Clinical features, diagnostics, and outcomes of patients presenting with acute respiratory illness: A retrospective cohort study of patients with and without COVID-19
Sachin J. Shah, Peter Barish, Priya A. Prasad, Amy Kistler, Norma Neff, Jack Kamm, Lucy M. Li, Charles Y. Chiu, Jennifer M. Babik, Margaret C. Fang, Yumiko Abe‐Jones, Narges Alipanah, Francisco N. Alvarez, Olga Botvinnik, Gloria Castañeda, Rand Dadasovich, Jennifer Davis, Xianding Deng, Joseph L. DeRisi, Angela M. Detweiler, Scot Federman, John Haliburton, Samantha Hao, Andrew D. Kerkhoff, G. Renuka Kumar, Katherine Malcolm, Sabrina A Mann, Sandra Martı́nez, Rupa K. Mary, Eran Mick, Lusajo Mwakibete, Nader Najafi, Michael J. Peluso, Maíra Phelps, Angela Oliveira Pisco, Kalani Ratnasiri, Luis Rubio, Anna B. Sellas, Kyla D. Sherwood, Jonathan Sheu, Natasha Spottiswoode, Michelle Tan, Guixia Yu, Kirsten N. Kangelaris, Charles Langelier
Abstract
Background Most data on the clinical presentation, diagnostics, and outcomes of patients with COVID-19 have been presented as case series without comparison to patients with other acute respiratory illnesses. Methods We examined emergency department patients between February 3 and March 31, 2020 with an acute respiratory illness who were tested for SARS-CoV-2. We determined COVID-19 status by PCR and metagenomic next generation sequencing (mNGS). We compared clinical presentation, diagnostics, treatment, and outcomes. Findings Among 316 patients, 33 tested positive for SARS-CoV-2; 31 without COVID-19 tested positive for another respiratory virus. Among patients with additional viral testing (27/33), no SARS-CoV-2 co-infections were identified. Compared to those who tested negative, patients with COVID-19 reported longer symptoms duration (median 7d vs. 3d, p < 0.001). Patients with COVID-19 were more often hospitalized (79% vs. 56%, p = 0.014). When hospitalized, patients with COVID-19 had longer hospitalizations (median 10.7d vs. 4.7d, p < 0.001) and more often developed ARDS (23% vs. 3%, p < 0.001). Most comorbidities, medications, symptoms, vital signs, laboratories, treatments, and outcomes did not differ by COVID-19 status. Interpretation While we found differences in clinical features of COVID-19 compared to other acute respiratory illnesses, there was significant overlap in presentation and comorbidities. Patients with COVID-19 were more likely to be admitted to the hospital, have longer hospitalizations and develop ARDS, and were unlikely to have co-existent viral infections. Funding National Center for Advancing Translational Sciences, National Heart Lung Blood Institute, National Institute of Allergy and Infectious Diseases, Chan Zuckerberg Biohub, Chan Zuckerberg Initiative.