EClinicalMedicine (Oct 2020)
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 N. 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 Borisovna Botvinnik,
- Gloria Castaneda,
- Rand M. Dadasovich,
- Jennifer Davis,
- Xianding Deng,
- Joseph L. DeRisi,
- Angela M. Detweiler,
- Scot Federman,
- John Haliburton,
- Samantha Hao,
- Andrew D. Kerkhoff,
- G. Renuka Kumar,
- Katherine B. Malcolm,
- Sabrina A. Mann,
- Sandra Martinez,
- Rupa K. Mary,
- Eran Mick,
- Lusajo Mwakibete,
- Nader Najafi,
- Michael J. Peluso,
- Maira Phelps,
- Angela Oliveira Pisco,
- Kalani Ratnasiri,
- Luis A. Rubio,
- Anna Sellas,
- Kyla D. Sherwood,
- Jonathan Sheu,
- Natasha Spottiswoode,
- Michelle Tan,
- Guixia Yu,
- Kirsten Neudoerffer Kangelaris,
- Charles Langelier
Affiliations
- Sachin J. Shah
- Corresponding authors.; Division of Hospital Medicine, University of California, San Francisco, CA, USA
- Peter N. Barish
- Division of Hospital Medicine, University of California, San Francisco, CA, USA
- Priya A. Prasad
- Division of Hospital Medicine, University of California, San Francisco, CA, USA
- Amy Kistler
- Chan Zuckerberg Biohub, San Francisco, CA, USA
- Norma Neff
- Chan Zuckerberg Biohub, San Francisco, CA, USA
- Jack Kamm
- Chan Zuckerberg Biohub, San Francisco, CA, USA
- Lucy M. Li
- Chan Zuckerberg Biohub, San Francisco, CA, USA
- Charles Y. Chiu
- Division of Infectious Diseases, University of California, San Francisco, CA, USA; Department of Laboratory Medicine, University of California, San Francisco, CA, USA
- Jennifer M. Babik
- Division of Infectious Diseases, University of California, San Francisco, CA, USA
- Margaret C. Fang
- Division of Hospital Medicine, University of California, San Francisco, CA, USA
- Yumiko Abe-Jones
- Division of Hospital Medicine, University of California, San Francisco, CA, USA
- Narges Alipanah
- Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, CA, USA
- Francisco N. Alvarez
- Division of Hospital Medicine, University of California, San Francisco, CA, USA
- Olga Borisovna Botvinnik
- Chan Zuckerberg Biohub, San Francisco, CA, USA
- Gloria Castaneda
- Chan Zuckerberg Biohub, San Francisco, CA, USA
- Rand M. Dadasovich
- Department of Medicine, University of California, San Francisco, CA, USA
- Jennifer Davis
- Department of Medicine, University of California, San Francisco, CA, USA
- Xianding Deng
- Department of Laboratory Medicine, University of California, San Francisco, CA, USA
- Joseph L. DeRisi
- Chan Zuckerberg Biohub, San Francisco, CA, USA; Department of Biochemistry and Biophysics, University of California, San Francisco, CA, USA
- Angela M. Detweiler
- Chan Zuckerberg Biohub, San Francisco, CA, USA
- Scot Federman
- Department of Laboratory Medicine, University of California, San Francisco, CA, USA
- John Haliburton
- Chan Zuckerberg Biohub, San Francisco, CA, USA
- Samantha Hao
- Chan Zuckerberg Biohub, San Francisco, CA, USA
- Andrew D. Kerkhoff
- Division of Infectious Diseases, University of California, San Francisco, CA, USA
- G. Renuka Kumar
- Chan Zuckerberg Biohub, San Francisco, CA, USA
- Katherine B. Malcolm
- Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, CA, USA
- Sabrina A. Mann
- Chan Zuckerberg Biohub, San Francisco, CA, USA; Department of Biochemistry and Biophysics, University of California, San Francisco, CA, USA
- Sandra Martinez
- Division of Hospital Medicine, University of California, San Francisco, CA, USA
- Rupa K. Mary
- Division of Hospital Medicine, University of California, San Francisco, CA, USA
- Eran Mick
- Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, CA, USA; Division of Infectious Diseases, University of California, San Francisco, CA, USA; Chan Zuckerberg Biohub, San Francisco, CA, USA
- Lusajo Mwakibete
- Chan Zuckerberg Biohub, San Francisco, CA, USA
- Nader Najafi
- Division of Hospital Medicine, University of California, San Francisco, CA, USA
- Michael J. Peluso
- Division of Infectious Diseases, University of California, San Francisco, CA, USA
- Maira Phelps
- Chan Zuckerberg Biohub, San Francisco, CA, USA
- Angela Oliveira Pisco
- Chan Zuckerberg Biohub, San Francisco, CA, USA
- Kalani Ratnasiri
- Chan Zuckerberg Biohub, San Francisco, CA, USA; Program in Immunology, Stanford University School of Medicine, Stanford, CA, 94305, USA
- Luis A. Rubio
- Division of Infectious Diseases, University of California, San Francisco, CA, USA
- Anna Sellas
- Chan Zuckerberg Biohub, San Francisco, CA, USA; Vitalant Research Institute, San Francisco, CA, USA
- Kyla D. Sherwood
- Department of Medicine, University of California, San Francisco, CA, USA
- Jonathan Sheu
- Chan Zuckerberg Biohub, San Francisco, CA, USA
- Natasha Spottiswoode
- Department of Medicine, University of California, San Francisco, CA, USA
- Michelle Tan
- Chan Zuckerberg Biohub, San Francisco, CA, USA
- Guixia Yu
- Department of Laboratory Medicine, University of California, San Francisco, CA, USA
- Kirsten Neudoerffer Kangelaris
- Division of Hospital Medicine, University of California, San Francisco, CA, USA
- Charles Langelier
- Division of Infectious Diseases, University of California, San Francisco, CA, USA; Chan Zuckerberg Biohub, San Francisco, CA, USA; Corresponding authors.
- Journal volume & issue
-
Vol. 27
p. 100518
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.
