Performance of Diagnostic Model for Differentiating Between COVID-19 and Influenza: A 2-Center Retrospective Study

Sensitivity and Specificity of Patient-Reported Clinical Manifestations to Diagnose COVID-19 in Adults from a National Database in Chile: A Cross-Sectional Study

Simple Summary

COVID-19 is frequently suspected based on clinical features, such as fever, cough, headache, or loss of taste. However, it remains unclear whether these manifestations are reliable indicators of disease. We sought to evaluate the diagnostic accuracy of clinical manifestations in identifying patients with COVID-19. Data from a nationwide database comprising of 2,187,962 patients who sought medical care in Chile were analysed. Information regarding age, gender, type of insurance, a history of a close contact with COVID-19, and several clinical features was obtained. The most common complaints were headache, muscle aches, and cough. No single clinical feature was precise enough to fully confirm or exclude COVID-19. The combination of several of these manifestations with epidemiological risk factors into a model showed a reasonable accuracy in detecting cases of COVID-19.

Abstract

(1) Background: The diagnosis of COVID-19 is frequently made on the basis of a suggestive clinical history and the detection of SARS-CoV-2 RNA in respiratory secretions. However, the diagnostic accuracy of clinical features is unknown. (2) Objective: To assess the diagnostic accuracy of patient-reported clinical manifestations to identify cases of COVID-19. (3) Methodology: Cross-sectional study using data from a national registry in Chile. Infection by SARS-CoV-2 was confirmed using RT-PCR in all cases. Anonymised information regarding demographic characteristics and clinical features were assessed using sensitivity, specificity, and diagnostic odds ratios. A multivariable logistic regression model was constructed to combine epidemiological risk factors and clinical features. (4) Results: A total of 2,187,962 observations were available for analyses. Male participants had a mean age of 43.1 ± 17.5 years. The most common complaints within the study were headache (39%), myalgia (32.7%), cough (31.6%), and sore throat (25.7%). The most sensitive features of disease were headache, myalgia, and cough, and the most specific were anosmia and dysgeusia/ageusia. A multivariable model showed a fair diagnostic accuracy, with a ROC AUC of 0.744 (95% CI 0.743–0.746). (5) Discussion: No single clinical feature was able to fully confirm or exclude an infection by SARS-CoV-2. The combination of several demographic and clinical factors had a fair diagnostic accuracy in identifying patients with the disease. This model can help clinicians tailor the probability of COVID-19 and select diagnostic tests appropriate to their setting.

Design and simulation of a millifluidic device for differential detection of SARS-CoV-2 and H1N1 based on triboelectricity

Differential diagnosis of pathogenic diseases, presently coronavirus disease 2019 (COVID-19) and influenza, is crucial with due attention to their superspreading events, presumably long incubation period, particular complications, and treatments. In this paper, a label-free, self-powered, and ultrafast immunosensor device working based on triboelectric effect is proposed. Equilibrium constants of specific antibody-antigen reactions are accompanied by IEP-relevant electric charges of antigens to recognize SARS-CoV-2 and H1N1. Simulation attributes including fluid flow and geometrical parameters are optimized so that the maximum capture efficiency of 85.63% is achieved. Accordingly, antibody-antigen complexes form electric double layers (EDLs) across the channel interfaces. The resultant built-in electric field affects the following external electric field derived from triboelectricity, leading to the variation of open-circuit voltage as a sensing metric. The device is flexible to operate in conductor-to-dielectric single-electrode and contact-separation modes simultaneously. While the detection limit is reduced utilizing the single-electrode mode compared to the latter one, surface treatment of the triboelectric pair contributes to the sensitivity enhancement. A threshold value equal to −4.113 V is featured to discriminate these two viruses in a vast detectable region; however, further surface engineering can allow the on-site detection of any electrically-charged pathogen applying the emerging triboelectric immunosensor enjoying a lower detection limit.

D-dimer, CRP, PCT, and IL-6 Levels at Admission to ICU Can Predict In-Hospital Mortality in Patients with COVID-19 Pneumonia

Introduction

Health care workers have had a challenging task since the COVID-19 outbreak. Prompt and effective predictors of clinical outcomes are crucial to recognize potentially critically ill patients and improve the management of COVID-19 patients. The aim of this study was to identify potential predictors of clinical outcomes in critically ill COVID-19 patients.

Methods

The study was designed as a retrospective cohort study, which included 318 patients treated from June 2020 to January 2021 in the Intensive Care Unit (ICU) of the Clinical Hospital Center “Bezanijska Kosa” in Belgrade, Serbia. The verified diagnosis of COVID-19 disease, patients over 18 years of age, and the hospitalization in ICU were the criteria for inclusion in the study. The optimal cutoff value of D-dimer, CRP, IL-6, and PCT for predicting hospital mortality was determined using the ROC curve, while the Kaplan-Meier method and log-rank test were used to assess survival.

Results

The study included 318 patients: 219 (68.9%) were male and 99 (31.1%) female. The median age of patients was 69 (60-77) years. During the treatment, 195 (61.3%) patients died, thereof 130 male (66.7%) and 65 female (33.3%). 123 (38.7%) patients were discharged from hospital treatment. The cutoff value of IL-6 for in-hospital death prediction was 74.98 pg/mL (Sn 69.7%, Sp 62.7%); cutoff value of CRP was 81 mg/L (Sn 60.7%, Sp 60%); cutoff value of procalcitonin was 0.56 ng/mL (Sn 81.1%, Sp 76%); and cutoff value of D-dimer was 760 ng/mL FEU (Sn 63.4%, Sp 57.1%). IL-6 ≥ 74.98 pg/mL, CRP ≥ 81 mg/L, PCT ≥ 0.56 ng/mL, and D-dimer ≥ 760 ng/mL were statistically significant predictors of in-hospital mortality.

Conclusion

IL-6 ≥ 74.98 pg/mL, CRP values ≥ 81 mg/L, procalcitonin ≥ 0.56 ng/mL, and D-dimer ≥ 760 ng/mL could effectively predict in-hospital mortality in COVID-19 patients.

Using logistic regression to develop a diagnostic model for COVID-19: A single-center study

BACKGROUND

The main manifestations of coronavirus disease-2019 (COVID-19) are similar to the many other respiratory diseases. In addition, the existence of numerous uncertainties in the prognosis of this condition has multiplied the need to establish a valid and accurate prediction model. This study aimed to develop a diagnostic model based on logistic regression to enhance the diagnostic accuracy of COVID-19.

MATERIALS AND METHODS

A standardized diagnostic model was developed on data of 400 patients who were referred to Ayatollah Talleghani Hospital, Abadan, Iran, for the COVID-19 diagnosis. We used the Chi-square correlation coefficient for feature selection, and logistic regression in SPSS V25 software to model the relationship between each of the clinical features. Potentially diagnostic determinants extracted from the patient's history, physical examination, and laboratory and imaging testing were entered in a logistic regression analysis. The discriminative ability of the model was expressed as sensitivity, specificity, accuracy, and area under the curve, respectively.

RESULTS

After determining the correlation of each diagnostic regressor with COVID-19 using the Chi-square method, the 15 important regressors were obtained at the level of P < 0.05. The experimental results demonstrated that the binary logistic regression model yielded specificity, sensitivity, and accuracy of 97.3%, 98.8%, and 98.2%, respectively.

CONCLUSION

The destructive effects of the COVID-19 outbreak and the shortage of healthcare resources in fighting against this pandemic require increasing attention to using the Clinical Decision Support Systems equipped with supervised learning classification algorithms such as logistic regression.