Typical and Atypical Clinics in COVID-19 (SARS-Cov-2) RT-PCR Positive Patients: A Multicenter Retrospective Study

Öz

In this study, we sought to determine the consistency of symptoms in patients admitted to three high-volume emergency departments with a diagnosis of COVID-19 with the standard definition published by the Turkish Ministry of Health, and to examine the relationship between symptom type and clinical outcomes. This multicentre, retrospective, observational study included adult patients aged 18 years and over who tested positive for SARS-CoV-2 by RT-PCR in the emergency departments of three hospitals between 11 March and 31 December 2020. Presentation symptoms were classified as typical or atypical in accordance with the national COVID-19 guidelines dated 7 December 2020. Demographic characteristics, vital signs, laboratory results, comorbidities and clinical outcomes were compared between the two groups. A total of 5,274 patients were enrolled; 2,763 (52.4%) were male, and the median age was 63 years. Of these, 4,262 (80.8%) had typical and 1,012 (19.2%) had atypical presentations. Dyspnea was the leading complaint (38.7%), followed by cough (29.9%) and fatigue (20.6%). Patients in the typical group were older (median 64 vs. 60 years, p<0.001), had lower oxygen saturation (90% vs. 91%, p<0.001), and demonstrated higher inflammatory markers including CRP, D-dimer, LDH, and ferritin. Intensive care unit admission was more frequent in the typical group (10.1% vs. 3.2%, p<0.001), as was in-hospital mortality (10.5% vs. 3.0%, p<0.001). Approximately one in five COVID-19 patients presented to the ED with atypical complaints. It should be noted that atypical or asymptomatic patients in terms of clinical course may be missed with symptom-based screening alone. Patients presenting with typical symptoms, particularly those with dyspnea and underlying comorbidities, had considerably worse outcomes and warrant close monitoring.

Anahtar Kelimeler

• COVID-19
• SARS-CoV-2
• pandemic
• emergency department
• symptoms
• mortality

Destekleyen Kurum

none

Etik Beyan

The study was approved by the Eskisehir Osmangazi University Non-Interventional Clinical Research Ethics Committee (Approval no: E-25403353-050.99-171631, Decision no: 01, Date: 02.03.2021). The study complied with the Declaration of Helsinki and research and publication ethics.

Teşekkür

none

COVID-19 (SARS-Cov-2) RT-PCR Testi Pozitif Hastalarda Tipik ve Atipik Klinik Bulgular: Çok Merkezli Retrospektif Çalışma

Öz

Çalışmada, üç büyük hacimli acil servise COVID-19 tanısıyla başvuran hastaların başvuru yakınmalarının Türkiye Cumhuriyeti Sağlık Bakanlığı tarafından yayımlanan standart vaka tanımı ile uyumluluğunu belirlemeyi ve yakınma tipi ile klinik sonuçlar arasındaki ilişkiyi incelemeyi amaçladık. Çok merkezli, retrospektif, gözlemsel çalışmaya 11 Mart – 31 Aralık 2020 tarihleri arasında üç hastanenin acil servislerinde RT-PCR ile SARS-CoV-2 pozitifliği saptanan 18 yaş ve üzeri yetişkin hastalar dahil edildi. Başvuru yakınmaları 07.12.2020 tarihli ulusal COVID-19 rehberine göre tipik veya atipik olarak sınıflandırıldı. İki grup arasında demografik özellikler, vital bulgular, laboratuvar sonuçları, komorbiditeler ve klinik sonuçlar karşılaştırıldı. Toplam 5.274 hasta çalışmaya dahil edildi; 2.763’ü (%52,4) erkekti ve medyan yaş 63 idi. Hastaların 4.262’si (%80,8) tipik, 1.012’si (%19,2) ise atipik yakınma ile başvurdu. En sık başvuru yakınması nefes darlığı (%38,7) olup bunu öksürük (%29,9) ve halsizlik (%20,6) izledi. Tipik gruptaki hastalar daha yaşlıydı (medyan 64’e karşı 60 yıl, p<0,001), daha düşük oksijen satürasyonuna sahipti (%90’a karşı %91, p<0,001) ve CRP, D-dimer, LDH ve ferritin dahil enflamatuvar belirteçleri daha yüksekti (tümü p<0,001). Yoğun bakım yatış oranı (%10,1’e karşı %3,2, p<0,001) ve hastane yatışı sırasında mortalite (%10,5’e karşı %3,0, p<0,001) tipik grupta anlamlı olarak daha yüksekti. COVID-19 tanılı hastaların yaklaşık beşte biri acil servise atipik yakınmalarla başvurmaktadır. Klinik seyir açısından atipik veya asemptomatik hastaların yalnızca semptom temelli taramayla gözden kaçabileceğine dikkat edilmelidir. Tipik semptomlarla başvuran, özellikle nefes darlığı ve altta yatan komorbiditeleri olan hastalar belirgin şekilde daha kötü klinik sonuçlara sahiptir ve yakın takip gerektirir.

Anahtar Kelimeler

• COVID-19
• SARS-CoV-2
• pandemi
• acil servis
• semptomlar
• mortalite

Kaynakça

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