Differential diagnosis of coronavirus disease 2019 pneumonia or influenza A pneumonia by clinical characteristics and laboratory findings

Abstract

Background: Pneumonia caused by the 2019 novel Coronavirus (COVID-2019) shares overlapping signs and symptoms, laboratory findings, imaging features with influenza A pneumonia. We aimed to identify their clinical characteristics to help early diagnosis.

Methods: We retrospectively retrieved data for laboratory-confirmed patients admitted with COVID-19-induced or influenza A-induced pneumonia from electronic medical records in Ningbo First Hospital, China. We recorded patients' epidemiological and clinical features, as well as radiologic and laboratory findings.

Results: The median age of influenza A cohort was higher and it exhibited higher temperature and higher proportion of pleural effusion. COVID-19 cohort exhibited higher proportions of fatigue, diarrhea and ground-glass opacity and higher levels of lymphocyte percentage, absolute lymphocyte count, red-cell count, hemoglobin and albumin and presented lower levels of monocytes, c-reactive protein, aspartate aminotransferase, alkaline phosphatase, serum creatinine. Multivariate logistic regression analyses showed that fatigue, ground-glass opacity, and higher level of albumin were independent risk factors for COVID-19 pneumonia, while older age, higher temperature, and higher level of monocyte count were independent risk factors for influenza A pneumonia.

Conclusions: In terms of COVID-19 pneumonia and influenza A pneumonia, fatigue, ground-glass opacity, and higher level of albumin tend to be helpful for diagnosis of COVID-19 pneumonia, while older age, higher temperature, and higher level of monocyte count tend to be helpful for the diagnosis of influenza A pneumonia.

Keywords: COVID-19; clinical characteristics; differential diagnosis; influenza A; pneumonia.

Figure 1

Imaging characteristics of chest computed tomographies from COVID‐19 pneumonia patients and influenza A pneumonia patients. (A) 63‐year‐old female patient with COVID‐19 pneumonia exhibited multiple ground‐glass opacities and stripe shadows in both lungs. (B) A 67‐year‐old male patient with COVID‐19 pneumonia exhibited diffuse ground‐glass opacities and paving stone shadows in both lungs. (C) A 67‐year‐old male patient with influenza A pneumonia exhibited exudation and consolidation distributed with bronchus in multiple lobes and segments. (D) A 59‐year‐old female patient with influenza A pneumonia exhibited multiple patchy ground‐glass opacities with grid shadow of map‐like change in both lungs