High Fever, Wide Distribution of Viral Pneumonia, and Pleural Effusion are More Critical Findings at the First Visit in Predicting the Prognosis of COVID-19: A Single Center, retrospective, Propensity Score-Matched Case–Control Study

Masahiro Shinoda,1 Shinichiro Ota,1 Yuto Yoshida,1,2 Takatomo Hirouchi,1,2 Kanako Shinada,1 Takashi Sato,1 Miwa Morikawa,1 Naoki Ishii,3 Masaharu Shinkai1 1Department of Respiratory Medicine, Tokyo Shinagawa Hospital, Tokyo, Japan; 2Department of Respiratory Medicine, Toho University Ohashi Medical Center, Tokyo, Japan; 3Department of Gastroenterology, Tokyo Shinagawa Hospital, Tokyo, JapanCorrespondence: Masahiro Shinoda, Department of Respiratory Medicine, Tokyo Shinagawa Hospital, 6-3-22 Higashi-Oi, Shinagawa, Tokyo, 140-8522, Japan, Tel +81-3-3764-0511, Fax +81-3-3764-3415, Email mshinopy@gmail.comIntroduction: Currently, infection control measures for SARS-COV2 are being relaxed, and it is important in daily clinical practice to decide which findings to focus on when managing patients with similar background factors.Methods: We retrospectively evaluated 66 patients who underwent blood tests (complete blood count, blood chemistry tests, and coagulation tests) and thin slice CT between January 1 and May 31, 2020, and performed a propensity score-matched case–control study. Cases and controls were a severe respiratory failure group (non-rebreather mask, nasal high-flow, and positive-pressure ventilation) and a non-severe respiratory failure group, matched at a ratio of 1:3 by propensity scores constructed by age, sex, and medical history. We compared groups for maximum body temperature up to diagnosis, blood test findings, and CT findings in the matched cohort. Two-tailed P-values < 0.05 were considered statistically significant.Results: Nine cases and 27 controls were included in the matched cohort. Significant differences were seen in maximum body temperature up to diagnosis (p=0.0043), the number of shaded lobes (p=0.0434), amount of ground-glass opacity (GGO) in the total lung field (p=0.0071), amounts of GGO (p=0.0001), and consolidation (p=0.0036) in the upper lung field, and pleural effusion (p=0.0117).Conclusion: High fever, the wide distribution of viral pneumonia, and pleural effusion may be prognostic indicators that can be easily measured at diagnosis in COVID-19 patients with similar backgrounds.Keywords: COVID-19, prognosis, fever, ground-glass opacity, consolidation, pleural effusion