| Objective:Coronavirus disease 2019(COVID-19)is an emerging infectiousrespiratory disease that has spread rapidly around the world.Many studies haveevaluated the clinical features of COVID-19,but how it differs from those of severe acute respiratory syndrome coronavirus 2(SARS-Co V-2)-negative community-acquired pneumonia(SN-CAP)remains unclear.We aimed to conduct a comparative study of the clinical features of COVID-19 and SN-CAP and to analyze the risk factors influencing severe illness in patients with COVID-19 and SN-CAP.Methods:Retrospective comparative analysis of 204 patients with COVID-19diagnosed at a designated hospital for COVID-19 admission in Gansu Province from January 2020 to January 2022(COVID-19 group)and 209 patients with SARS-Co V diagnosed at a tertiary hospital in Gansu Province from January 2020 to January 2022-2-negative community-acquired pneumonia patients(SN-CAP group).General information(gender,age,diagnosis,combined underlying diseases),clinical symptoms,laboratory tests,imaging tests,treatment plan,length of hospital stay and prognosis(discharge or death)were collected at the time of admission in both groups.To compare the differences between the clinical data of patients in the COVID-19 and SN-CAP groups and to analyze the risk factors affecting the COVID-19 and SN-CAP readmissions.Results:1.General data:The mean age,proportion of male patients and proportion of combined underlying diseases were higher in the SN-CAP group than in the COVID-19 group(all P<0.05),the proportion of patients aged 18-44 years was lower in the SN-CAP group than in the COVID-19 group(P>0.05),the proportion of patients aged≥60 years was higher than in the COVID-19 group(P<0.05),and the proportion of patients aged 45-59 years the differences were not statistically significant(P>0.05).2.Clinical symptoms:Fever,cough and sputum were the main clinical symptoms in both groups.The proportion of cough,sputum,blood in sputum or hemoptysis,fatigue,dizziness and headache,chest tightness and shortness of breath and chest pain were higher in the SN-CAP group than in the COVID-19 group(all P<0.05),and the proportion of throat discomfort and nasal congestion and runny nose were lower than in the COVID-19 group(all P<0.05).The differences in symptoms such as fever,muscle pain,abdominal pain and diarrhea,and disorders of consciousness were not statistically significant between the two groups(all P>0.05).A few patients in the COVID-19 group showed symptoms such as olfactory disturbance,taste disturbance,and numbness of the tongue.3.Laboratory indexes:WBC>10.0×10~9/L,PLT>300×10~9/L,CRP>5.0mg/L,ALT>40 U/L,AST>40 U/L,GGT>50.0μ/L,LDH>240.0 U/L,BUN>7.1mmol/L,in the SN-CAP group.INR>1.13,and D-D>0.5μg/L were higher than those in the COVID-19 group(all P<0.05),and the proportion of WBC<4.0×10~9/L was lower than that of the COVID-19 group(P<0.05);There was no significant difference in the comparison of other laboratory-related indexes between the two groups(all P>0.05).4.Imaging:The proportion of left-sided lesions,pleural effusion,and pericardial effusion was higher in the SN-CAP group than in the COVID-19 group(all P<0.05),and bilateral lesions were lower than in the COVID-19 group(P<0.05).The differences in the proportions of right-sided lesions,1 lobe lesions,2 lobe lesions,and≥3 lobe lesions between the two groups were not statistically different(all P>0.05).There were no statistical differences in the proportions of lesions,2 lobe lesions,and≥3 lobe lesions(all P>0.05).5.Treatment:The SN-CAP group was treated mainly with antibacterial therapy,while the COVID-19 group was treated mainly with antiviral therapy.The proportion of patients in the COVID-19 group receiving oxygen therapy was lower than that in the SN-CAP group(P<0.05),but 127 patients(62.3%)in the COVID-19 group received prone ventilation.The proportion of patients in the COVID-19 group receiving glucocorticoids and anticoagulation was higher than that in the SN-CAP group(all P<0.05).SN-CAP group(all P>0.05),and there was no statistical difference in mechanical ventilation and hepatoprotective therapy between the two groups(all P>0.05).6.Prognosis:The mortality rate was low in both groups,and the difference was not statistically significant(P>0.05);The hospital stay was shorter in the SN-CAP group than in the COVID-19 group(P<0.05).7.Comparison of clinical data of patients with common type COVID-19 and common type SN-CAP:The results are consistent with the previous results of comparison of clinical data of patients with COVID-19 and SN-CAP.8.Comparison of clinical data of patients with severe coronavirus disease 2019(s COVID-19)and severe community-acquired pneumonia(s CAP):In terms of symptoms,the proportion of cough,sputum and chest tightness and shortness of breath was higher in the s CAP group than in the s COVID-19 group(all P<0.05),and the proportion of throat discomfort was lower than in the s COVID-19 group(P<0.05),and the remaining differences in symptoms between the two groups were not statistically The differences between the two groups were not statistically significant(all P>0.05).On imaging,the proportion of 1 lobe lesions was lower in the s CAP group than in the s COVID-19 group(P<0.05),and the proportion of pleural effusion was higher than in the s COVID-19 group(P<0.05).There were no statistical differences in the proportions of left-sided lesions,right-sided lesions,bilateral lesions,2 lobe lesions,≥3 lobe lesions,and pericardial effusion between the two groups(all P>0.05).In terms of treatment,the proportion of the s CAP group receiving oxygen therapy and hepatoprotective therapy was higher than that of the s COVID-19 group(all P<0.05),and the proportion receiving anticoagulation therapy was lower than that of the s COVID-19 group(all P>0.05),and there was no statistical difference in the proportion receiving glucocorticoids and mechanical ventilation between the two groups(all P>0.05).The rest of the results of the comparison of clinical data were consistent with the results of the previous comparison of clinical data of patients with COVID-19 and SN-CAP.9.Multifactorial logistic regression analysis of the differential diagnosis of COVID-19 and SN-CAP suggested that the COVID-19 group was more likely to have pharyngeal discomfort(OR 6.854,95%CI[2.219～0.537],P=0.001),while the SN-CAP group had coughing sputum(OR 0.119,95%CI[0.046～0.537],P<0.001),chest tightness and shortness of breath(OR 0.180,95%CI[0.077～0.537],P<0.001),and chest pain(OR 0.135,95%CI[0.037～0.537],P=0.002)were more frequent in the SN-CAP group.PLT in the SN-CAP group(OR 0.067,95%CI[0.01～0.434],P=0.005),GGT(OR 0.299,95%CI[0.111～0.802],P=0.017),INR(OR 0.308,95%CI[0.109～0.869],P=0.001),and D-Dimer(OR 0.149,95%CI[0.066～0.334],P<0.001)were elevated at a higher rate.10.Further analysis of clinical indicators related to patients’severe disease revealed that for COVID-19,age,basic diseases,LYM,CRP,ALB,LDH,BUN,CK,and CK-MB were statistically significant differences between the moderate and severe groups(all P<0.05),and the proportion of pleural effusion,pericardial effusion,receiving hormone,anticoagulation,and oxygen therapy was also higher in the severe group than in the moderate group(all P<0.05);Logistic regression analysis showed that combined underlying disease,ALB<32g/L,and pericardial effusion may be independent risk factors for severe disease in patients with COVID-19(all P<0.05).For SN-CAP,age,WBC,LYM,PLT,ALT,AST,ALB,LDH,BUN,Crea,CK,CK-MB,INR,and D-D were statistically significant differences between the moderate and severe groups(all P<0.05),and pleural effusion,pericardial effusion,and treatment with hormone,anticoagulation,hepatoprotection,and oxygen therapy in the severe group The proportion was also higher in the moderate group than in the severe group(all P<0.05);Logistic regression analysis showed that age≥60 years,WBC>10.0×10~9/L,CK>171.0 U/L,INR>1.13 might be independent risk factors for severe disease in patients with SN-CAP(all P<0.05).Conclusions:1.Compared with COVID-19,patients with SN-CAP had higher mean age,higher male morbidity,more comorbid underlying diseases,and more severe clinical manifestations and laboratory findings on admission than COVID-19.Patients with COVID-19 had longer hospital stays than SN-CAP,but both had lower mortality rates.2.During the COVID-19 epidemic,the presence of pharyngeal discomfort may contribute to the diagnosis of COVID-19,and coughing sputum,chest tightness and shortness of breath,chest pain,and elevated PLT,GGT,INR,and D-D may contribute to the diagnosis of SN-CAP.3.The indicators that differed between the moderate and severe groups of COVID-19 and SN-CAP patients were similar,suggesting similar effects of both diseases on organ function,nutritional status,and coagulation,but differences in risk factors affecting severe disease between the two.Combined underlying disease,ALB<32 g/L,and pericardial effusion may be independent risk factors for severe disease in patients with COVID-19;age≥60 years,WBC>10.0×10~9/L,CK>171.0 U/L,INR>1.13 may be independent risk factors for severe disease in patients with SN-CAP. |
