University of New Haven Epidemiological and Clinical Predictors of COVID 19 Paper Read TWO (2) articles, and write your Critical Analysis of the veracity (

University of New Haven Epidemiological and Clinical Predictors of COVID 19 Paper Read TWO (2) articles, and write your Critical Analysis of the veracity (truthfulness) of the conclusions, the consistency of the research, and the comprehensiveness of the explanation/discussion. You are the consumer here.Post in the Discussion Board and “argue” with each other, choosing to be pro or con (regardless of your personal interpretation posted in your initial post).Summarize your personal “So What, What is Next” related to the chosen article’s findings.Apply all you have studied in the interpretation (Critical Analysis required) of the two articles posted. Your performance is expected to be comprehensive, and in accord with the Universal Intellectual Standards. [
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Critical Care Original Research
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Comparison of Hospitalized Patients With
ARDS Caused by COVID-19 and H1N1
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Xiao Tang, MD; Ronghui Du, MD; Rui Wang, MD; Tanze Cao, MD; Lulu Guan, MD; Chengqing Yang, MD; Qi Zhu, MD;
Ming Hu, MD; Xuyan Li, MD; Ying Li, MD; Lirong Liang, MD; Zhaohui Tong, MD, PhD; Bing Sun, MD, PhD;
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Peng Peng, MD; and Huanzhong Shi, MD, PhD
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Since the outbreak of coronavirus disease 2019 (COVID-19) in China in
December 2019, considerable attention has been focused on its elucidation. However, it is
also important for clinicians and epidemiologists to differentiate COVID-19 from other
respiratory infectious diseases such as in?uenza viruses.
BACKGROUND:
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The aim of this study was to explore the different clinical presentations
between COVID-19 and in?uenza A (H1N1) pneumonia in patients with ARDS.
RESEARCH QUESTION:
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This analysis was a retrospective case-control study. Two independent cohorts of patients with ARDS infected with either COVID-19 (n ¼ 73) or H1N1
(n ¼ 75) were compared. Their clinical manifestations, imaging characteristics, treatments,
and prognosis were analyzed and compared.
STUDY DESIGN AND METHODS:
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The median age of patients with COVID-19 was higher than that of patients with
H1N1, and there was a higher proportion of male subjects among the COVID-19 cohort (P < .05). Patients with COVID-19 exhibited higher proportions of nonproductive coughs, fatigue, and GI symptoms than those of patients with H1N1 (P < .05). Patients with H1N1 had higher Sequential Organ Failure Assessment (SOFA) scores than patients with COVID-19 (P < .05). The PaO2/FIO2 of 198.2 mm Hg in the COVID-19 cohort was signi?cantly higher than the PaO2/FIO2 of 107.0 mm Hg in the H1N1 cohort (P < .001). Ground-glass opacities was more common in patients with COVID-19 than in patients with H1N1 (P < .001). There was a greater variety of antiviral therapies administered to COVID-19 patients than to H1N1 patients. The in-hospital mortality of patients with COVID-19 was 28.8%, whereas that of patients with H1N1 was 34.7% (P ¼ .483). SOFA score-adjusted mortality of H1N1 patients was signi?cantly higher than that of COVID-19 patients, with a rate ratio of 2.009 (95% CI, 1.563-2.583; P < .001). RESULTS: 29 30 31 32 33 Q6 34 35 36 37 38 39 40 41 42 There were many differences in clinical presentations between patients with ARDS infected with either COVID-19 or H1N1. Compared with H1N1 patients, patients with COVID-19-induced ARDS had lower severity of illness scores at presentation and lower SOFA score-adjusted mortality. CHEST 2020; -(-):--INTERPRETATION: 43 44 45 46 47 Q7 48 KEY WORDS: 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 ARDS; COVID-19; H1N1; in?uenza A; mortality 103 49 104 50 105 51 52 53 54 55 ABBREVIATIONS: Q2 COVID-19 = coronavirus disease 2019; ECMO = extracorporeal membrane oxygenation; H1N1 = in?uenza A; SARSCoV-2 = severe acute respiratory syndrome coronavirus 2; SOFA = Sequential Organ Failure Assessment AFFILIATIONS: From the Department of Respiratory and Critical Care Medicine (Drs Tang, Wang, X. Li, Y. Li, Liang, Tong, Sun, and Shi), Beijing Chao-Yang Hospital, Capital Medical University, Beijing Institute of Respiratory Medicine, Beijing Engineering Research Center for Diagnosis and Treatment of Respiratory and Critical Care Medicine (Beijing Chao-Yang Hospital), Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing, China; and the Department of Respiratory and Critical Care Medicine 1 chestjournal.org FLA 5.6.0 DTD CHEST3017_proof 11 April 2020 2:01 pm EO: CHEST-20-0919 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 Since December 2019, there has been a cluster of patients with pneumonia of previously unknown cause in Wuhan, China. Research by the Chinese Center for Disease Control and Prevention assessed the lower respiratory tracts of these patients and discovered a novel coronavirus, which has since been named the 2019 novel coronavirus.1 On February 11, 2020, the World Health Organization of?cially named this novel coronavirus pneumonia as coronavirus disease 2019 (COVID-19), whereas the International Committee on Taxonomy of Viruses has named it severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Huang et al2 reported that the ?rst 41 patients with COVID-19 exhibited fever, cough, myalgia, and/or fatigue as common symptoms, 29% of whom had ARDS and six of whom died (15%). The typical ?ndings from chest CT scans were bilateral ground-glass opacity and subsegmental areas of consolidation. At earlier times during the COVID-19 outbreak, patients with COVID-19 were more likely to report exposure to food from the Huanan Seafood Wholesale Market. With the epidemic gradually growing, it is now clear that human-to-human transmission has been prevalent.3 As of March 10, 2020, there have been a total of 113,702 con?rmed cases and 4,012 related deaths, among which 80,924 cases have occurred in China.4 Importantly, when assessing COVID-19, it is noteworthy that in?uenza viruses share common etiologies and occur in the same season. Recently, global in?uenza associated with respiratory mortality is occurring at a higher frequency than what has been previously reported.5 From September 2019 through 148 149 (Drs Du, Cao, Guan, Yang, Zhu, Hu, and Peng), Wuhan Pulmonary Hospital, Wuhan, China. 151 Drs Tang and Du contributed equally to this study. 152 Q3 FUNDING/SUPPORT: This work was supported by the Beijing Municipal Administration of Hospitals’ Mission Plan [SML20150301], 153 the 1351 Talents Program of Beijing Chao-Yang Hospital [WXZXZ154 2017-01], and Novel Coronavirus Pneumonia Key Technology 155 Q24 Research and Development Funding of the Beijing Hospital Authority. CORRESPONDENCE TO: Huanzhong Shi, MD, PhD, Department of 156 Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, 157 Q4 Capital Medical University, No. 8 Gongtinan Rd, Chao-Yang District, 158 Q5 Beijing, China, 100020; e-mail: shihuanzhong@sina.com; or Peng Peng, MD, Department of Respiratory and Critical Care Medicine, Wuhan 159 Pulmonary Hospital, No. 28 Baofeng Rd, Wuhan, China, 430030; 160 e-mail: pengpengwg@126.com; or Bing Sun, MD, PhD, Department of 161 Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gongtinan Rd, Chao-Yang District, 162 Beijing, China, 100020; e-mail: ricusunbing@126.com 163 Copyright Ó 2020 Published by Elsevier Inc under license from the 164 American College of Chest Physicians. 165 DOI: https://doi.org/10.1016/j.chest.2020.03.032 150 2 Original Research 166 167 Take Home Point 168 169 Study Question: 170 The aim of the study was to explore the different clinical presentations between COVID-19 and H1N1 pneumonia in patients with ARDS. 171 172 173 174 175 Results: 176 There were many differences between COVID-19induced ARDS patients and H1N1-induced ARDS patients in clinical presentations and outcome. 177 178 179 180 Interpretation: 181 Compared with H1N1, patients with COVID-19induced ARDS had lower severity of illness scores at presentation and lower SOFA score adjusted mortality. 182 183 184 185 186 187 188 189 present-day, there have been > 170,000 patients with
in?uenza in the United States, more than one-half of
whom have been infected with the in?uenza A (H1N1)
virus. The percentage of deaths attributed to pneumonia
induced by in?uenza is 6.8%.6 During the H1N1 global
epidemic in 2009, Jain et al7 found that 5% of patients
with H1N1 in?uenza were admitted to ICUs and
7% died. Another study from Canada showed that the
overall mortality among patients critically ill with H1N1
at 28 days was 14.3%.8 The common symptoms of H1N1
infection include fever and productive cough, whereas
GI symptoms (eg, nausea, vomiting, diarrhea) are less
common. Furthermore, ground-glass opacities are not
commonly found on chest CT scans from patients with
H1N1.9
Although these two respiroviruses have loomed as
epidemics in different regions at present, such
epidemics can easily propagate to further regions over
time due to climate change and global travel by
individuals. Because of their distinct treatments and
prognoses, it is important for clinicians and
epidemiologists to accurately identify these two
respiroviral infections via their differential clinical
manifestations. The aim of the current study therefore
was to compare the different clinical presentations
between ARDS patients infected with COVID-19
vs those infected with H1N1 to provide some guidance
for their differential diagnoses.
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Patients and Methods
Data Collection
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Study Design
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This analysis was a retrospective case-control study. All of the COVID19 subjects were con?rmed by using results of laboratory tests and were
hospitalized at Wuhan Pulmonary Hospital (Hubei Province of China)
between December 24, 2019, and February 7, 2020. The H1N1
pneumonia cases were from a single-center prospective cohort
study10 of patients with H1N1-induced ARDS at Beijing Chao-Yang
Hospital (China). All of the H1N1 cases were con?rmed by using
laboratory test results, and corresponding patients were hospitalized
from March 2016 to December 2019. All of the patients met the
criteria of the Berlin de?nition11 for diagnosis of ARDS. Following
ful?llment of these criteria, all of the patients with COVID-19induced or H1N1-induced ARDS were included in this study.
Demographic and clinical data of the patients were entered into an
electronic case report form. The data included the following:
demographic characteristics (age and sex), underlying diseases,
comorbidities, clinical symptoms (fever, cough, sputum, dyspnea,
chest pain, rash, nausea, vomiting, abdominal pain, diarrhea, and
headache), signs (body temperature, heart rate, respiratory frequency,
and BP), laboratory tests (blood routine test, arterial blood gas
analysis, and blood chemistry), and microbiologic ?ndings/images of
the lung (chest CT scan). Antimicrobiologic therapy, respiratory
support, complications, and outcomes were also recorded.
Data analysis was performed by using SPSS 23.0 (IBM SPSS Statistics,
IBM Corporation) software. Categorical variables were summarized by
using frequencies and percentages, and continuous data are presented
as the medians (interquartile ranges). The Mann-Whitney U test was
used for continuous variables, and the c2 test or the Fisher exact test
was used for categorical variables. Variables with a P value < .05 in the univariate analysis were entered into multivariate logistic regression analysis to identify independent risk factors associated with COVID-19 or H1N1. All P values < .05 are considered statistically signi?cant. 292 222 225 226 227 228 229 230 231 232 233 234 235 236 237 238 239 240 241 242 243 244 The Ethics Committee of Beijing Chao-Yang Hospital (2017-KE61) and Wuhan Pulmonary Hospital (wufeilunli-2020-02) approved the collection of clinical data from the included patients with H1N1 or COVID-19 infections, respectively. For the H1N1 cohort, written informed consent was obtained from all of the patients or their legal guardians. For the COVID-19 cohort, informed consent from each patient was waived because we prospectively collected and analyzed all of the data from each patient according to the policy for public health outbreak investigation of emerging infectious diseases issued by the National Health Commission of the People’s Republic of China. Results 248 From December 24, 2019, to February 7, 2020, there were a total of 179 patients infected with COVID-19 admitted to the Department of Pulmonary and Critical Care at Wuhan Pulmonary Hospital in Hubei Province of China, among which 73 cases included ARDS. There were 345 patients with ARDS induced by pneumonia of various etiologies admitted to the respiratory ICU at Beijing Chao-Yang Hospital from March 2016 to December 2019, among whom 75 patients were infected with H1N1. 252 253 254 255 256 257 258 259 260 COVID-19 and H1N1 Patient Characteristics 261 The median age of patients with COVID-19 was 67 years, which was signi?cantly higher than that of patients with H1N1 (52 years; P < .001). The proportion of male subjects in the COVID-19 group was 61.5%, which was signi?cantly lower than that of the H1N1 group (80.0%; P ¼ .011). In terms of underlying diseases, 31.5% of COVID-19 patients has a history of cardiovascular disease, whereas that of H1N1 patients was signi?cantly lower (10.7%; P ¼ .002). There was no signi?cant difference in the history of hypertension, diabetes, or chronic airway diseases between the two groups. At the time of admission, septic shock had occurred in 31.5% of patients with COVID-19, which was greater than that reported in patients with H1N1 262 263 264 265 266 267 268 269 270 271 272 273 274 275 282 283 284 285 293 294 295 296 297 298 299 301 247 251 281 300 246 250 280 286 Diagnoses of patients infected with COVID-19 or H1N1 were based on 287 clinical presentations, imaging characteristics, and the presence of either SARS-CoV-2 or H1N1 detected in samples from either the 288 289 respiratory tract or blood. 290 Statistical Analysis 291 245 249 279 (13.3%; P < .001). However, the median Sequential Organ Failure Assessment (SOFA) score and the Acute Physiology and Chronic Health Evaluation II (APACHE II) score of COVID-19 patients were 2 and 11, respectively, which were lower than the scores of 5 (P < .001) and 14 (P ¼ .019) for H1N1 patients. There was no signi?cant difference in the duration of onset to ARDS or duration of onset to diagnosis (Table 1). 302 303 304 305 306 307 308 309 310 311 312 Clinical Symptoms and Laboratory Examinations 313 Both COVID-19 and H1N1 groups presented with fever, 314 cough, and dyspnea, whereas hemoptysis was less 315 common. Furthermore, 53.4% of patients with COVID- 316 19 had productive cough, which was signi?cantly less 317 than that of patients with H1N1 (78.7%; P ¼ .002). The Q9 318 proportions of fatigue (63.0%), myalgia (37.0%), and GI 319 320 symptoms (34.2%) in patients with COVID-19 were higher than those of patients with H1N1 (18.7%, P < 321 .001; 6.7%, P < .001; and 14.7%, P ¼ .007, respectively) 322 323 (Table 2). 324 The median PaO2/FIO2 in patients with COVID-19 was 198.2 mm Hg, which was signi?cantly higher than the 107.0 mm Hg of patients with H1N1 (P < .001). Following biochemical testing, aspartate transaminase, lactate dehydrogenase, and troponin I levels in patients with COVID-19 were all signi?cantly lower than those 3 chestjournal.org FLA 5.6.0 DTD CHEST3017_proof 11 April 2020 2:01 pm EO: CHEST-20-0919 325 326 327 328 329 330 331 332 333 TABLE 1 ] Characteristics of Patients With COVID-19 or H1N1 Characteristic Q21 Total (N ¼ 148) COVID-19 (n ¼ 73) H1N1 (n ¼ 75) 386 387 P Value 388 < .001 334 Age, y 62 (47, 69) 67 (57, 72) 52 (41, 64) 335 Male sex 105 (70.9) 45 (61.6) 60 (80.0) .011 390 336 Onset to ARDS, d 8 (6, 11) 8 (6, 10) 8 (6, 12) .755 391 337 Onset to con?rm diagnosis, d 10 (7, 14) 11 (8, 14) 9 (7, 13) .079 392 338 CURB-65 score 1 (1, 2) 1 (1, 2) 1 (1, 2) .255 393 339 SOFA score 4 (2, 6) 2 (2, 4) 5 (4, 8) < .001 394 12 (8, 15) 11 (8, 13) 14 (9, 19) 38.5 (36.8, 39.3) 36.8 (36.5, 38.2) 39 (38.7, 39.8) < .001 340 341 342 APACHE II score Highest temperature, C 389 395 .019 396 397 343 Systolic BP, mm Hg 127 (110, 140) 123 (118, 128) 128 (108, 143) .626 398 344 Diastolic BP, mm Hg 70 (62, 82) 76 (70, 84) 70 (60, 82) .554 399 345 Respiratory rate, breaths/min 22 (20, 31) 21 (20, 30) 26 (21, 33) .021 400 346 Heart rate, beats/min 90 (80, 104) 86 (78, 101) 96 (81, 112) .006 401 347 Underlying diseases 348 402 403 Smoke 43 (29.3) 8 (11.0) 35 (47.3) < .001 Hypertension 70 (47.3) 38 (52.1) 32 (42.7) .323 351 Diabetes 35 (23.6) 20 (27.4) 15 (20.0) .336 352 Cardiovascular disease 31 (20.9) 23 (31.5) 8 (10.7) .002 407 353 Chronic kidney failure 9 (6.1) 3 (4.1) 6 (8.0) .494 408 354 Chronic respiratory disease 2 (1.4) 1 (1.4) 1 (1.3) .745 409 349 350 355 356 65 (86.7) .502 Septic shock 33 (22.3) 23 (31.5) 10 (13.3) .010 359 Acute kidney injury 21 (14.2) 13 (17.8) 8 (10.7) .245 360 Liver disfunction 67 (45.3) 33 (45.2) 34 (45.3) .999 361 362 363 Leukocytopenia 366 367 Q10 368 369 370 371 372 373 374 411 412 413 414 415 Data are presented as medians (interquartile ranges) or No. (%). APACHE ¼ Acute Physiology and Chronic Health Evaluation; COVID-19 ¼ coronavirus disease 2019; CURB-65 ¼ confusion, urea nitrogen, respiratory rate, blood pressure, 65 years of age and older; HINI ¼ in?uenza A; SOFA ¼ Sequential Organ Failure Assessment. 364 365 406 410 60 (82.2) 358 405 Complications 125 (84.5) 357 404 in patients with H1N1 (25.5 vs 70.0 U/L, 483 vs 767 U/L, and 0.03 vs 0.14 ng/mL, respectively; P < .001 for each). Both COVID-19 and H1N1 cohorts exhibited impairments in cellular immune function. However, the median CD3þ T lymphocyte concentration in patients with COVID-19 was 193 cells/mL, and the median CD4þCD3þ T lymphocyte concentration was 97 cells/ TABLE 2 mL, which were signi?cantly lower than those in patients with H1N1 (303 cells/mL, P ¼ .007; and 185 cells/mL, P < .001) (Table 3). Q22 416 Q23 417 418 419 420 421 422 423 In terms of imaging characteristics, ground-glass opacity on chest CT scans was more common in patients with COVID-19 (94.5%) than in patients with H1N1 (45.3%; 424 425 426 427 428 ] Clinical Symptoms of Patients With COVID-19 or H1N1 429 Total (N ¼ 148) COVID-19 (n ¼ 73) H1N1 (n ¼ 75) P Value Fever 141 (95.3) 72 (98.6) 69 (92.0) .116 431 377 Cough 125 (84.5) 58 (79.5) 67 (89.3) .115 432 378 Sputum 98 (66.2) 39 (53.4) 59 (78.7) .002 433 379 Dyspnea 108 (73.0) 52 (71.2) 56 (74.7) .712 434 380 Fatigue 60 (63.0) 46 (63.0) 14 (18.7) < .001 GI symptoms 32 (21.6) 27 (37.0) 5 (6.7) < .001 383 Myalgia 36 (24.3) 25 (34.2) 11 (14.7) .007 384 Hemoptysis 9 (6.1) 4 (5.5) 5 (6.7) .517 375 Symptom 376 381 382 385 430 435 436 437 438 439 440 Data are presented as No. (%). See Table 1 legend for expansion of abbreviations. 4 Original Research [ -#- CHEST - 2020 FLA 5.6.0 DTD CHEST3017_proof 11 April 2020 2:01 pm EO: CHEST-20-0919 ] 441 442 443 444 TABLE 3 ] Laboratory Examinations and Imaging Characteristics at Admission in Patients With COVID-19 or H1N1 496 Variable COVID-19 (n ¼ 73) H1N1 (n ¼ 75) P Value 6.9 (4.6, 10.0) 7.2 (4.8, 10.0) 6.6 (4.3, 10.1) .511 500 6.0 (3.3, 9.1) 6.3 (3.2, 9.2) 5.5 (3.4, 9.0) .511 501 86.0 (77.9, 91.2) 85.4 (75.4, 90.2) 86.6 (80.0, 92.0) .439 503 0.6 (0.4, 0.8) 0.7 (0.5, 0.9) 0.5 (0.4, 0.8) .251 504 498 Blood routine test 445 WBC (109/L) 446 Neutrophil granulocyte (109/L) 447 497 Total (N ¼ 148) 499 502 448 Neutrophil granulocyte, % 449 Lymphocyte (109/L) 450 Lymphocyte, % 9.2 (5.0, 13.8) 9.2 (6.1, 16.0) 9.2 (4.8, 12.3) .930 505 451 Hemoglobin, g/L 126.0 (105.5, 138.5) 136.0 (127.5, 147.0) 124 (104.5, 138.0) .094 506 Platelet (109/L) 129.0 (99, 176.5) 166.5 (145.5, 192.5) 123.0 (96.5, 173.0) .117 452 453 454 Prothrombin t... 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