymphocyte percentage, absolute lymphocyte count, red-cell count, and hemoglobin levels in COVID-19 pneumonia cohort were all significantly higher than those in influenza A pneumonia cohort COVID-19 patients also in Shi's report. 15 Wang et al 16 Undoubtedly, the most common patterns on chest CT of COVID-19 pneumonia patients were ground-glass opacity and bilateral patchy shadowing and this proportion in this study was higher than that in a research by Guan WJ. 10 The radiological findings of 81 patients with COVID-19 pneumonia showed that diffused bilateral ground-glass opacities were the most predominant pattern of abnormalities in chest CTs within 1-3 weeks after disease onset. 17 Compared with features in influenza A pneumonia cohort, groundglass opacities in chest CTs were characteristics of COVID-19 pneumonia cohort and were independent risk factors to differentiate COVID-19 pneumonia from influenza A pneumonia. In contrast, only 3 patients with influenza A pneumonia presented ground-glass opacity ( Figure 1D ). Therefore, radiologic assessments have been applied to the diagnosis of COVID-19 pneumonia in Chinese guidelines. 18 Guan WJ et al 10 In summary, clinical characteristics and laboratory findings contribute to differential diagnose COVID-19 pneumonia and influenza A pneumonia. All authors: No reported conflicts. The data used to support the findings of this study are available from the corresponding author upon request. Ding-feng Lv https://orcid.org/0000-0002-2369-870X Xing-bei Weng https://orcid.org/0000-0001-8893-1704 Coronavirus envelope protein: current knowledge Coronavirus infection in equines: a review A novel coronavirus from patients with pneumonia in China Epidemiological determinants of spread of causal agent of severe acute respiratory syndrome in Hong Kong Middle East respiratory syndrome coronavirus: quantification of the extent of the epidemic, surveillance biases, and transmissibility Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia Handbook of Infectious Diseases. Springhouse The origin, transmission and clinical therapies on coronavirus disease 2019 (COVID-19) outbreak -an update on the status Clinical characteristics of coronavirus disease 2019 in China Epidemiologic and clinical characteristics of 91 hospitalized patients with COVID-19 in Zhejiang, China: a retrospective, multi-centre case series Guidelines for the management of adult lower respiratory tract infections-Summary Clinical features of patients infected with 2019 novel coronavirus in Wuhan Comparison of hospitalized patients with ARDS caused by COVID-19 and H1N1 Analysis of clinical features and outcomes of 161 patients with severe and critical COVID-19: a multicenter descriptive study Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study General Office of National Health Commission PRC. Guidelines of Diagnosis and Treatment of COVID-19 Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study Dynamic change process of target genes by RT-PCR testing of SARS-Cov-2 during the course of a Coronavirus Disease 2019 patient Laboratory abnormalities and risk factors associated with in-hospital death in patients with severe COVID-19 Dexamethasone in hospitalized patients with COVID-19-preliminary report Oseltamivir, amantadine, and ribavirin combination antiviral therapy versus oseltamivir monotherapy for the treatment of influenza: a multicentre, double-blind, randomised phase 2 trial laboratory findings