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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">As a result of its broad clinical presentation &#8211; from asymptomatic infection to severe acute respiratory syndrome &#40;SARS&#41; &#8211; as well as non-specific laboratory and radiological features&#44; differential diagnosis of COVID-19&#44; particularly at admission&#44; is challenging&#46; Influenza&#44; pneumonia&#44; tuberculosis&#44; arbovirus infections&#44; and even non-infectious illnesses have been reported as conditions that can mimic COVID-19&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">1&#8211;3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Identification of patients at high-risk for COVID-19 before confirmatory testing is key to prioritize containment efforts&#44; RT-PCR tests&#44; and personal protective equipment &#40;PPE&#41;&#44; especially in hospital settings&#46; Considering that RT-PCR sensitivity is variable &#8211; in some reports&#44; it is as low as 71&#37;&#44;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">4</span></a> patients at high-risk for COVID-19 with a negative RT-PCR result should be re-tested before being transferred to a non-COVID ward&#46; However&#44; there is little knowledge on how to identify patients who have a higher pre-test probability for COVID-19&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">In this study we analyzed significant variables associated with initial COVID-19 diagnosis&#46; Our objective was to develop a useful predictive tool for COVID-19 diagnosis based on clinical&#44; laboratory and image data prior to RT-PCR test confirmation&#46; ROC Curve models and a clinical score are provided aiming to predict early SARS-CoV-2 infection diagnosis&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">The first 118 consecutive patients aged 18 or older admitted to Hospital de Cl&#237;nicas de Porto Alegre&#44; an 831 bed tertiary referral hospital located in Southern Brazil&#44; due to suspected COVID-19 were assessed&#46; Clinical&#44; laboratory and radiological findings at presentation were analyzed&#46; Patients discharged within 24<span class="elsevierStyleHsp" style=""></span>h of admission were excluded&#46; This study protocol was approved by the institutional review board&#44; and informed consent was obtained from each patient or closest family member&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Upon admission&#44; samples of nasal and throat swabs were collected by trained healthcare professionals according to the American Centers for Disease Control and Prevention &#40;CDC&#41; guidelines&#46; The sample was used for real-time polymerase chain reaction &#40;RT- PCR&#41;&#44; designed to detect three regions of the virus nucleocapsid &#40;N1&#44; N2&#44; N3&#41;&#44; according to the CDC diagnostic panel&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">5</span></a> Patients undertook chest image exams before RT-PCR results&#59; therefore&#44; radiologists were unaware of the patient diagnosis&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Patients were divided into those who had positive RT-PCR for SARS-CoV-2 and those with negative results&#46; Kruskal&#8211;Wallis test&#44; <span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup">2</span> test and Fisher&#39;s exact test were used to compare differences between groups&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">For our predictive score&#44; variables associated with outcome &#40;defined as <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41; in univariate analysis were tested in a logistic regression model&#46; Each significant variable received points based on multivariate model odds ratio &#40;OR&#41;&#46; Variables that showed no significant association with COVID-19 diagnosis in univariate analysis were not included&#46; The final model included abnormality on chest radiography&#44; LDH levels&#44; and leukocyte count&#46; Bootstrapping was performed to assess overfitting of the models&#46; Development of this score was performed according to TRIPOD guidelines&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">6</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Results</span><p id="par0040" class="elsevierStylePara elsevierViewall">Patients were admitted from March 17 to April 10&#44; 2020&#59; 18 were excluded because they had been discharged within 24<span class="elsevierStyleHsp" style=""></span>h of admission&#46; Out of 100 patients&#44; 29 were SARS-CoV-2 positive&#46; Main characteristics are listed in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">Four patients &#40;13&#46;7&#37;&#41; of the confirmed group were hospital healthcare staff&#46; In the negative RT-PCR group&#44; six &#40;21&#46;4&#37;&#41; patients had no contact with confirmed or suspected cases&#44; compared to 58 &#40;82&#46;8&#37;&#41; in the confirmed group &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; No patients in the negative group had traveled in the previous three weeks&#44; compared to eight &#40;28&#46;6&#37;&#41; patients in the confirmed group &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Patients in the negative group were more likely to have a higher number of comorbidities and to present with a higher PSI&#47;PORT index&#46; There was no difference in CURB-65 score among groups &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;10&#41;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The optimal cut-off value was 273<span class="elsevierStyleHsp" style=""></span>U&#47;L for LDH and 7&#46;7<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">3</span> per mm<span class="elsevierStyleSup">3</span> for leukocyte count&#46; Results from the multivariable analyses are presented in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">Of the 29 patients who tested positive for SARS-CoV-2&#44; four had a previous negative result&#46; For the remaining 71 who were considered negative&#44; 19 &#40;26&#37;&#41; were re-tested &#8211; 15 of them because the first test was inconclusive&#44; and four patients because of clinical suspicion&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Predictive score</span><p id="par0065" class="elsevierStylePara elsevierViewall">A predictive score for COVID-19 was built including variables that had shown an association with outcome in multivariate analysis&#59; it yielded two points for LDH &#62;273<span class="elsevierStyleHsp" style=""></span>U&#47;L&#44; three for leukocyte count &#8804;7&#46;7<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">3</span> per mm<span class="elsevierStyleSup">3</span> and four for any chest radiography abnormality&#46; A result &#8805;5 points was considered positive&#46; This score had 96&#37; sensitivity and 73&#46;5&#37; specificity in our sample&#44; with an area under ROC curve &#40;AUC&#41; of 0&#46;847 &#40;95&#37; CI 0&#46;77&#8211;0&#46;92&#41;&#44; as seen in <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">After bootstrapping&#44; this model had an AUC of 0&#46;827 &#40;95&#37; CI 0&#46;75&#8211;0&#46;90&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Discussion</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect2055">RT-PCR TESTING</span><p id="par0075" class="elsevierStylePara elsevierViewall">Two patients in the COVID-19 group had tested negative at admission&#59; after negative results&#44; they were transferred to non-COVID wards&#46; Because of clinical suspicion&#44; these patients were re-tested&#44; yielding positive results&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Admitting a COVID-19 patient into a regular ward can be catastrophic&#46; We advocate that patients who are to be moved to regular wards be re-tested before they are transferred&#59; if testing all of them was not possible&#44; patients with higher probability for COVID-19 &#8211; using a combination of clinical&#44; laboratory and radiological data &#8211; should be prioritized for testing&#46; Those who are discharged with one negative RT-PCR result should be advised to remain isolated at home for two weeks&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">In addition&#44; two other cases in the positive group were health workers who had tested negative two days before retesting&#46; Infected health care workers are likely to transmit SARS-CoV-2 to patients with comorbidities &#8211; which are at higher risk for severe infection&#46; Hence&#44; we highlight the need for more than one negative result in order to allow health care workers to return to work&#46; Although the CDC advocates the need for at least two negative nasopharyngeal swab specimens&#44;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">7</span></a> some local guidelines around the world require only one negative test&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">8</span></a></p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Predictive score</span><p id="par0090" class="elsevierStylePara elsevierViewall">There is increasing need for a validated clinical score estimating COVID-19 probability&#46; Considering shortage of PPE&#44; PCR testing and isolation units in many countries around the world&#44; as well as non-ideal sensitivity of nasopharyngeal swabs&#44; doctors at Emergency and Intensive Care Units should be provided with clinical tools&#44; other than contact history&#44; in order to prioritize isolation and testing&#46; A combination of clinical findings&#44; laboratory data and radiological patterns &#40;when available&#41; can be useful in this context&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Our predictive score yielded good sensitivity and specificity after adjusting for overfitting&#46; Fever was not included in the model because patients without fever are rarely admitted for suspected COVID-19&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Clinical presentation</span><p id="par0100" class="elsevierStylePara elsevierViewall">Most patients with confirmed COVID-19 diagnosis had fever&#44; consistent with data published so far on clinical manifestations of COVID-19&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">9&#8211;11</span></a> Most of them had traveled and&#47;or had contact with a suspected case&#59; this was expected&#44; as our study sample reflects some of the first cases of COVID-19 in our region and most of them were infected before community transmission was declared&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">In our sample&#44; patients without COVID-19 were more likely to present with a higher PSI&#47;PORT at admission&#46; We believe these higher scores reflect a higher number of comorbidities and increased severity in the differential diagnosis group&#44; which could explain their increased serum lactate and bilirubin levels at admission&#46; In addition&#44; patients who were returning travelers&#44; and those who had a positive contact history for SARS-CoV-2 seemed to be more prone to have an early hospital presentation&#46; We have excluded patients who were discharged within 24<span class="elsevierStyleHsp" style=""></span>h to diminish this bias&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Our analysis did not have enough power to demonstrate a significant association for each of the included comorbidities&#59; however&#44; there was an inverse association between number of comorbidities and COVID-19 diagnosis&#46; This can be explained by a number reasons&#58; patients with other comorbidities are more likely to present with severe bacterial pneumonia and sepsis&#44; for example&#59; also&#44; almost a third of COVID-19 cases had traveled in the previous three weeks&#44; compared to none in the other group&#46; Patients with more comorbidities might be less able to travel &#8211; which might have lessened the probability of being infected in the first days of transmission in Brazilian territory&#46; As community transmission increases in our region&#44; we believe the contrast in number of comorbidities between COVID-19 and other respiratory conditions may decrease&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Laboratorial findings</span><p id="par0115" class="elsevierStylePara elsevierViewall">Many studies have found that COVID-19 correlates with lower leukocyte count&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">12&#8211;14&#44;16</span></a> Relationship between this finding and severity of COVID-19 cases is unknown&#59; some studies have reported that more severe cases had lower leukocyte count<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">12</span></a> while some have reported the inverse&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">9</span></a> In our cohort&#44; a lower leukocyte count &#40;however not sufficient to be categorized as leukopenia&#41; was a predictor for COVID-19 diagnosis&#46; This might be due to marked leukocytosis of some differentials&#44; for instance bacterial infections&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">In our sample LDH was a strong predictor for COVID-19 diagnosis&#46; LDH is a predictor of inflammation in several lung diseases&#46; Consistently with data from previous studies&#44;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">10</span></a> higher LDH levels were associated with COVID-19 diagnosis&#46; Most studies revealed that it is a good predictor of severity and ICU admission&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">10&#44;12&#44;15</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">Elevation of ALT and AST have already been described as severity markers&#59; in our study higher levels of ALT were associated with COVID-19 diagnosis&#46; In a systematic review of COVID-19 presentation&#44; 17&#46;2 to 28&#46;3&#37; had elevated ALT&#44; and 29&#46;4 to 75&#46;8&#37; had elevated LDH&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">17</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">In our sample&#44; CRP and D-dimer levels were markers of disease severity and associated with ICU admission and higher CURB-65 at admission&#44; irrespective of COVID-19 diagnosis&#46; In a study by Guan et al&#46;&#44; CRP was elevated in 60&#37; of COVID-19 patients upon arrival&#44; also associated with ICU admission<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">12</span></a>&#59; some articles reported an association between CRP levels and extension of pulmonary involvement&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">15</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">The lack of a significant association between COVID-19 diagnosis and CRP levels in this study may be due to a small sample size and also increased severity of presentation for non-COVID patients&#46; Also&#44; we have only used CRP levels upon admission&#59; perhaps CRP increase would occur later on in COVID-19 presentation&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Image findings</span><p id="par0140" class="elsevierStylePara elsevierViewall">In our patients submitted to chest CT&#44; the most relevant image findings were ground-glass opacities&#46; In addition&#44; positive cases usually presented with lower lobe predominance&#59; this is consistent with some of the data published so far on radiological patterns of COVID-19&#44;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">17</span></a> although some studies have not found a lobe predominance&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">18</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">It is worth to highlight that in our sample&#44; only one COVID-19 patient had normal chest image&#46; Radiographic patterns associated with COVID-19 are unspecific&#44; indicating the need to correlate imaging with clinical data&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Contact history</span><p id="par0150" class="elsevierStylePara elsevierViewall">Even though report of contact with patients who were positive for SARS-CoV-2 increased accuracy of our score&#44; it was not included as a variable&#46; Once local transmission is established within a region&#44; tracking an epidemiological history becomes impractical&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Differential diagnoses</span><p id="par0155" class="elsevierStylePara elsevierViewall">Although <span class="elsevierStyleItalic">Influenza</span> is reported as one of the most important differential diagnoses of COVID- 19&#44; we had no cases reported&#44; probably due to seasonality&#59; in our region&#44; Influenza cases peak by June&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">19</span></a> In winter months&#44; we also expect higher rates of COPD exacerbation&#59; differentiating between these conditions will be challenging&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Excluding COVID-19 is burdensome in a number of ways&#44; but especially in the emergency department&#44; considering COVID-19 can be asymptomatic&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">20</span></a> One of our patients sought medical assistance for acute onset of hemiparesis and tested positive for SARS-CoV-2 after a head and neck computed tomography angiography with an incidental finding of ground glass opacities in both superior lung lobes&#46; Among a group of pregnant women admitted for delivery in a New York City hospital&#44; Sutton et al&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">21</span></a> found 13&#37; of asymptomatic patients tested positive&#46; Due to lack of resources&#44; universal testing is not a plausible option&#44; therefore high clinical suspicion&#44; along with low threshold for chest imaging&#44; is advisable&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Limitations</span><p id="par0165" class="elsevierStylePara elsevierViewall">Our study has some limitations&#44; aside from intrinsic limitations of an observational study&#59; most of them are associated with data collected from medical records&#46; Visiting and interviewing patients was not possible at all times&#59; collecting data from patients in mechanical ventilation was challenging and likely to be compromised since it was not always possible to reach for family members&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Our control population has a high number of comorbidities and may not represent the general public&#59; in addition&#44; optimal cut-points for this study may not be the same in other samples&#46; Our study has a small sample size and may not have enough power to evaluate other variables that might be associated with COVID-19 diagnosis&#46; It is important to note that this score has not yet been validated&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Another limitation of our study was the unavailability of a second negative PCR testing for the ruled-out group&#46; Of 23 patients who were re-tested&#44; four turned out positive at re-testing&#59; it is possible that some patients classified as negative would result positive in further testing&#44; particularly those with inconclusive diagnosis&#46; This can also underestimate relationships between COVID- 19 diagnosis and some of the variables analyzed&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Nevertheless&#44; considering the need to segregate in a special ward a patient with a low pre- test probability of COVID19&#44; we find our score useful&#44; especially on the fact that LDH&#44; blood counts and X ray are easily available&#44; even in low income emergency rooms&#44; and poses a low risk to healthcare infection spread&#46; We acknowledge that future evaluation of our proposed scores are needed&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conclusion</span><p id="par0185" class="elsevierStylePara elsevierViewall">We propose that clinicians use diagnostic tools to anticipate RT-PCR testing&#46; This instrument encompassing WBC count&#44; LDH&#44; and image findings offers adequate sensitivity and specificity for this task&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Contributors</span><p id="par0190" class="elsevierStylePara elsevierViewall">Study design was idealized by TV&#44; CF&#44; BS and RS&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">Data were collected by M Berger&#44; CF&#44; TV and PS and were reviewed by LA&#44; PC&#44; M Butzke and RZ&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">Statistical analyses and predictive models were performed by TV&#46; All investigators contributed equally in writing&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">We would like to thank Jeffrey Hau for providing key insights on statistical analysis&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflicts of interest</span><p id="par0210" class="elsevierStylePara elsevierViewall">The authors declare no conflicts of interest&#46;</p></span></span>"
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    "fechaRecibido" => "2020-04-19"
    "fechaAceptado" => "2020-06-22"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Differential diagnosis of COVID-19 includes a broad range of conditions&#46; Prioritizing containment efforts&#44; protective personal equipment and testing can be challenging&#46; Our aim was to develop a tool to identify patients with higher probability of COVID-19 diagnosis at admission&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">This cross-sectional study analyzed data from 100 patients admitted with suspected COVID-19&#46; Predictive models of COVID-19 diagnosis were performed based on radiology&#44; clinical and laboratory findings&#59; bootstrapping was performed in order to account for overfitting&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A total of 29&#37; of patients tested positive for SARS-CoV-2&#46; Variables associated with COVID-19 diagnosis in multivariate analysis were leukocyte count &#8804;7&#46;7<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">3</span><span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleSup">&#8211;3</span>&#44; LDH &#62;273<span class="elsevierStyleHsp" style=""></span>U&#47;L&#44; and chest radiographic abnormality&#46; A predictive score was built for COVID-19 diagnosis&#44; with an area under ROC curve of 0&#46;847 &#40;95&#37; CI 0&#46;77&#8211;0&#46;92&#41;&#44; 96&#37; sensitivity and 73&#46;5&#37; specificity&#46; After bootstrapping&#44; the corrected AUC for this model was 0&#46;827 &#40;95&#37; CI 0&#46;75&#8211;0&#46;90&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Considering unavailability of RT-PCR at some centers&#44; as well as its questionable early sensitivity&#44; other tools might be used in order to identify patients who should be prioritized for testing&#44; re-testing and admission to isolated wards&#46; We propose a predictive score that can be easily applied in clinical practice&#46; This score is yet to be validated in larger populations&#46;</p></span>"
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                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Dyspnea&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cough&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Expectoration&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Chest pain&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Asthenia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>URT Symptoms&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>GI Symptoms&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">38 &#40;38&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">13 &#40;44&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">25 &#40;35&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;72&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Respiratory distress&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2 &#40;6&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">PSI&#47;PORT score</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;007<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8804;70&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">38 &#40;45&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">16 &#40;57&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">22 &#40;40&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>71&#8211;90&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">13 &#40;15&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8 &#40;28&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5 &#40;9&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>91&#8211;30&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Comorbidities</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hypertension&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ever smoker&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Lung disease&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Heart disease&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Diabetes&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 &#40;10&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Obesity&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4 &#40;14&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Malignancy&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;3&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Number of comorbidities</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;005<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No comorbidities&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">32 &#40;33&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">14 &#40;51&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>1&#8211;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">48 &#40;49&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">13 &#40;48&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">35 &#40;50&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8805;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">17 &#40;17&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Laboratory findings</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hemoglobin&#44; g&#47;dL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#46;7 &#40;11&#46;1&#8211;13&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#46;2 &#40;12&#46;6&#8211;14&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#46;2 &#40;10&#46;5&#8211;13&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>RDW &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#46;2 &#40;12&#46;4&#8211;14&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#46;8 &#40;12&#46;1&#8211;13&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#46;5 &#40;12&#46;6&#8211;14&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;006&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Platelet count&#44; &#215;103 per mm3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">207 &#40;170&#8211;275&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">194 &#40;175&#8211;248&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">212 &#40;170&#8211;278&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Leukocyte count&#44; &#215;103 per mm3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;9 &#40;6&#46;3&#8211;13&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;4 &#40;5&#46;3&#8211;9&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;7 &#40;8&#46;1&#8211;15&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#60;7&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32 &#40;32&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19 &#40;65&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;18&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Lymphocyte count&#44; &#215;103 per mm3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;2 &#40;6&#46;5&#8211;1&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;9 &#40;0&#46;6&#8211;1&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;3 &#40;6&#46;5&#8211;2&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#60;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42 &#40;42&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;51&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27 &#40;38&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Neutrophil&#47;lymphocyte ratio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;25 &#40;3&#46;1&#8211;12&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;14 &#40;3&#46;1&#8211;7&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;9 &#40;3&#46;5&#8211;13&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#60;3&#46;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23 &#40;23&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;24&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;22&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Creatinine&#44; mg&#47;dL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;97 &#40;0&#46;76&#8211;1&#46;28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;99 &#40;0&#46;77&#8211;1&#46;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;96 &#40;0&#46;76&#8211;1&#46;34&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8805;1&#46;33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24 &#40;24&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;13&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20 &#40;28&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Urea&#44; mg&#47;dL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32 &#40;23&#8211;51&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29 &#40;23&#8211;42&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36 &#40;23&#8211;58&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Lactate dehydrogenase&#44; U&#47;L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">256 &#40;186&#8211;379&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">344 &#40;258&#8211;421&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">213 &#40;182&#8211;297&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>C-Reactive Protein&#44; mg&#47;dL&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Serum lactate levels&#44; mmol&#47;L&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t">25 &#40;86&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">47 &#40;67&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">22 &#40;75&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">25 &#40;60&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;3&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">LDH &#62;273<span class="elsevierStyleHsp" style=""></span>U&#47;L&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5&#46;42 &#40;1&#46;18&#8211;24&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Any chest radiographic abnormality&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">27&#46;8 &#40;2&#46;5&#8211;309&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;007&nbsp;\t\t\t\t\t\t\n
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                      "titulo" => "Clinical management of severe acute respiratory infection &#40;SARI&#41; when COVID-19 disease is suspected"
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                      "titulo" => "Differential diagnosis of illness in patients under investigation for the novel coronavirus &#40;SARS-CoV-2&#41;&#44; Italy"
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                            0 => "H&#46; Nickel Christian"
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                      "doi" => "10.4414/smw.2020.20231"
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Original article
A predictive score for COVID-19 diagnosis using clinical, laboratory and chest image data
Tarsila Vieceli
Corresponding author
tarsilavieceli@gmail.com

Corresponding author.
, Cilomar Martins de Oliveira Filho, Mariana Berger, Marina Petersen Saadi, Pedro Antonio Salvador, Leonardo Bressan Anizelli, Pedro Castilhos de Freitas Crivelaro, Mauricio Butzke, Roberta de Souza Zappelini, Beatriz Graeff dos Santos Seligman, Renato Seligman
Hospital de Clínicas de Porto Alegre, Departamento de Medicina Interna, Porto Alegre, RS, Brazil
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    "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
    "titulo" => "A predictive score for COVID-19 diagnosis using clinical&#44; laboratory and chest image data"
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        "autoresLista" => "Tarsila Vieceli, Cilomar Martins de Oliveira Filho, Mariana Berger, Marina Petersen Saadi, Pedro Antonio Salvador, Leonardo Bressan Anizelli, Pedro Castilhos de Freitas Crivelaro, Mauricio Butzke, Roberta de Souza Zappelini, Beatriz Graeff dos Santos Seligman, Renato Seligman"
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            "nombre" => "Cilomar Martins de"
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            "nombre" => "Mariana"
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            "nombre" => "Leonardo Bressan"
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            "nombre" => "Pedro Castilhos de Freitas"
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            "entidad" => "Hospital de Cl&#237;nicas de Porto Alegre&#44; Departamento de Medicina Interna&#44; Porto Alegre&#44; RS&#44; Brazil"
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          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">ROC Curve for model including leukocyte count&#44; LDH and chest radiography abnormality&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">As a result of its broad clinical presentation &#8211; from asymptomatic infection to severe acute respiratory syndrome &#40;SARS&#41; &#8211; as well as non-specific laboratory and radiological features&#44; differential diagnosis of COVID-19&#44; particularly at admission&#44; is challenging&#46; Influenza&#44; pneumonia&#44; tuberculosis&#44; arbovirus infections&#44; and even non-infectious illnesses have been reported as conditions that can mimic COVID-19&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">1&#8211;3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Identification of patients at high-risk for COVID-19 before confirmatory testing is key to prioritize containment efforts&#44; RT-PCR tests&#44; and personal protective equipment &#40;PPE&#41;&#44; especially in hospital settings&#46; Considering that RT-PCR sensitivity is variable &#8211; in some reports&#44; it is as low as 71&#37;&#44;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">4</span></a> patients at high-risk for COVID-19 with a negative RT-PCR result should be re-tested before being transferred to a non-COVID ward&#46; However&#44; there is little knowledge on how to identify patients who have a higher pre-test probability for COVID-19&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">In this study we analyzed significant variables associated with initial COVID-19 diagnosis&#46; Our objective was to develop a useful predictive tool for COVID-19 diagnosis based on clinical&#44; laboratory and image data prior to RT-PCR test confirmation&#46; ROC Curve models and a clinical score are provided aiming to predict early SARS-CoV-2 infection diagnosis&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">The first 118 consecutive patients aged 18 or older admitted to Hospital de Cl&#237;nicas de Porto Alegre&#44; an 831 bed tertiary referral hospital located in Southern Brazil&#44; due to suspected COVID-19 were assessed&#46; Clinical&#44; laboratory and radiological findings at presentation were analyzed&#46; Patients discharged within 24<span class="elsevierStyleHsp" style=""></span>h of admission were excluded&#46; This study protocol was approved by the institutional review board&#44; and informed consent was obtained from each patient or closest family member&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Upon admission&#44; samples of nasal and throat swabs were collected by trained healthcare professionals according to the American Centers for Disease Control and Prevention &#40;CDC&#41; guidelines&#46; The sample was used for real-time polymerase chain reaction &#40;RT- PCR&#41;&#44; designed to detect three regions of the virus nucleocapsid &#40;N1&#44; N2&#44; N3&#41;&#44; according to the CDC diagnostic panel&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">5</span></a> Patients undertook chest image exams before RT-PCR results&#59; therefore&#44; radiologists were unaware of the patient diagnosis&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Patients were divided into those who had positive RT-PCR for SARS-CoV-2 and those with negative results&#46; Kruskal&#8211;Wallis test&#44; <span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup">2</span> test and Fisher&#39;s exact test were used to compare differences between groups&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">For our predictive score&#44; variables associated with outcome &#40;defined as <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41; in univariate analysis were tested in a logistic regression model&#46; Each significant variable received points based on multivariate model odds ratio &#40;OR&#41;&#46; Variables that showed no significant association with COVID-19 diagnosis in univariate analysis were not included&#46; The final model included abnormality on chest radiography&#44; LDH levels&#44; and leukocyte count&#46; Bootstrapping was performed to assess overfitting of the models&#46; Development of this score was performed according to TRIPOD guidelines&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">6</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Results</span><p id="par0040" class="elsevierStylePara elsevierViewall">Patients were admitted from March 17 to April 10&#44; 2020&#59; 18 were excluded because they had been discharged within 24<span class="elsevierStyleHsp" style=""></span>h of admission&#46; Out of 100 patients&#44; 29 were SARS-CoV-2 positive&#46; Main characteristics are listed in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">Four patients &#40;13&#46;7&#37;&#41; of the confirmed group were hospital healthcare staff&#46; In the negative RT-PCR group&#44; six &#40;21&#46;4&#37;&#41; patients had no contact with confirmed or suspected cases&#44; compared to 58 &#40;82&#46;8&#37;&#41; in the confirmed group &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; No patients in the negative group had traveled in the previous three weeks&#44; compared to eight &#40;28&#46;6&#37;&#41; patients in the confirmed group &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Patients in the negative group were more likely to have a higher number of comorbidities and to present with a higher PSI&#47;PORT index&#46; There was no difference in CURB-65 score among groups &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;10&#41;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The optimal cut-off value was 273<span class="elsevierStyleHsp" style=""></span>U&#47;L for LDH and 7&#46;7<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">3</span> per mm<span class="elsevierStyleSup">3</span> for leukocyte count&#46; Results from the multivariable analyses are presented in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">Of the 29 patients who tested positive for SARS-CoV-2&#44; four had a previous negative result&#46; For the remaining 71 who were considered negative&#44; 19 &#40;26&#37;&#41; were re-tested &#8211; 15 of them because the first test was inconclusive&#44; and four patients because of clinical suspicion&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Predictive score</span><p id="par0065" class="elsevierStylePara elsevierViewall">A predictive score for COVID-19 was built including variables that had shown an association with outcome in multivariate analysis&#59; it yielded two points for LDH &#62;273<span class="elsevierStyleHsp" style=""></span>U&#47;L&#44; three for leukocyte count &#8804;7&#46;7<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">3</span> per mm<span class="elsevierStyleSup">3</span> and four for any chest radiography abnormality&#46; A result &#8805;5 points was considered positive&#46; This score had 96&#37; sensitivity and 73&#46;5&#37; specificity in our sample&#44; with an area under ROC curve &#40;AUC&#41; of 0&#46;847 &#40;95&#37; CI 0&#46;77&#8211;0&#46;92&#41;&#44; as seen in <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">After bootstrapping&#44; this model had an AUC of 0&#46;827 &#40;95&#37; CI 0&#46;75&#8211;0&#46;90&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Discussion</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect2055">RT-PCR TESTING</span><p id="par0075" class="elsevierStylePara elsevierViewall">Two patients in the COVID-19 group had tested negative at admission&#59; after negative results&#44; they were transferred to non-COVID wards&#46; Because of clinical suspicion&#44; these patients were re-tested&#44; yielding positive results&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Admitting a COVID-19 patient into a regular ward can be catastrophic&#46; We advocate that patients who are to be moved to regular wards be re-tested before they are transferred&#59; if testing all of them was not possible&#44; patients with higher probability for COVID-19 &#8211; using a combination of clinical&#44; laboratory and radiological data &#8211; should be prioritized for testing&#46; Those who are discharged with one negative RT-PCR result should be advised to remain isolated at home for two weeks&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">In addition&#44; two other cases in the positive group were health workers who had tested negative two days before retesting&#46; Infected health care workers are likely to transmit SARS-CoV-2 to patients with comorbidities &#8211; which are at higher risk for severe infection&#46; Hence&#44; we highlight the need for more than one negative result in order to allow health care workers to return to work&#46; Although the CDC advocates the need for at least two negative nasopharyngeal swab specimens&#44;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">7</span></a> some local guidelines around the world require only one negative test&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">8</span></a></p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Predictive score</span><p id="par0090" class="elsevierStylePara elsevierViewall">There is increasing need for a validated clinical score estimating COVID-19 probability&#46; Considering shortage of PPE&#44; PCR testing and isolation units in many countries around the world&#44; as well as non-ideal sensitivity of nasopharyngeal swabs&#44; doctors at Emergency and Intensive Care Units should be provided with clinical tools&#44; other than contact history&#44; in order to prioritize isolation and testing&#46; A combination of clinical findings&#44; laboratory data and radiological patterns &#40;when available&#41; can be useful in this context&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Our predictive score yielded good sensitivity and specificity after adjusting for overfitting&#46; Fever was not included in the model because patients without fever are rarely admitted for suspected COVID-19&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Clinical presentation</span><p id="par0100" class="elsevierStylePara elsevierViewall">Most patients with confirmed COVID-19 diagnosis had fever&#44; consistent with data published so far on clinical manifestations of COVID-19&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">9&#8211;11</span></a> Most of them had traveled and&#47;or had contact with a suspected case&#59; this was expected&#44; as our study sample reflects some of the first cases of COVID-19 in our region and most of them were infected before community transmission was declared&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">In our sample&#44; patients without COVID-19 were more likely to present with a higher PSI&#47;PORT at admission&#46; We believe these higher scores reflect a higher number of comorbidities and increased severity in the differential diagnosis group&#44; which could explain their increased serum lactate and bilirubin levels at admission&#46; In addition&#44; patients who were returning travelers&#44; and those who had a positive contact history for SARS-CoV-2 seemed to be more prone to have an early hospital presentation&#46; We have excluded patients who were discharged within 24<span class="elsevierStyleHsp" style=""></span>h to diminish this bias&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Our analysis did not have enough power to demonstrate a significant association for each of the included comorbidities&#59; however&#44; there was an inverse association between number of comorbidities and COVID-19 diagnosis&#46; This can be explained by a number reasons&#58; patients with other comorbidities are more likely to present with severe bacterial pneumonia and sepsis&#44; for example&#59; also&#44; almost a third of COVID-19 cases had traveled in the previous three weeks&#44; compared to none in the other group&#46; Patients with more comorbidities might be less able to travel &#8211; which might have lessened the probability of being infected in the first days of transmission in Brazilian territory&#46; As community transmission increases in our region&#44; we believe the contrast in number of comorbidities between COVID-19 and other respiratory conditions may decrease&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Laboratorial findings</span><p id="par0115" class="elsevierStylePara elsevierViewall">Many studies have found that COVID-19 correlates with lower leukocyte count&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">12&#8211;14&#44;16</span></a> Relationship between this finding and severity of COVID-19 cases is unknown&#59; some studies have reported that more severe cases had lower leukocyte count<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">12</span></a> while some have reported the inverse&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">9</span></a> In our cohort&#44; a lower leukocyte count &#40;however not sufficient to be categorized as leukopenia&#41; was a predictor for COVID-19 diagnosis&#46; This might be due to marked leukocytosis of some differentials&#44; for instance bacterial infections&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">In our sample LDH was a strong predictor for COVID-19 diagnosis&#46; LDH is a predictor of inflammation in several lung diseases&#46; Consistently with data from previous studies&#44;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">10</span></a> higher LDH levels were associated with COVID-19 diagnosis&#46; Most studies revealed that it is a good predictor of severity and ICU admission&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">10&#44;12&#44;15</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">Elevation of ALT and AST have already been described as severity markers&#59; in our study higher levels of ALT were associated with COVID-19 diagnosis&#46; In a systematic review of COVID-19 presentation&#44; 17&#46;2 to 28&#46;3&#37; had elevated ALT&#44; and 29&#46;4 to 75&#46;8&#37; had elevated LDH&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">17</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">In our sample&#44; CRP and D-dimer levels were markers of disease severity and associated with ICU admission and higher CURB-65 at admission&#44; irrespective of COVID-19 diagnosis&#46; In a study by Guan et al&#46;&#44; CRP was elevated in 60&#37; of COVID-19 patients upon arrival&#44; also associated with ICU admission<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">12</span></a>&#59; some articles reported an association between CRP levels and extension of pulmonary involvement&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">15</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">The lack of a significant association between COVID-19 diagnosis and CRP levels in this study may be due to a small sample size and also increased severity of presentation for non-COVID patients&#46; Also&#44; we have only used CRP levels upon admission&#59; perhaps CRP increase would occur later on in COVID-19 presentation&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Image findings</span><p id="par0140" class="elsevierStylePara elsevierViewall">In our patients submitted to chest CT&#44; the most relevant image findings were ground-glass opacities&#46; In addition&#44; positive cases usually presented with lower lobe predominance&#59; this is consistent with some of the data published so far on radiological patterns of COVID-19&#44;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">17</span></a> although some studies have not found a lobe predominance&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">18</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">It is worth to highlight that in our sample&#44; only one COVID-19 patient had normal chest image&#46; Radiographic patterns associated with COVID-19 are unspecific&#44; indicating the need to correlate imaging with clinical data&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Contact history</span><p id="par0150" class="elsevierStylePara elsevierViewall">Even though report of contact with patients who were positive for SARS-CoV-2 increased accuracy of our score&#44; it was not included as a variable&#46; Once local transmission is established within a region&#44; tracking an epidemiological history becomes impractical&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Differential diagnoses</span><p id="par0155" class="elsevierStylePara elsevierViewall">Although <span class="elsevierStyleItalic">Influenza</span> is reported as one of the most important differential diagnoses of COVID- 19&#44; we had no cases reported&#44; probably due to seasonality&#59; in our region&#44; Influenza cases peak by June&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">19</span></a> In winter months&#44; we also expect higher rates of COPD exacerbation&#59; differentiating between these conditions will be challenging&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Excluding COVID-19 is burdensome in a number of ways&#44; but especially in the emergency department&#44; considering COVID-19 can be asymptomatic&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">20</span></a> One of our patients sought medical assistance for acute onset of hemiparesis and tested positive for SARS-CoV-2 after a head and neck computed tomography angiography with an incidental finding of ground glass opacities in both superior lung lobes&#46; Among a group of pregnant women admitted for delivery in a New York City hospital&#44; Sutton et al&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">21</span></a> found 13&#37; of asymptomatic patients tested positive&#46; Due to lack of resources&#44; universal testing is not a plausible option&#44; therefore high clinical suspicion&#44; along with low threshold for chest imaging&#44; is advisable&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Limitations</span><p id="par0165" class="elsevierStylePara elsevierViewall">Our study has some limitations&#44; aside from intrinsic limitations of an observational study&#59; most of them are associated with data collected from medical records&#46; Visiting and interviewing patients was not possible at all times&#59; collecting data from patients in mechanical ventilation was challenging and likely to be compromised since it was not always possible to reach for family members&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Our control population has a high number of comorbidities and may not represent the general public&#59; in addition&#44; optimal cut-points for this study may not be the same in other samples&#46; Our study has a small sample size and may not have enough power to evaluate other variables that might be associated with COVID-19 diagnosis&#46; It is important to note that this score has not yet been validated&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Another limitation of our study was the unavailability of a second negative PCR testing for the ruled-out group&#46; Of 23 patients who were re-tested&#44; four turned out positive at re-testing&#59; it is possible that some patients classified as negative would result positive in further testing&#44; particularly those with inconclusive diagnosis&#46; This can also underestimate relationships between COVID- 19 diagnosis and some of the variables analyzed&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Nevertheless&#44; considering the need to segregate in a special ward a patient with a low pre- test probability of COVID19&#44; we find our score useful&#44; especially on the fact that LDH&#44; blood counts and X ray are easily available&#44; even in low income emergency rooms&#44; and poses a low risk to healthcare infection spread&#46; We acknowledge that future evaluation of our proposed scores are needed&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conclusion</span><p id="par0185" class="elsevierStylePara elsevierViewall">We propose that clinicians use diagnostic tools to anticipate RT-PCR testing&#46; This instrument encompassing WBC count&#44; LDH&#44; and image findings offers adequate sensitivity and specificity for this task&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Contributors</span><p id="par0190" class="elsevierStylePara elsevierViewall">Study design was idealized by TV&#44; CF&#44; BS and RS&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">Data were collected by M Berger&#44; CF&#44; TV and PS and were reviewed by LA&#44; PC&#44; M Butzke and RZ&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">Statistical analyses and predictive models were performed by TV&#46; All investigators contributed equally in writing&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">We would like to thank Jeffrey Hau for providing key insights on statistical analysis&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflicts of interest</span><p id="par0210" class="elsevierStylePara elsevierViewall">The authors declare no conflicts of interest&#46;</p></span></span>"
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            0 => array:2 [
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              "titulo" => "RT-PCR TESTING"
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          "titulo" => "Laboratorial findings"
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          "identificador" => "sec0050"
          "titulo" => "Image findings"
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        11 => array:2 [
          "identificador" => "sec0055"
          "titulo" => "Contact history"
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        12 => array:2 [
          "identificador" => "sec0060"
          "titulo" => "Differential diagnoses"
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        13 => array:2 [
          "identificador" => "sec0065"
          "titulo" => "Limitations"
        ]
        14 => array:2 [
          "identificador" => "sec0070"
          "titulo" => "Conclusion"
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        15 => array:2 [
          "identificador" => "sec0075"
          "titulo" => "Contributors"
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        16 => array:2 [
          "identificador" => "sec0080"
          "titulo" => "Conflicts of interest"
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        17 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2020-04-19"
    "fechaAceptado" => "2020-06-22"
    "PalabrasClave" => array:1 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1269116"
          "palabras" => array:4 [
            0 => "Diagnosis"
            1 => "COVID-19"
            2 => "SARS-CoV-2"
            3 => "Predictive score"
          ]
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      ]
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    "tieneResumen" => true
    "resumen" => array:1 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Differential diagnosis of COVID-19 includes a broad range of conditions&#46; Prioritizing containment efforts&#44; protective personal equipment and testing can be challenging&#46; Our aim was to develop a tool to identify patients with higher probability of COVID-19 diagnosis at admission&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">This cross-sectional study analyzed data from 100 patients admitted with suspected COVID-19&#46; Predictive models of COVID-19 diagnosis were performed based on radiology&#44; clinical and laboratory findings&#59; bootstrapping was performed in order to account for overfitting&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A total of 29&#37; of patients tested positive for SARS-CoV-2&#46; Variables associated with COVID-19 diagnosis in multivariate analysis were leukocyte count &#8804;7&#46;7<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">3</span><span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleSup">&#8211;3</span>&#44; LDH &#62;273<span class="elsevierStyleHsp" style=""></span>U&#47;L&#44; and chest radiographic abnormality&#46; A predictive score was built for COVID-19 diagnosis&#44; with an area under ROC curve of 0&#46;847 &#40;95&#37; CI 0&#46;77&#8211;0&#46;92&#41;&#44; 96&#37; sensitivity and 73&#46;5&#37; specificity&#46; After bootstrapping&#44; the corrected AUC for this model was 0&#46;827 &#40;95&#37; CI 0&#46;75&#8211;0&#46;90&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Considering unavailability of RT-PCR at some centers&#44; as well as its questionable early sensitivity&#44; other tools might be used in order to identify patients who should be prioritized for testing&#44; re-testing and admission to isolated wards&#46; We propose a predictive score that can be easily applied in clinical practice&#46; This score is yet to be validated in larger populations&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objectives"
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            "titulo" => "Methods"
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          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
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          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusions"
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        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
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          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">ROC Curve for model including leukocyte count&#44; LDH and chest radiography abnormality&#46;</p>"
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Male&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Fever&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Dyspnea&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">20 &#40;68&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">45 &#40;64&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cough&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">21 &#40;72&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">48 &#40;68&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#46;70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Expectoration&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">20 &#40;20&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">3 &#40;10&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">17 &#40;24&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Chest pain&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">23 &#40;23&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">3 &#40;10&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20 &#40;28&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Headache&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">34 &#40;34&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">13 &#40;44&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">21 &#40;30&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Myalgias&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>URT Symptoms&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>GI Symptoms&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Respiratory distress&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8804;70&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>71&#8211;90&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>91&#8211;30&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#62;130&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">14 &#40;16&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2 &#40;7&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">12 &#40;21&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " colspan="5" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Comorbidities</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hypertension&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">10 &#40;34&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">30 &#40;42&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ever smoker&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">36 &#40;36&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8 &#40;27&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">28 &#40;40&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Lung disease&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">30 &#40;30&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5 &#40;17&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Heart disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 &#40;18&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;6&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;22&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Diabetes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 &#40;18&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;10&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;21&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Obesity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;12&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;11&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;14&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Malignancy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;11&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;3&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;14&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Number of comorbidities</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;005<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No comorbidities&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32 &#40;33&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;51&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 &#40;25&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>1&#8211;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48 &#40;49&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;48&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35 &#40;50&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8805;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17 &#40;17&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17 &#40;24&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Laboratory findings</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hemoglobin&#44; g&#47;dL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#46;7 &#40;11&#46;1&#8211;13&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#46;2 &#40;12&#46;6&#8211;14&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#46;2 &#40;10&#46;5&#8211;13&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>RDW &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#46;2 &#40;12&#46;4&#8211;14&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#46;8 &#40;12&#46;1&#8211;13&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#46;5 &#40;12&#46;6&#8211;14&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;006&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Platelet count&#44; &#215;103 per mm3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">207 &#40;170&#8211;275&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">194 &#40;175&#8211;248&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">212 &#40;170&#8211;278&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Leukocyte count&#44; &#215;103 per mm3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;9 &#40;6&#46;3&#8211;13&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;4 &#40;5&#46;3&#8211;9&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;7 &#40;8&#46;1&#8211;15&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#60;7&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32 &#40;32&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19 &#40;65&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;18&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Lymphocyte count&#44; &#215;103 per mm3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#46;3 &#40;6&#46;5&#8211;2&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;04&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#60;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">42 &#40;42&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">15 &#40;51&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">27 &#40;38&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Neutrophil&#47;lymphocyte ratio&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6&#46;25 &#40;3&#46;1&#8211;12&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5&#46;14 &#40;3&#46;1&#8211;7&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6&#46;9 &#40;3&#46;5&#8211;13&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#60;3&#46;13&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">23 &#40;23&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7 &#40;24&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">16 &#40;22&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Creatinine&#44; mg&#47;dL&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;97 &#40;0&#46;76&#8211;1&#46;28&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;99 &#40;0&#46;77&#8211;1&#46;14&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;96 &#40;0&#46;76&#8211;1&#46;34&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8805;1&#46;33&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">24 &#40;24&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4 &#40;13&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">20 &#40;28&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Urea&#44; mg&#47;dL&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">32 &#40;23&#8211;51&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">29 &#40;23&#8211;42&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">36 &#40;23&#8211;58&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Lactate dehydrogenase&#44; U&#47;L&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">256 &#40;186&#8211;379&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">344 &#40;258&#8211;421&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">213 &#40;182&#8211;297&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;004&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8805;273&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">34 &#40;45&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">18 &#40;72&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">16 &#40;32&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Creatine kinase&#44; U&#47;L&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">77&#46;5 &#40;50&#8211;129&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">93&#46;5 &#40;49&#8211;139&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">74 &#40;50&#8211;119&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#62;185&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">8 &#40;11&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4 &#40;18&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4 &#40;8&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>D-dimer&#44; &#956;g&#47;L&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">1&#46;17 &#40;0&#46;46&#8211;2&#46;17&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#46;29 &#40;0&#46;58&#8211;1&#46;73&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#46;14 &#40;0&#46;37&#8211;2&#46;25&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8804;0&#46;5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">24 &#40;30&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4 &#40;16&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">20 &#40;35&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;08<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>C-Reactive Protein&#44; mg&#47;dL&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Serum lactate levels&#44; mmol&#47;L&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Radiographic findings</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pleural effusion&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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Article information
ISSN: 14138670
Original language: English
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The Brazilian Journal of Infectious Diseases