Chest
Volume 158, Issue 1, July 2020, Pages 195-205
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Critical Care: Original Research
Comparison of Hospitalized Patients With ARDS Caused by COVID-19 and H1N1

https://doi.org/10.1016/j.chest.2020.03.032Get rights and content

Background

Since the outbreak of coronavirus disease 2019 (COVID-19) in China in December 2019, considerable attention has been focused on its elucidation. However, it is also important for clinicians and epidemiologists to differentiate COVID-19 from other respiratory infectious diseases such as influenza viruses.

Research question

The aim of this study was to explore the different clinical presentations between COVID-19 and influenza A (H1N1) pneumonia in patients with ARDS.

Study Design and Methods

This analysis was a retrospective case-control study. Two independent cohorts of patients with ARDS infected with either COVID-19 (n = 73) or H1N1 (n = 75) were compared. Their clinical manifestations, imaging characteristics, treatments, and prognosis were analyzed and compared.

Results

The median age of patients with COVID-19 was higher than that of patients with H1N1, and there was a higher proportion of male subjects among the H1N1 cohort (P < .05). Patients with COVID-19 exhibited higher proportions of nonproductive coughs, fatigue, and GI symptoms than those of patients with H1N1 (P < .05). Patients with H1N1 had higher Sequential Organ Failure Assessment (SOFA) scores than patients with COVID-19 (P < .05). The Pao2/Fio2 of 198.5 mm Hg in the COVID-19 cohort was significantly higher than the Pao2/Fio2 of 107.0 mm Hg in the H1N1 cohort (P < .001). Ground-glass opacities was more common in patients with COVID-19 than in patients with H1N1 (P < .001). There was a greater variety of antiviral therapies administered to COVID-19 patients than to H1N1 patients. The in-hospital mortality of patients with COVID-19 was 28.8%, whereas that of patients with H1N1 was 34.7% (P = .483). SOFA score-adjusted mortality of H1N1 patients was significantly higher than that of COVID-19 patients, with a rate ratio of 2.009 (95% CI, 1.563-2.583; P < .001).

Interpretation

There were many differences in clinical presentations between patients with ARDS infected with either COVID-19 or H1N1. Compared with H1N1 patients, patients with COVID-19-induced ARDS had lower severity of illness scores at presentation and lower SOFA score-adjusted mortality.

Key Words

ARDS
COVID-19
H1N1
influenza A
mortality

Abbreviations

COVID-19
coronavirus disease 2019
ECMO
extracorporeal membrane oxygenation
H1N1
influenza A
SARS-CoV-2
severe acute respiratory syndrome coronavirus 2
SOFA
Sequential Organ Failure Assessment

Cited by (0)

Drs Tang, Du, and Peng contributed equally to this study.

FUNDING/SUPPORT: This work was supported by the Beijing Municipal Administration of Hospitals’ Mission Plan [SML20150301], the 1351 Talents Program of Beijing Chao-Yang Hospital [WXZXZ-2017-01], and Novel Coronavirus Pneumonia Key Technology Research and Development Funding of the Beijing Hospital Authority [Covid-19-BHA03].

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