Clinical Characteristics and Outcome of Patients with Suspected COVID-19 in Emergency Department (RESILIENCY Study II)

Alessandro Russo; Elio Gentilini Cacciola; Cristian Borrazzo; Valeria Filippi; Tommaso Bucci; Francesco Vullo; Luigi Celani; Erica Binetti; Luigi Battistini; Giancarlo Ceccarelli; Maria Alessandroni; Gioacchino Galardo; Claudio Maria Mastroianni; Gabriella d’Ettorre

doi:10.3390/diagnostics11081368

Diagnostics (Jul 2021)

Clinical Characteristics and Outcome of Patients with Suspected COVID-19 in Emergency Department (RESILIENCY Study II)

Alessandro Russo,
Elio Gentilini Cacciola,
Cristian Borrazzo,
Valeria Filippi,
Tommaso Bucci,
Francesco Vullo,
Luigi Celani,
Erica Binetti,
Luigi Battistini,
Giancarlo Ceccarelli,
Maria Alessandroni,
Gioacchino Galardo,
Claudio Maria Mastroianni,
Gabriella d’Ettorre

Affiliations

Alessandro Russo: Department of Medical and Surgical Sciences, Infectious and Tropical Disease Unit, “Magna Graecia” University of Catanzaro, 88100 Catanzaro, Italy
Elio Gentilini Cacciola: Policlinico “Umberto I”, Department of Public Health and Infectious Diseases, “Sapienza” University of Rome, 00185 Rome, Italy
Cristian Borrazzo: Policlinico “Umberto I”, Department of Public Health and Infectious Diseases, “Sapienza” University of Rome, 00185 Rome, Italy
Valeria Filippi: Policlinico “Umberto I”, Department of Public Health and Infectious Diseases, “Sapienza” University of Rome, 00185 Rome, Italy
Tommaso Bucci: Department of General Surgery, Surgical Specialties and Organ Transplantation “Paride Stefanini”, Sapienza University of Rome, 00185 Rome, Italy
Francesco Vullo: Department of Radiological, Oncological and Pathological Sciences, “Sapienza” University of Rome, 00185 Rome, Italy
Luigi Celani: Policlinico “Umberto I”, Department of Public Health and Infectious Diseases, “Sapienza” University of Rome, 00185 Rome, Italy
Erica Binetti: Policlinico “Umberto I”, Department of Public Health and Infectious Diseases, “Sapienza” University of Rome, 00185 Rome, Italy
Luigi Battistini: Policlinico “Umberto I”, Department of Public Health and Infectious Diseases, “Sapienza” University of Rome, 00185 Rome, Italy
Giancarlo Ceccarelli: Policlinico “Umberto I”, Department of Public Health and Infectious Diseases, “Sapienza” University of Rome, 00185 Rome, Italy
Maria Alessandroni: Medical Emergency Unit, Sapienza University of Rome, Policlinico Umberto I, 00185 Rome, Italy
Gioacchino Galardo: Medical Emergency Unit, Sapienza University of Rome, Policlinico Umberto I, 00185 Rome, Italy
Claudio Maria Mastroianni: Policlinico “Umberto I”, Department of Public Health and Infectious Diseases, “Sapienza” University of Rome, 00185 Rome, Italy
Gabriella d’Ettorre: Policlinico “Umberto I”, Department of Public Health and Infectious Diseases, “Sapienza” University of Rome, 00185 Rome, Italy

DOI: https://doi.org/10.3390/diagnostics11081368
Journal volume & issue: Vol. 11, no. 8
p. 1368

Abstract

Read online

Objectives: COVID-19 may show no peculiar signs and symptoms that may differentiate it from other infective or non-infective etiologies; thus, early recognition and prompt management are crucial to improve survival. The aim of this study was to describe clinical, laboratory, and radiological characteristics and outcomes of hospitalized COVID-19 patients compared to those with other infective or non-infective etiologies. Methods: We performed a prospective study from March 2020 to February 2021. All patients hospitalized for suspected or confirmed COVID-19 were prospectively recruited. All patients were evaluated according to a predefined protocol for diagnosis of suspected SARS-CoV-2 infection. The primary endpoint was evaluation of clinical, laboratory, and radiological characteristics associated or not with COVID-19 etiology at time of hospitalization in an emergency department. Results: A total of 1036 patients were included in the study: 717 (69%) patients with confirmed COVID-19 and 319 (31%) without COVID-19, hospitalized for other causes. The main causes of hospitalization among non-COVID-19 patients were acute heart failure (44%) and bacterial pneumonia (45.8%). Overall, 30-day mortality was 9% among the COVID-19 group and 35% in the non-COVID-19 group. Multivariate analysis showed variables (fever > 3 days, dry cough, acute dyspnea, lymphocytes 3/µL, and ferritin > 250 ng/mL) independently associated with COVID-19 etiology. A decision tree was elaborated to early detect COVID-19 patients in the emergency department. Finally, Kaplan–Meier curves on 30-day survival in COVID-19 patients during the first wave (March–May 2020, n = 289 patients) and the second wave (October–February 2021, n = 428 patients) showed differences between the two study periods (p = 0.021). Conclusions: Patients with confirmed diagnosis of COVID-19 may show peculiar characteristics at time of hospitalization that could help physicians to distinguish from other infective or non-infective etiologies. Finally, a different 30-day mortality rate was observed during different periods of the pandemic.

Published in Diagnostics

ISSN: 2075-4418 (Online)
Publisher: MDPI AG
Country of publisher: Switzerland
LCC subjects: Medicine: Medicine (General)
Website: http://www.mdpi.com/journal/diagnostics

About the journal

Abstract

Keywords