Acute Clinical Syndromes and Suspicion of SARS-CoV-2 Infection: The Experience of a Single Romanian Center in the Early Pandemic Period

Abstract

Background and Objectives: During the coronavirus disease 2019 (COVID-19) pandemic, patients with chronic diseases suffering exacerbations have required acute medical care. The purpose of our study was to determine useful criteria for the differentiation of patients with acute clinical syndromes and suspicion of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Materials and Methods: This was an observational retrospective study, conducted in an internal medicine clinic from April to May 2020. We collected clinical, biological, and computed tomography (CT) data on patients with exacerbations of chronic diseases and clinical suspicion of SARS-CoV-2 infection. Patients with an already-positive real-time reverse-transcription polymerase chain reaction (RT-PCR) test for SARS-CoV-2 on presentation at the emergency department were excluded from our study. Results: Of 253 suspected cases, 20 were laboratory-confirmed as having SARS-CoV-2 infection by RT-PCR, whereas COVID-19 diagnosis was ruled out in the remaining 233. Venous thromboembolism (VTE) correlated significantly with COVID-19 diagnosis in suspected patients, while laboratory markers were not significantly different between the two groups. Of the suspected patients, significantly higher percentages of dry cough, fever, myalgias, sore throat, loss of smell and appetite, and ground-glass opacities (GGOs) on CT were found in SARS-CoV-2-positive individuals. Conclusions: The study demonstrated that, until receiving the result of an RT-PCR test for SARS-CoV-2 (usually 12–24 h), association with VTE as a comorbidity, fever, dry cough, and myalgia as clinical features, and GGO on CT are the main markers for the identification of COVID-19 patients among those suspected with acute clinical syndromes. Our results also provide evidence for doctors not to rely solely on biological markers in the case of suspected SARS-CoV-2 infection in patients with exacerbations of chronic diseases. These data are useful for faster decision-making with regard to suspected COVID-19 patients before receiving RT-PCR test results, thus avoiding keeping patients in crowded emergency departments.

COVID-19 and Laboratory Markers from Romanian Patients—A Narrative Review

“…Low levels of iron have been reported in Romanian patients early on, accordingly to international data [ 56 , 72 , 88 ]; however, there have been cases of normal values reported [ 54 , 86 , 89 , 90 ], while others have reported high levels of FER, including in children [ 14 , 21 , 23 , 24 , 25 , 26 , 29 , 30 , 31 , 35 , 36 , 41 , 43 , 48 , 62 , 74 , 79 ], with a few rare cases of vertical transmission describing increased FER levels, as observed in Iacob et al’s study [ 64 ].…”

“…Normal cardiac markers were observed in a few studies [ 21 , 86 ], while elevated levels were observed in others [ 23 , 37 , 45 , 63 , 74 ]. Furthermore, cardiac markers varied by NYHA classification and were considered an independent risk factor [ 33 ].…”

Beneficial Effects of Anticoagulants on the Clinical Outcomes of COVID-19 Patients

“…This infectious disease has a wild range of clinical symptoms, starting from mild respiratory illness with fever, cough, myalgia, headache, anosmia and diarrhea to severe pneumonia with acute respiratory distress syndrome, cardiac arrhythmias, septic shock, hypercoagulability, disseminated intra-vascular coagulation with multi-organ failure and even death [ 12 ]. These clinical features help in identifying the patients suffering from SARS-CoV-2 infection even before the RT-PCR for COVID-19 comes back as positive; therefore, they help in managing these patients in a timely manner [ 13 ].…”

The Significance of Low Magnesium Levels in COVID-19 Patients

“…The main cause of death in COVID-19 patients is documented as acute respiratory distress. The cardiovascular system and shock are also often implicated [ 5 , 8 ].…”