The following is a summary of “A clinico-epidemiological profile, coinfections and outcome of patients with Influenza Like Illnesses (ILI) presenting to the emergency department during the COVID-19 pandemic,” published in the April 2023 issue of Primary Care by Hazra, et al.
The COVID-19 pandemic has led to an increased number of patients presenting to the emergency department (ED) with symptoms resembling Influenza-like illnesses (ILI) and other atypical presentations. For a study, researchers sought to determine the underlying causes, co-infections, and clinical characteristics of patients with ILI.
A prospective observational study was conducted on patients who visited the ED between April and August 2020. The inclusion criteria were fever and/or cough, breathing difficulty, sore throat, myalgia, gastrointestinal complaints, loss of taste, altered sensorium, or asymptomatic patients residing in or traveling from containment zones or those in contact with COVID-19-positive individuals during the first wave of the pandemic. A subset of COVID-19 patients underwent respiratory virus screening to identify co-infections.
During the study period, 1,462 patients with Influenza-like illnesses (ILI) and 857 patients with confirmed COVID-19 infection but non-ILI presentations were included. The mean age of the patient population was 51.4 years with a standard deviation (SD) of 14.9, and there was a male predominance with 1,593 cases (68.7%). The average duration of symptoms was 4.1 days, with an SD of 2.9. A subset of 293 ILI patients (16.4%) underwent a sub-analysis to determine an alternate viral etiology. Among them, 54 patients (19.4%) had co-infection with COVID-19 and other viruses, with Adenovirus being the most common (n=39; 14.0%). In the ILI-COVID-19 positive group, apart from fever, cough, and breathing difficulty, the most common symptoms were loss of taste (n=385; 26.3%) and diarrhea (n=123; 8.4%). In terms of clinical parameters, the ILI group had a statistically significant higher respiratory rate (mean: 27.5 breaths per minute, SD: 8.1; P-value < 0.001) and lower oxygen saturation (mean: 92.1%, SD: 11.2) on room air compared to the non-ILI group (P-value < 0.001). Age greater than 60 years (adjusted odds ratio (OR): 4.826, 95% confidence interval (CI): 3.348-6.956; P-value: <0.001), Sequential Organ Function Assessment (SOFA) score of four or higher (adjusted OR: 5.619, 95% CI: 3.526-8.957; P-value: <0.001), and WHO critical severity score (Adjusted OR: 13.812, 95% CI: 9.656-19.756; P-value: <0.001) were identified as independent predictors of mortality.
COVID-19 patients were more likely to present with ILI symptoms rather than atypical features. Adenovirus co-infection was frequently observed. Age over 60 years, a high SOFA score, and a WHO critical severity score were associated with an increased risk of mortality.