The major predictors of testing positive for COVID-19 among symptomatic hospitalized patients

  1. Samson Barasa
  2. Josephine Kiage-Mokaya
  3. Geraldine Luna
  4. Michael Friedlander

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Abstract

Introduction

Increasing corona virus disease 2019 (COVID-19) pre-test probability can minimize testing patients who are less likely to have COVID-19 and therefore reducing personal protective equipment and COVID-19 testing kit use. The aim of this study was to identify patients who were likely to test positive for COVID-19 among symptomatic patients suspected of having COVID-19 during hospitalization by comparing COVID-19 positive and negative patients.

Method

We conducted a retrospective chart review of patients who were ≥18 years old and underwent COVID-19 Polymerase chain reaction test because they presented with symptoms thought to be due to COVID-19. The Poisson regression analysis was conducted after clinical presentation, demographic, medical co-morbidities, laboratory and chest image data was retrieved from the medical records.

Results

Charts of 277 and 35 COVID-19 negative and positive patients respectively were analyzed. Dyspnea (61%) was the most common symptom among COVID-19 negative patients, while 83% and 77% COVID-19 positive patients had cough and fever respectively.

COVID-19 positive patients were more likely to present initially with cough [1.082 (1.022 - 1.145)] and fever [1.066 (1.013 - 1.122)], besides being males [1.066 (1.013 - 1.123)] and 50 to 69 years old [1.090 (1.019 - 1.166)]. Dyspnea, weakness, lymphopenia and bilateral chest image abnormality were not associated with COVID-19 positivity.

COVID-19 positive patients were less likely to have non-COVID-19 respiratory viral illness [0.934 (0.893 - 0.976)], human immunodeficiency virus [0.847 (0.763 - 0.942)] and heart failure history [0.945 (0.908 - 0.984)]. Other chronic medical problems (hypertension, diabetes mellitus, chronic obstructive pulmonary disease and coronary artery disease) were not associated with testing positive for COVID-19.

Conclusion

Cough and fever are better predictors of symptomatic COVID-19 positivity during hospitalization. Despite published studies reporting a high prevalence of lymphopenia among COVID-19 positive patients, lymphopenia is not associated with the risk of testing positive for COVID-19.

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  1. ScreenIT

    SciScore for 10.1101/2020.09.11.20192963: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board StatementIRB: The PeaceHealth institutional review board (IRB) approved the study and waived the written informed consent requirement.
    Consent: The PeaceHealth institutional review board (IRB) approved the study and waived the written informed consent requirement.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Data collection: The Microsoft Access software was used to manage data after being extracted from the electronic medical records.
    Microsoft Access
    suggested: None
    The statistical analysis was performed using STATA version 15.
    STATA
    suggested: (Stata, RRID:SCR_012763)

    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:
    Limitations: Limitations of our study included missing data and not all patients had laboratory and chest image tests done. Non-COVID-19 respiratory viral illness data was missing for some patients, because the hospital stopped testing for non-COVID-19 respiratory viral illness in the middle of the pandemic. In addition, we didn’t have data on how long those with history of smoking had quit smoking as well as whether their presenting cough symptom was new, an exacerbation or their baseline smokers’ cough.

    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

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  2. Version published to 10.1101/2020.09.11.20192963v2 on medRxiv
  3. Version published to 10.1101/2020.09.11.20192963v1 on medRxiv