COVID-19 Is Distinct From SARS-CoV-2-Negative Community-Acquired Pneumonia

Abstract

Background: Corona virus disease (COVID-19) is an infectious respiratory disease that has spread rapidly across the world. Many studies have already evaluated the clinical features of COVID-19, but how it compares with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-negative community-acquired pneumonia (SN-CAP) is still unclear. Moreover, COVID-19 mortality is correlated with disease severity, but indicators for severity grading have not been specified. We aimed to analyze the clinical characteristics of COVID-19 in comparison with SN-CAP and find indicators for disease severity in COVID-19. Methods: Patients diagnosed with COVID-19 and SN-CAP were enrolled. Clinical, radiological, and laboratory data were analyzed. Results: The numbers of COVID-19 and SN-CAP patients enrolled were 304 and 138, respectively. The age of the patients was not significantly different between the groups. Compared with SN-CAP, COVID-19 patients had more symptoms of fever and dyspnea; and showed significant difference in blood count results. Computed tomography (CT) imaging of COVID-19 patients showed patchy ground-glass opacities that correlated with disease severity, whereas the CT imaging of SN-CAP patients showed patchy high-density shadows. COVID-19 patients were classified into moderate, severe, and critically severe groups. The severe and critically severe groups had elevated levels of white blood cells (WBC), neutrophils, platelets, C-reaction protein (CRP), lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), troponin-I, creatinine, and blood urea nitrogen (BUN). However, they had decreased levels of lymphocytes, lymphocyte ratio, and albumin. Compared with the younger patients, the older COVID-19 individuals had more chronic diseases and significantly elevated levels of WBC, neutrophil, and CRP levels. Conclusion: SN-CAP showed more inflammatory reaction than COVID-19. Old people with chronic diseases are more susceptible to COVID-19 and have a high likelihood of developing severe and critically severe infection. Levels of WBC, lymphocytes, neutrophils, CRP, NLR, PLR, troponin-I, creatinine, and BUN are important indicators for severity grading in COVID-19.

Keywords: CAP; COVID-19; SARS-CoV-2; clinical features; severity.

Figure 1

CT imaging of COVID-19 patients. (A) Moderate-severity pneumonia in a 36-year-old man presenting as ground-glass opacity under the pleura in both the lungs. (B) Severe pneumonia in a 50-year-old man presenting as ground-glass opacity and large exudative shadows in both the lungs. (C) Critically severe pneumonia in a 58-year-old man presenting as large patches of exudative shadows in both lungs. (D) Moderate-severity pneumonia in a 63-year-old woman presenting as ground-glass opacity in the right upper lobe. (E) Severe pneumonia in a 78-year-old woman presenting as large exudative shadows in both lungs. (F) Critically severe pneumonia in a 69-year-old man presenting as large patches of ground-glass opacity and exudative shadows in both lungs.

Figure 2

CT imaging of SN-CAP patients. (G) Moderate-severity pneumonia in a 49-year-old woman presenting as patchy exudative shadows in the right upper lobe. (H) Severe pneumonia in a 50-year-old man presenting as large exudative shadows in both lungs. (I) Moderate-severity pneumonia in a 90-year-old man presenting as exudative shadows in the left lower lobe. (J) Severe pneumonia in an 80-year-old woman presenting as large exudative shadows in both lungs.