Analysis Of Clinical Characteristics Of Outpatients In COVID-19’s Adult Fever Clinic

Objective:Fever clinic is the first sentinel for prevention and control of public health events,especially during major public health events such as COVID-19 epidemic,which plays an important role in centralized diagnosis and treatment of fever patients,early detection and control of infectious diseases.At present,the screening rate of COVID-19 patients in adult fever clinic is extremely low.With the epidemic prevention and control during the epidemic period and the normalization of adult fever clinic,the clinical characteristics of COVID-19 patients are clarified by understanding the clinical characteristics of patients in adult fever clinic during the epidemic period,which provides reference for pre-examination and triage of adult fever clinic,rapid screening and diagnosis of COVID-19.Community-acquisition pneumonia(CAP)is one of the deadliest diseases in the world.Most patients have fever or respiratory symptoms.According to the policies of epidemic prevention and control,the adult fever clinic is the first diagnosis department of most CAP patients.The clinical manifestations of CAP patients are similar to the early symptoms of COVID-19 patients.Therefore,comparing and summarizing the clinical characteristics of CAP patients and COVID-19 patients is helpful for adult fever clinic doctors to identify COVID-19 patients early from many CAP patients,and it is of great significance to improve the diagnosis and treatment level of clinicians and improve the awareness of prevention and control of major infectious diseases.Methods:Since the local epidemic situation has obviously eased after June 2020,and there are no more confirmed cases in Guangzhou,the clinical data of fever outpatients in our hospital from January 28,2020 to June 30,2020 were collected and analyzed retrospectively.The analysis is mainly divided into the following parts:1.Summarizing the clinical characteristics of fever outpatients in different age groups in our hospital;2.To compare the clinical features of COVID-19 patients and high-risk cases,and analyze the risk factors of COVID-19 patients,so as to provide reference for early identification and diagnosis of COVID-19;3.Comparing the clinical characteristics between CAP patients and COVID-19 patients is helpful for adult fever clinic doctors to identify COVID-19 patients early from many CAP patients.First,we collected the data of patients’sex,age,disease history,epidemiological history of COVID-19,clinical symptoms and signs,diagnostic examination results,clinical diagnosis and outcome information,and then set up a database.Finally,all the data were statistically analyzed by SPSS22.0 software.The measurement data of normal distribution is expressed by mean standard deviation((?)±s),and the comparison between groups is made by group T-test.The measurement data of non-normal distribution are expressed by median and interquartile distance[M(Q1,Q3)].Kolmogorov-Smirnov test and Kruskal-Wallis test are used for comparison between two samples and multiple groups respectively.The frequency and rate of counting data or grade data are listed in the form of four-grid table or contingency table,andc~2 test is used.If the expected frequency does not meet the requirements,the exact probability method is used to calculate;P<0.05 was the difference with statistical significance.Combined with clinical and univariate analysis,the possible risk factors were substituted into the binary Logistic regression model,and the stepwise regression method was used for regression analysis.Results:1.Demography:There are 2108 fever outpatients,the ratio of male to female is 1101:1007,and the majority of them are young adults(66.11%).2.The duration of the disease at the time of visit:from the overall distribution,the duration of disease of quinquagenarian people is slightly longer than that of young adults and elderly people(p<0.05),but patients of all ages mainly go to adult fever clinic within3 days after fever(78.07%of young adults,73.97%of quinquagenarian and elderly people,79.26%of elderly people).3.Epidemiological history:Fever outpatients have less epidemiological history related to COVID-19(6.17%),but the results of intergroup analysis suggest that young adults are more likely to have epidemiological history related to COVID-19(P<0.05).4.Clinical manifestation:The median of the heat peak of the total sample is 38.0℃.On the whole trend,compared with the other two groups,the heat peak of young(37.9℃)and quinquagenarian patients is lower(P<0.05),but there is no significant difference between quinquagenarian and elderly patients(P>0.05).Respiratory symptoms were the most common among patients of all ages(46.11%).5.Diagnostic examination results:The results of laboratory examination showed that C-reactive protein,white blood cell count level and neutrophil also showed an increasing trend with age;On the contrary,the number of lymphocytes,red blood cells and hemoglobin are negatively correlated with the increase of age,and there are statistical differences between every two groups(P<0.05).In terms of imaging findings,patch exudation is the most common(22.53%),and pairwise comparison between groups shows that the rate of patch exudation in chest CT increases with age.6.Etiological distribution:The most common diagnosis of fever outpatients is upper respiratory tract infection,followed by lower respiratory tract infection,that is,respiratory system infection is the main disease of fever outpatients,accounting for 59.58%of the total sample size;Among them,the upper respiratory tract infection is the most common among young patients(42.63%),while the lower respiratory tract infection is more common among quinquagenarian and elderly patients(38.36%,47.16%).7.A total of 8 patients diagnosed with COVID-19 were included in this study,with a male-to-female ratio of 1 to 1,distributed in all age groups,6 of the 8 patients confirmed by COVID-19 had a clear epidemiological history of COVID-19,all of them had acute onset and the incubation period was 0-8 days,and the main clinical symptoms were fever(8 cases)and/or respiratory symptoms(6 cases).The white blood cell count of all the patients diagnosed by COVID-19 was in the normal range,the lymphocyte count was normal in 5 cases and decreased in 3 cases,6 patients underwent plain chest CT scan,and viral pneumonia could be seen in 6 patients’chest CT,and the lesions were all distributed in the extrapulmonary zone.Ground glass shadow changes were found in 4 cases.8.Compared with patients in high-risk group,patients with COVID-19-related epidemiological history are more common in COVID-19 group.In peripheral blood analysis,the overall level of leukocytes and neutrophils in COVID-19 group was significantly lower than that in high-risk group,while the level of basophils was higher than that in high-risk group Compared with the high-risk group,the ground-glass shadow changes of chest CT in COVID-19 group were more common,and the above differences were statistically significant(P<0.05).Multivariate analysis showed that epidemiological history of COVID-19,ground glass shadow of chest CT and lung consolidation were independent risk factors for diagnosis of COVID-19.9.Compared with CAP group,the proportion of patients with COVID-19-related epidemiological history in COVID-19 group was higher(75%).In peripheral blood analysis,the overall level of leukocyte,neutrophil and monocyte count in COVID-19group was significantly lower than that in CAP group,while the level of basophil was higher than that in CAP group(P<0.05).Compared with CAP group,the ground-glass shadow changes of chest CT in COVID-19 group were more common(P<0.05).Binary Logistic regression analysis showed that the epidemiological history of COVID-19 and the ground glass shadow of chest CT were of great value in early identification of COVID-19.Conclusion:1.Outpatients in adult fever clinic are mainly young people,most of whom have acute onset,and respiratory symptoms are more common.Young patients are commonly diagnosed with upper respiratory tract infection,while elderly patients are mostly diagnosed with lower respiratory tract infection.2.The epidemiological history of COVID-19 is an independent risk factor for the diagnosis of COVID-19 in fever outpatients,and the young patients is more likely to have the epidemiological history of COVID-19,so we should pay attention to the epidemiological history of young and quinquagenarian patients in the process of diagnosis and treatment.3.Patients with ground glass shadow and/or consolidation of lung on chest CT should be paid attention to,and they are more likely to be diagnosed as COVID-19 confirmed cases.