Abstract
Background: The outbreak of coronavirus disease 2019 (COVID-19) in December 2019 overlaps with the flu season. Methods: We compared clinical and laboratory results from 719 influenza and 973 COVID-19 patients from January to April 2020. We compiled laboratory results from the first 14 days of the hospitalized patients using parameters that are most significantly different between COVID-19 and influenza and hierarchically clustered COVID-19 patients. Findings: Compared to influenza, patients with COVID-19 exhibited a continued increase in white blood cell count, rapid decline of hemoglobin, more rapid increase in blood urea nitrogen (BUN) and D-dimer, and higher level of alanine transaminase, C-reactive protein, ferritin, and fibrinogen. COVID-19 patients were sub-classified into 5 clusters through a hierarchical clustering analysis. Medical records were reviewed and patients were risk stratified based on the clinical outcomes. The cluster with the highest risk showed 27·8% fatality, 94% ICU admission, 94% intubation, and 28% discharge rates compared to 0%, 38%, 22%, and 88% in the lowest risk cluster, respectively. Patients in the highest risk cluster had leukocytosis including neutrophilia and monocytosis, severe anemia, increased red blood cell distribution width, higher BUN, creatinine, D-dimer, alkaline phosphatase, bilirubin, and troponin. Interpretation: There are significant differences in the clinical and laboratory courses between COVID-19 and influenza. Risk stratification in hospitalized COVID-19 patients using laboratory data could be useful to predict clinical outcomes and pathophysiology of these patients. Funding: National Institute of Diabetes and Digestive and Kidney Disease, Department of Defense, and National Heart, Lung, and Blood Institute.
| Original language | English (US) |
|---|---|
| Article number | 100475 |
| Journal | EClinicalMedicine |
| Volume | 26 |
| DOIs | |
| State | Published - Sep 2020 |
Funding
This work was supported by National Institute of Diabetes and Digestive and Kidney Disease (NIDDK) grant R01-DK124220 (P.J.), Department of Defense grant CA140119 (P.J.), and National Heart, Lung, and Blood Institute (NHLBI) grant R01-HL148012 (P.J.). P.J. is a scholar of the Leukemia and Lymphoma Society. Dr. Ji reports grants from National Institute of Diabetes and Digestive and Kidney Diseases, grants from National Heart, Lung, and Blood Institute, grants from Leukemia and Lymphoma Society, during the conduct of the study. All other authors declare no relevant conflicts of interest. The corresponding author has funding support from the National Institute of Diabetes and Digestive and Kidney Diseases, National Heart, Lung, and Blood Institute, and the Leukemia and Lymphoma Society. These sponsors had no roles in study design, data collection and analyses, interpretation of the data, or writing of the manuscript.
ASJC Scopus subject areas
- General Medicine
