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COVID-19 Clinical Features

COVID-19 vs Flu: What are the Differences in Hospitalization Risk Factors, Clinical Characteristics, and Outcomes?

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BACKGROUND AND PURPOSE:

  • Piroth et al. (Lancet Respiratory Medicine, 2020) compared patients hospitalized with COVID-19 vs those with influenza

METHODS:

  • Retrospective cohort study
  • Data sources
    • French national administrative database (PMSI)
    • Includes discharge summaries for all hospital admissions in France
  • Participants
    • Patients hospitalized with COVID-19 from March 1 to April 30, 2020
    • Patients hospitalized with influenza from Dec 1, 2018, and Feb 28, 2019
  • Study design
    • The authors compared risk factors, clinical characteristics, and outcomes between patients hospitalized with COVID-19 and influenza
    • Stratified by age group

RESULTS:

  • Patient cohorts
    • COVID-19: 89,530 patients
    • Influenza: 45,819 patients
  • Median age
    • COVID-19: 68 years (IQR 52 to 82)
    • Influenza: 71 years (IQR 34 to 84)

Risk Factors

  • COVID-19 vs influenza patients were more likely  
    • To be obese or overweight
    • To have diabetes, hypertension, and dyslipidemia
  • Influenza patients vs COVID-19 patients more frequently
    • Had heart failure, chronic respiratory disease, cirrhosis, and deficiency anemia

Clinical Characteristics

  • COVID-19 vs influenza patients more frequently developed
    • Acute respiratory failure, pulmonary embolism, septic shock, or hemorrhagic stroke
  • COVID-19 patients vs influenza patients less frequently developed
    • Myocardial infarction or atrial fibrillation

Outcomes

  • In-hospital mortality was higher in patients with COVID-19 than in patients with influenza
    • COVID-19: 16.9%
    • Influenza: 5.8%
    • Relative risk of death from COVID-19 of 2.9 (95% CI, 2.8 to 3.0)
    • Age-standardized mortality ratio: 2.82
  • The proportion of pediatric patients (<18 years) was smaller for COVID-19 than for influenza
    • COVID-19: 1.4%
    • Influenza: 19.5%
  • Larger proportion of patients >5 years needed ICU support for COVID-19 than for influenza
    • COVID-19: 2.3%
    • Influenza: 0.9%
  • For adolescents, the in-hospital mortality was 10x higher for COVID-19 than influenza
    • COVID-19: 1.1%
    • Influenza: 0.1%
  • No difference seen between COVID-19 and influenza severity among patients living with HIV

CONCLUSION:

  • Compared to influenza, COVID-19 is more likely to have respiratory pathogenicity and consequent higher mortality
    • COVID-19 in-hospital mortality was approximately 3X higher than for seasonal influenza
    • While COVID-19 patients did have significant rates of diabetes and obesity, patients with influenza were more likely to have significant comorbidities such as heart failure and COPD
    • Greater COVID-19 disease severity may be due to exaggerated immune response in COVID-19
  • Caution advised regarding mortality rates in adolescent population due to small ‘n’
  • The rate of COVID-19 hospitalizations in children is much lower than for influenza but associated with higher mortality

Learn More – Primary Sources:

Comparison of the characteristics, morbidity, and mortality of COVID-19 and seasonal influenza: a nationwide, population-based retrospective cohort study

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Related ObG Topics:

How Do Clinical Characteristics of COVID-19 Infection Differ Between Symptomatic and Asymptomatic Patients?
Hyperinflammatory Shock in Children and COVID-19
CDC Weekly Update: Which Comorbidities are Associated with COVID-19 in the US?
Is Obesity an Independent Risk Factor for COVID-19 Related Mortality?

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