A comparative multi-center study on the clinical and imaging features of confirmed and unconfirmed patients with COVID-19

  1. Congliang Miao
  2. Jinqiang Zhuang
  3. Mengdi Jin
  4. Huanwen Xiong
  5. Peng Huang
  6. Qi Zhao
  7. Li Miao
  8. Jiang Du
  9. Xinying Yang
  10. Peijie Huang
  11. Jiang Hong

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Abstract

Background

Previous studies had described the differences in clinical characteristics between ICU and non-ICU patients. However, seldom study focused on confirmed and unconfirmed groups. Our aim was to compare clinical and imaging characteristics of COVID-19 patients outside Hubei province between confirmed and unconfirmed group.

Methods

We retrospectively enrolled 163 consecutive adult patients with suspected COVID-19 from three tertiary hospitals in two provinces outside Hubei province from January 12, 2020 to February 13, 2020 and the differences in epidemiological, clinical, laboratory and imaging characteristics between the two groups were compared.

Results

This study enrolled 163 patients with 62 confirmed cases and 101 unconfirmed cases. Most confirmed patients were clustered (31, 50.0%) and with definite epidemiological exposure. Symptoms of COVID-19 were nonspecific, largely fever and dry cough. Laboratory findings in confirmed group were characterized by normal or reduced white blood cell count, reduced the absolute value of lymphocytes, and elevated levels of C-reactive protein (CRP) and accelerated Erythrocyte sedimentation rate (ESR). The typical chest CT imaging features of patients with confirmed COVID-19 were peripherally distributed multifocal GGO with predominance in the lower lung lobe. Compared with unconfirmed patients, confirmed patients had significantly higher proportion of dry cough, leucopenia, lymphopenia and accelerated ESR ( P <0.05); but not with alanine aminotransferase, aspartate aminotransferase, D-dimer, lactic dehydrogenase, and myoglobin ( P >0.05). Proportion of peripheral, bilateral or lower lung distribution and multi-lobe involvement, GGO, crazy-paving pattern, air bronchogram and pleural thickening in the confirmed group were also higher ( P <0.05).

Conclusions

Symptoms of COVID-19 were nonspecific. Leukopenia, lymphopenia and ESR, as well as chest CT could be used as a clue for clinical diagnosis of COVID-19.

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    SciScore for 10.1101/2020.03.22.20040782: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: This study was approved by the Ethics of Committees of Shanghai General Hospital Affiliated to School of Medicine of Shanghai Jiao Tong University.
    Consent: Informed consent for this retrospective study was waived.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    All statistical analyses were performed using SPSS version 13.0 software (SPSS Inc).
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    There are several limitations in our study. First, although the RT-PCR test is the current gold standard for the diagnosis of COVID-19, it might still present a certain false-negative rate after repetitions. This is mainly due to the fact that the test samples are mostly pharynx swabs rather than bronchoalveolar lavage fluid (BALF) and RNA was easily degraded. Second, we did not complete the tests of influenza A virus, influenza B virus, parainfluenza virus, mycoplasma pneumoniae, chlamydia pneumoniae, respiratory syncytial virus, adenovirus, coxsackie virus, the nucleic acid of influenza viruses A and B and microbial culture in all patients. We could not clearly distinguish the specific pathogen infections in patients with unconfirmed group. Therefore, we did not further compare the differences between COVID-19 and specific pathogen infections. In summary, most patients with COVID-19 had a definite epidemiological history of exposure in Wuhan or to infected patients. The clinical symptoms of COVID-19 were nonspecific, largely fever and dry cough. The reduced white blood cell count, lymphocytes count and ESR could be used as a reference index for clinical diagnosis of COVID-19. Chest CT could become an effective clinical diagnostic tool for screening patients with suspected COVID-19, but the final diagnosis still needs to be combined with the results of RT-PCR tests.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2020.03.22.20040782v1 on medRxiv