Investigations

Laboratory Findings:

  • CBC 

    • Lymphopenia (43%; 19-67) [1]

    • Leukopenia (19%; 8-29) [1]

    • Leukocytosis (17%; 5-28) [1]

  • High Creatinine (4.5%; 1-8) [1]

  • LFTs

    • High AST (33%; 26-40) [1]

    • High ALT (24%; 13-35) [1]

  • Low Albumin (76% of patients are estimated to present with this; 95% CI is 31-100) [1]

  • High CRP (58%; 22-95) [1]

  • High LDH (57%; 38-76) [1]

  • High ESR (42%; 0-92.8) [1]

  • High CK (21%; 3-39) [1]

  • High Bilirubin (11%; 0-25) [1]

  • Elevated Ferritin [2]

  • Elevated IL-6 [2]

  • Higher D-Dimer (2.4 (0.6 – 14.4)), higher prothrombin time, higher ferritin are correlated with a more severe clinical course [2,3] 

  • Elevated hypersensitive troponin I has been reported in association with virus-related cardiac injury and more severe clinical course [3] 

  • High procalcitonin has been reported specifically with bacterial superinfection [3] 

Imaging: 

  • Chest X-Ray and CT Findings 

    • Predominantly bilateral pneumonia (73%; 95%CI was 59-87).[1] Unilateral pneumonia was less common at 25% (5-45).[1]

    • Ground glass opacities were seen in 69% (52-85) of patients [1]

    • Predominantly basal and peripheral [4]

    • This may progress to consolidation which is seen in 59% of patients [2]

    • Compared to non-COVID-19 pneumonia, COVID-19 more likely to present with peripheral distribution, ground glass opacity, fine reticular opacity and vascular thickening. It is less likely to present with central and peripheral distribution, pleural effusion, and lymphadenopathy [5] 

    • Example CT and CXR: [6,7]

  • Ultrasound [8]

    • Numerous B-lines in a variety of patterns including focal, multi-focal and confluent

    • Pleural line thickening

    • Consolidations in a variety of patterns

    • A-lines appear during the recovery phase

    • Pleural effusions are uncommon

    • Example ultrasound images:

References:

1.        Rodriguez-Morales, A. J. et al. Clinical, laboratory and imaging features of COVID-19: A systematic review and meta-analysis. Travel Med. Infect. Dis. 101623 (2020). doi:10.1016/j.tmaid.2020.101623

2.        Zhou, F. et al. Articles Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan , China : a retrospective cohort study. Lancet (2020). doi:10.1016/S0140-6736(20)30566-3

3.        Huang, C. et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet(2020). doi:10.1016/S0140-6736(20)30183-5

4.        Shi, H. et al. Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study. Lancet. Infect. Dis. (2020). doi:10.1016/S1473-3099(20)30086-4

5.        Bai, H. X. et al. Performance of radiologists in differentiating COVID-19 from viral pneumonia on chest CT. Radiology (2020). doi:10.1148/radiol.2020200823

6.        Guan, W.-J. et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N. Engl. J. Med. (2020). doi:10.1056/NEJMoa2002032

7.        Ai, T. et al. Correlation of Chest CT and RT-PCR Testing in Coronavirus Disease                     2019 (COVID-19) in China: A Report of 1014 Cases. Radiology 200642 (2020). doi:10.1148/radiol.2020200642

8.        Peng, Q.-Y., Wang, X.-T., Zhang, L.-N. & (CCUSG), C. C. C. U. S. G. Findings of lung ultrasonography of novel corona virus pneumonia during the 2019–2020 epidemic. Intensive Care Med. (2020). doi:10.1007/s00134-020-05996-6

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