Clinical Features of 154 COVID-19 Patients and the Parameters for the Effective Detection of Pneumonia at the Time of the Initial Diagnosis in Japan

• Published in: Internal Medicine 2021/01/01, Vol.60(1), pp.31-37
• Main Authors: Morikawa, Miwa, Shinoda, Masahiro, Ota, Shinichiro, Yoshida, Yuto, Hirouchi, Takatomo, Shinada, Kanako, Sasaki, Osamu, Sato, Takashi, Kamachi, Kenichi, Shinkai, Masaharu
• Format: Article
• Language: English
• Subjects: Adult; Age Factors; Blood tests; C-reactive protein; C-Reactive Protein - analysis; Cell number; clinical feature; Coronaviruses; COVID-19; COVID-19 - blood; COVID-19 - diagnosis; COVID-19 Nucleic Acid Testing; CRP; Female; Fever; Fever - virology; Fibrinogen; Fibrinogen - metabolism; Humans; Internal medicine; Japan; L-Lactate dehydrogenase; L-Lactate Dehydrogenase - blood; Lactic acid; Leukocyte Count; Lymphocyte Count; Lymphocytes; Male; Medical records; Middle Aged; Neutrophils; Original; Oximetry; Patients; Platelet Count; Pneumonia; Polymerase chain reaction; Retrospective Studies; Risk Factors; SARS-CoV-2; screening; Tachycardia; Tachycardia - virology
• ISSN: 0918-2918; 1349-7235
• DOI: 10.2169/internalmedicine.5528-20

Objective We aimed to clarify clinical and laboratory characteristics of coronavirus disease 2019 (COVID-19) patients, and further explore the features to detect COVID-19 pneumonia at the first visit to community-based hospitals. Methods Diagnoses of COVID-19 were based on positive results from real-time reverse-transcription polymerase chain reaction testing of nasopharyngeal-swab specimens. We retrospectively reviewed the medical records of patients showing positive results. The clinical characteristics and results of blood tests were compared between the patients with and without pneumonia. The risk factors associated with pneumonia were then evaluated by a multivariable analysis. Results The study cohort comprised 154 patients, including 117 patients (76.0%) with pneumonia at first visit. Significant differences were seen in age, the frequency of fever, tachycardia, desaturation (peripheral oxygen saturation ≤95%), any comorbidity, neutrocyte count and fraction, lymphocyte count and fraction, platelet count, lactate dehydrogenase (LDH), C-reactive protein (CRP), and fibrinogen between the patients with and without pneumonia. Using a multivariable analysis, CRP ≥0.3 mg/dL and fibrinogen >400 mg/dL were found to be associated with the presence of pneumonia. Conclusion Community-based settings for screening COVID-19 patients should perform chest X-ray and blood tests for white blood cell fractions, fibrinogen, LDH, and CRP. Of these, elevations in the CRP and fibrinogen levels could be critically associated with the presence of COVID-19 pneumonia.