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Article: Clinical Predictors for Abnormal ALT in Patients Infected with COVID-19-A Retrospective Single Centre Study.

Chew, Wei Da / Kuang, Jonathan / Lin, Huiyu / Ang, Li Wei / Yang, Wei Lyn / Lye, David C / Young, Barnaby E

2023 Volume 12, Issue 3

Abstract: Objective: Abnormal liver tests have been associated with worse clinical outcomes in patients infected with COVID-19. This retrospective observational study from Singapore aims to elucidate simple clinical predictors of abnormal alanine aminotransferase ...

Abstract	Objective: Abnormal liver tests have been associated with worse clinical outcomes in patients infected with COVID-19. This retrospective observational study from Singapore aims to elucidate simple clinical predictors of abnormal alanine aminotransferase (ALT) in COVID-19 infections. Design: 717 patients hospitalised with COVID-19 at the National Centre for Infectious Diseases (NCID), Singapore, from 23 January-15 April 2020 were screened, of which 163 patients with baseline normal alanine transferase (ALT) and at least two subsequent ALTs performed were included in the final analysis. Information on baseline demographics, clinical characteristics and biochemical laboratory tests were collected. Results: 30.7% of patients developed abnormal ALT. They were more likely to be older (60 vs. 55, Conclusions: Liver injury is associated with poor clinical outcomes in patients with COVID-19. R-factor ≥1 on admission and hypoxia are independent simple clinical predictors for developing abnormal ALT in COVID-19.
Language	English
Publishing date	2023-03-16
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2695572-6
ISSN	2076-0817
ISSN	2076-0817
DOI	10.3390/pathogens12030473
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Article ; Online: An observational study of the prevalence of metabolic syndrome in treatment-experienced people living with HIV in Singapore.

Ang, Li Wei / Ng, Oon Tek / Boudville, Irving Charles / Leo, Yee Sin / Wong, Chen Seong

PloS one

2021 Volume 16, Issue 6, Page(s) e0252320

Abstract: Background: While the use of combination antiretroviral therapy (cART) has conferred significant reduction in morbidity and mortality, there are growing concerns about the metabolic complications of antiretroviral regimens in HIV-infected patients. The ... ...

Abstract	Background: While the use of combination antiretroviral therapy (cART) has conferred significant reduction in morbidity and mortality, there are growing concerns about the metabolic complications of antiretroviral regimens in HIV-infected patients. The aim of this study was to estimate the prevalence of metabolic syndrome (MetS) among people living with HIV (PLHIV) in Singapore. Methods: We conducted a retrospective study using the clinical database maintained by the Clinical HIV Programme at the National Centre for Infectious Diseases, Singapore. Treatment-experienced PLHIV on follow-up during 2015-2017 were included. MetS was defined as having three or more of the following five abnormalities: hypertriglyceridemia, HDL hypocholesterolemia, hypertension, obesity, and diabetes. Results: A total of 2,231 PLHIV were included in this study. 93.9% were men, and the median age at latest follow-up was 48 years. The median duration of HIV infection and duration of exposure to cART was 6.8 years and 5.7 years, respectively. All had been exposed to nucleoside reverse transcriptase inhibitors (NRTIs) as the first line of treatment, 93.9% to non-NRTIs, 28.6% to protease inhibitors (PIs) and 12.8% to integrase strand transfer inhibitors. The most common metabolic abnormality among PLHIV was HDL hypocholesterolemia (60.2%) followed by hypertriglyceridemia (45.5%). Of all the 2,231 individuals, 68.8% had at least one component of MetS. The overall prevalence of MetS was 23.6% (95% confidence interval 21.9%-25.4%). Of the 526 with MetS, the most common combination was HDL hypocholesterolemia, hypertriglyceridemia and hypertension (51.0%), followed by HDL hypocholesterolemia, hypertriglyceridemia, hypertension and diabetes (25.1%). Compared with PLHIV without MetS, a significantly higher proportion of those with MetS were ever on protease inhibitors (33.5% vs. 27.1%). Conclusion: MetS is common in PLHIV. In view of the progressive aging of HIV-infected population and long-term use of cART, regular monitoring for metabolic abnormalities, surveillance of drug effects and behavioural interventions are needed to optimize management and prevention of metabolic disorders in PLHIV.
MeSH term(s)	Adolescent ; Adult ; Aged ; Anti-HIV Agents/adverse effects ; Female ; Follow-Up Studies ; HIV/drug effects ; HIV/isolation & purification ; HIV Infections/drug therapy ; HIV Infections/virology ; Humans ; Male ; Metabolic Syndrome/chemically induced ; Metabolic Syndrome/epidemiology ; Metabolic Syndrome/pathology ; Middle Aged ; Prevalence ; Prognosis ; Retrospective Studies ; Singapore/epidemiology ; Young Adult
Chemical Substances	Anti-HIV Agents
Language	English
Publishing date	2021-06-02
Publishing country	United States
Document type	Journal Article ; Observational Study ; Research Support, Non-U.S. Gov't
ISSN	1932-6203
ISSN (online)	1932-6203
DOI	10.1371/journal.pone.0252320
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Article ; Online: Hepatitis C virus infection in HIV-infected men in Singapore, 2006-2018: incidence and associated factors.

Ang, Li Wei / Choy, Chiaw Yee / Ng, Oon Tek / Leo, Yee Sin / Wong, Chen Seong

Sexual health

2021 Volume 18, Issue 3, Page(s) 221–231

Abstract: Background The epidemiology of hepatitis C virus (HCV) infection in people living with HIV has been evolving, with increasing evidence of permucosal (sexual) transmission identified predominantly in HIV-positive men who have sex with men (MSM). The aim ... ...

Abstract	Background The epidemiology of hepatitis C virus (HCV) infection in people living with HIV has been evolving, with increasing evidence of permucosal (sexual) transmission identified predominantly in HIV-positive men who have sex with men (MSM). The aim of this study was to estimate the incidence rate and elucidate epidemiological factors associated with HCV infection among HIV-infected men in Singapore from 2006 to 2018. Methods: A retrospective cohort study was conducted using a clinical database maintained by the Clinical HIV Program at the National Centre for Infectious Diseases, Singapore. Factors associated with incident HCV infections were identified using Cox proportional hazards regression analyses. Results: Among 1348 HIV-infected male patients who were HCV seronegative at baseline, 64 (4.7%) subsequently tested positive for HCV, giving an incidence of 0.88 per 100 person-years of follow-up (PYFU) (95% confidence interval (CI) 0.69-1.13). The incidence rate of HCV seroconversion increased from 0.33 (95% CI 0.12-0.71) per 100 PYFU in 2010-2012 to 1.93 (95% CI 1.36-2.67) in 2016-2018. Independent factors associated with incident HCV infection were younger age groups at HIV diagnosis versus ≥45 years, HIV acquisition via MSM or via both sexual contact and intravenous drug use versus heterosexual transmission, HIV diagnosis in later periods versus 2006-2009, and recent syphilis acquisition. Conclusions: An increasing trend of incident HCV infection was seen in HIV-infected men, particularly for MSM. Preventive and behavioural interventions should be targeted at HIV-infected individuals engaged in high-risk sexual behaviour.
MeSH term(s)	HIV Infections/epidemiology ; Hepacivirus ; Hepatitis C/epidemiology ; Homosexuality, Male ; Humans ; Incidence ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; Sexual and Gender Minorities ; Singapore/epidemiology
Language	English
Publishing date	2021-06-20
Publishing country	Australia
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2256731-8
ISSN	1449-8987 ; 1448-5028
ISSN (online)	1449-8987
ISSN	1448-5028
DOI	10.1071/SH20197
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Article ; Online: Health-seeking behavior of COVID-19 cases during the first eight weeks of the outbreak in Singapore: differences between local community and imported cases and having visits to single or multiple healthcare providers.

Tay, Min Zhi / Ang, Li Wei / Wei, Wycliffe Enli / Lee, Vernon J M / Leo, Yee-Sin / Toh, Matthias Paul H S

BMC public health

2022 Volume 22, Issue 1, Page(s) 239

Abstract: Background: COVID-19 is a novel pandemic affecting almost all countries leading to lockdowns worldwide. In Singapore, locally-acquired cases emerged after the first wave of imported cases, and these two groups of cases may have different health-seeking ... ...

Abstract	Background: COVID-19 is a novel pandemic affecting almost all countries leading to lockdowns worldwide. In Singapore, locally-acquired cases emerged after the first wave of imported cases, and these two groups of cases may have different health-seeking behavior affecting disease transmission. We investigated differences in health-seeking behavior between locally-acquired cases and imported cases, and within the locally-acquired cases, those who saw single versus multiple healthcare providers. Methods: We conducted a retrospective study of 258 patients who were diagnosed with COVID-19 from 23 January to 17 March 2020. Variables related to health-seeking behavior included number of visits prior to hospitalization, timing of the first visit, duration from symptom onset to admission, and places where the cases had at least one visit. Results: Locally-acquired cases had longer duration from onset of symptoms to hospital admission (median 6 days, interquartile range [IQR] 4-9) than imported cases (median 4 days, IQR 2-7) (p < 0.001). Singapore residents were more likely to have at least one visit to private clinics and/or government-subsidized public clinics than non-residents (84.0% vs. 58.7%, p < 0.001). Among locally-acquired cases, those who sought care from a single healthcare provider had fewer visits before their hospital admissions compared with those who went to multiple providers (median 2 vs. 3, p = 0.001). Conclusion: Our study indicates the need to encourage individuals to seek medical attention early on in their patient journey, particularly from the same healthcare provider. This in turn, would facilitate early detection and isolation, hence limiting local transmission and enabling better control of the COVID-19 outbreak.
MeSH term(s)	COVID-19 ; Communicable Disease Control ; Disease Outbreaks ; Health Personnel ; Humans ; Patient Acceptance of Health Care ; Retrospective Studies ; SARS-CoV-2 ; Singapore/epidemiology
Language	English
Publishing date	2022-02-05
Publishing country	England
Document type	Journal Article
ZDB-ID	2041338-5
ISSN	1471-2458 ; 1471-2458
ISSN (online)	1471-2458
ISSN	1471-2458
DOI	10.1186/s12889-022-12637-8
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Article ; Online: Incidence of syphilis among HIV-infected men in Singapore, 2006-2017: temporal trends and associated risk factors.

Ang, Li Wei / Wong, Chen Seong / Ng, Oon Tek / Leo, Yee Sin

Sexually transmitted infections

2019 Volume 96, Issue 4, Page(s) 293–299

Abstract: Objective: There have been recent reports globally on substantial increase in syphilis diagnoses particularly among high-risk men. The aim of this study was to assess temporal trends of incident syphilis and associated risk factors among HIV-infected ... ...

Abstract	Objective: There have been recent reports globally on substantial increase in syphilis diagnoses particularly among high-risk men. The aim of this study was to assess temporal trends of incident syphilis and associated risk factors among HIV-infected men in Singapore. Methods: We conducted retrospective cohort analysis using the clinical database maintained by the Clinical HIV Programme at the National Centre for Infectious Diseases, Singapore. HIV-infected men with a negative syphilis result at baseline who had undergone at least one subsequent test in 2006-2017 were included. Factors associated with incident syphilis were investigated using Cox proportional hazards regression analyses. Results: A total of 1069 HIV-infected men were tested for syphilis at least once following their negative baseline test during the 12-year period, and they contributed 4284 person-years of follow-up (PYFU). There were 266 cases of incident syphilis, giving an overall incidence of 6.21 per 100 PYFU (95% CI 5.49-7.00). The incidence of syphilis per 100 PYFU increased from 1.21 (95% CI 0.33 to 3.10) in 2010 to 26.04 (95% CI 19.97 to 33.40) in 2017. In the multivariable model, risk factors for syphilis seroconversion were: age 15-24 years at HIV diagnosis (adjusted HR (aHR) 1.64, 95% CI 1.05 to 2.56) versus ≥45 years, being Chinese (aHR 1.82, 95% CI 1.01 to 3.29) versus Indian and other minority ethnic groups, men having sex with men (MSM) (aHR 3.29, 95% CI 2.22 to 4.87) versus heterosexuals, and HIV diagnosis in later periods of 2009-2011 (aHR 1.96, 95% CI 1.41 to 2.74), 2012-2014 (aHR 3.96, 95% CI 2.68 to 5.83) and 2015-2017 (aHR 7.94, 95% CI 4.52 to 13.95) versus 2006-2008. Conclusion: The annual incidence rate of syphilis in HIV-infected men was on the rise, and it was consistently higher among MSM than in heterosexual men. The findings supported regular screening for syphilis and enhanced behavioural interventions in Singapore.
MeSH term(s)	Adolescent ; Adult ; Aged ; HIV Infections/complications ; Humans ; Incidence ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; Sexual Behavior ; Singapore/epidemiology ; Syphilis/epidemiology ; Young Adult
Language	English
Publishing date	2019-08-01
Publishing country	England
Document type	Journal Article
ZDB-ID	1420303-0
ISSN	1472-3263 ; 1368-4973
ISSN (online)	1472-3263
ISSN	1368-4973
DOI	10.1136/sextrans-2019-054163
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Article ; Online: Risk Factors for Severe Disease and Efficacy of Treatment in Patients Infected With COVID-19: A Systematic Review, Meta-Analysis, and Meta-Regression Analysis.

Zhang, John J Y / Lee, Keng Siang / Ang, Li Wei / Leo, Yee Sin / Young, Barnaby Edward

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

2020 Volume 71, Issue 16, Page(s) 2199–2206

Abstract: The coronavirus disease 2019 (COVID-19) pandemic spread globally in the beginning of 2020. At present, predictors of severe disease and the efficacy of different treatments are not well understood. We conducted a systematic review and meta-analysis of ... ...

Abstract	The coronavirus disease 2019 (COVID-19) pandemic spread globally in the beginning of 2020. At present, predictors of severe disease and the efficacy of different treatments are not well understood. We conducted a systematic review and meta-analysis of all published studies up to 15 March 2020, which reported COVID-19 clinical features and/or treatment outcomes. Forty-five studies reporting 4203 patients were included. Pooled rates of intensive care unit (ICU) admission, mortality, and acute respiratory distress syndrome (ARDS) were 10.9%, 4.3%, and 18.4%, respectively. On meta-regression, ICU admission was predicted by increased leukocyte count (P < .0001), alanine aminotransferase (P = .024), and aspartate transaminase (P = .0040); elevated lactate dehydrogenase (LDH) (P < .0001); and increased procalcitonin (P < .0001). ARDS was predicted by elevated LDH (P < .0001), while mortality was predicted by increased leukocyte count (P = .0005) and elevated LDH (P < .0001). Treatment with lopinavir-ritonavir showed no significant benefit in mortality and ARDS rates. Corticosteroids were associated with a higher rate of ARDS (P = .0003).
MeSH term(s)	Adrenal Cortex Hormones/adverse effects ; COVID-19/mortality ; COVID-19/therapy ; Clinical Trials as Topic ; Coronavirus/drug effects ; Hospitalization/statistics & numerical data ; Humans ; Intensive Care Units/statistics & numerical data ; Regression Analysis ; Respiratory Distress Syndrome/drug therapy ; Respiratory Distress Syndrome/mortality ; Respiratory Distress Syndrome/virology ; Risk Factors ; Ritonavir/therapeutic use ; SARS-CoV-2 ; Severity of Illness Index ; Treatment Outcome ; COVID-19 Drug Treatment
Chemical Substances	Adrenal Cortex Hormones ; Ritonavir (O3J8G9O825)
Keywords	covid19
Language	English
Publishing date	2020-04-15
Publishing country	United States
Document type	Journal Article ; Meta-Analysis ; Research Support, Non-U.S. Gov't ; Systematic Review
ZDB-ID	1099781-7
ISSN	1537-6591 ; 1058-4838
ISSN (online)	1537-6591
ISSN	1058-4838
DOI	10.1093/cid/ciaa576
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Article: Recurrent Tuberculosis Disease in Singapore.

Gan, Suay Hong / KhinMar, Kyi Win / Ang, Li Wei / Lim, Leo K Y / Sng, Li Hwei / Wang, Yee Tang / Chee, Cynthia B E

Open forum infectious diseases

2021 Volume 8, Issue 7, Page(s) ofab340

Abstract: Background: Previously treated (ie, recurrent) tuberculosis (TB) cases account for approximately 7%-8% of incident TB globally and in Singapore. Molecular fingerprinting has enabled the differentiation of these patients into relapsed or reinfection ... ...

Abstract	Background: Previously treated (ie, recurrent) tuberculosis (TB) cases account for approximately 7%-8% of incident TB globally and in Singapore. Molecular fingerprinting has enabled the differentiation of these patients into relapsed or reinfection cases. Methods: Patient demographics, disease characteristics, and treatment information were obtained from the national TB notification registry and TB Control Unit. We performed a retrospective, case-control study to evaluate factors associated with recurrent TB disease in Singapore citizens and permanent residents with culture-positive TB from 2006 to 2013 and who developed a second episode of culture-positive TB up to 2016 using multivariable logistic regression analyses. Results: Ninety-one cases with culture-positive first and recurrent TB disease episodes were identified. Recurrent TB was associated with age ≥60 years (adjusted odds ratio [aOR], 1.98 [95% confidence interval {CI}, 1.09-3.61), male sex (aOR, 2.29 [95% CI, 1.22-4.51]), having concomitant pulmonary and extrapulmonary TB (aOR, 3.10 [95% CI, 1.59-6.10]) and extrapulmonary TB alone (aOR, 3.82 [95% CI, 1.12-13.31]), and was less likely in non-Malays (aOR, 0.52 [95% CI, .27-.99]). DNA fingerprinting results for both episodes in 49 cases differentiated these into 28 relapsed and 21 reinfection cases. Relapse was associated with having concomitant pulmonary and extrapulmonary TB (aOR, 9.24 [95% CI, 2.50-42.42]) and positive sputum acid-fast bacilli smear (aOR, 3.95 [95% CI, 1.36-13.10]). Conclusions: Relapse and reinfection contributed to 57% and 43%, respectively, of recurrent TB in Singapore. Our study highlights the underappreciated association of concomitant pulmonary and extrapulmonary TB as a significant risk factor for disease relapse.
Language	English
Publishing date	2021-06-27
Publishing country	United States
Document type	Journal Article
ZDB-ID	2757767-3
ISSN	2328-8957
ISSN	2328-8957
DOI	10.1093/ofid/ofab340
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Article ; Online: Epidemiological factors associated with the absence of previous HIV testing among HIV-positive persons in Singapore, 2012-2017.

Ang, Li Wei / Toh, Matthias Paul Han Sim / Boudville, Irving Charles / Wong, Chen Seong / Archuleta, Sophia / Lee, Vernon / Chow, Angela / Leo, Yee Sin

BMJ open

2021 Volume 11, Issue 8, Page(s) e050133

Abstract: Objective: To assess the temporal trend and identify risk factors associated with the absence of previous HIV testing prior to their diagnosis among HIV-positive persons in Singapore.: Study design: Cross-sectional.: Setting and participants: We ... ...

Abstract	Objective: To assess the temporal trend and identify risk factors associated with the absence of previous HIV testing prior to their diagnosis among HIV-positive persons in Singapore. Study design: Cross-sectional. Setting and participants: We analysed data of HIV-positive persons infected via sexual transmission, who were notified to the National HIV Registry in 2012-2017. Outcomes: Epidemiological factors associated with the absence of HIV testing prior to diagnosis were determined separately for two groups of HIV-positive persons: early and late stages of HIV infection at diagnosis. Results: 2188 HIV-positive persons with information on HIV testing history and CD4 cell count were included in the study. The median age at HIV diagnosis was 40 years (IQR 30-51). Nearly half (45.1%) had never been tested for HIV prior to their diagnosis. The most common reason cited for no previous HIV testing was 'not necessary to test' (73.7%). The proportion diagnosed at late-stage HIV infection was significantly higher among HIV-positive persons who had never been tested for HIV (63.9%) compared with those who had undergone previous HIV tests (29.0%). Common risk factors associated with no previous HIV testing in multivariable logistic regression analysis stratified by stage of HIV infection were: older age at HIV diagnosis, lower educational level, detection via medical care and HIV infection via heterosexual transmission. In the stratified analysis for persons diagnosed at early-stage of HIV infection, in addition to the four risk factors, women and those of Malay ethnicity were also less likely to have previous HIV testing prior to their diagnosis. Conclusion: Targeted prevention efforts and strategies are needed to raise the level of awareness of HIV/AIDS and to encourage early and regular screening among the at-risk groups by making HIV testing more accessible.
MeSH term(s)	Acquired Immunodeficiency Syndrome ; Aged ; Cross-Sectional Studies ; Female ; HIV Infections/diagnosis ; HIV Infections/epidemiology ; HIV Testing ; Humans ; Singapore/epidemiology
Language	English
Publishing date	2021-08-17
Publishing country	England
Document type	Journal Article
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2021-050133
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Article ; Online: Food sources of dietary fibre and risk of total knee replacement related to severe osteoarthritis, the Singapore Chinese Health Study.

Leung, Ying Ying / Jin, Aizhen / Tan, Kelvin Bryan / Ang, Li-Wei / Yuan, Jian-Min / Koh, Woon-Puay

RMD open

2021 Volume 7, Issue 2

Abstract: Objectives: We aimed to evaluate the association between fibre intake and its food sources, and the risk of total knee replacement (TKR) due to severe knee osteoarthritis (KOA).: Methods: We used data from the Singapore Chinese Health Study, a ... ...

Abstract	Objectives: We aimed to evaluate the association between fibre intake and its food sources, and the risk of total knee replacement (TKR) due to severe knee osteoarthritis (KOA). Methods: We used data from the Singapore Chinese Health Study, a prospective cohort study that recruited 63 257 participants aged 45-74 years from 1993 to 1998. At baseline, we assessed diet using a validated 165-item semiquantitative food frequency questionnaire, together with body mass index (BMI) and lifestyle factors. Incident TKR cases were identified via record linkage with nationwide hospital discharge database through 2017. Results: There were 2816 cases of incident TKR due to severe KOA. The total fibre intake at baseline was not associated with the risk of TKR after adjustment for confounders. Among the food sources of fibre, higher intake of legumes was associated with a lower risk of TKR in a dose-dependent manner; compared with those having the lowest quartile intake, HR (95% CI) was 0.86 (0.76, 0.96) for those having the highest quartile intake (p for trend=0.004). This association was consistent after including BMI in the model and homogeneous across BMI categories. The consumption of other fibre sources, namely grain products, nuts and seeds, soy food, fruits and vegetables, was not associated with the risk of TKR. Conclusion: Intake of legumes, but not total fibre, was associated with a reduced risk of TKR. Further research is needed to replicate our findings and to evaluate possible biological mechanisms that could explain the effect of dietary legumes on pathogenesis or progression of KOA.
MeSH term(s)	Arthroplasty, Replacement, Knee/adverse effects ; China ; Dietary Fiber ; Humans ; Osteoarthritis, Knee/epidemiology ; Osteoarthritis, Knee/etiology ; Osteoarthritis, Knee/surgery ; Prospective Studies ; Singapore/epidemiology
Chemical Substances	Dietary Fiber
Language	English
Publishing date	2021-07-10
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	2812592-7
ISSN	2056-5933 ; 2056-5933
ISSN (online)	2056-5933
ISSN	2056-5933
DOI	10.1136/rmdopen-2021-001602
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Article ; Online: Differentiating coronavirus disease 2019 (COVID-19) from influenza and dengue.

Thein, Tun-Linn / Ang, Li Wei / Young, Barnaby Edward / Chen, Mark I-Cheng / Leo, Yee-Sin / Lye, David Chien Boon

Scientific reports

2021 Volume 11, Issue 1, Page(s) 19713

Abstract: The novel coronavirus disease 2019 (COVID-19) presents with non-specific clinical features. This may result in misdiagnosis or delayed diagnosis, and lead to further transmission in the community. We aimed to derive early predictors to differentiate ... ...

Abstract	The novel coronavirus disease 2019 (COVID-19) presents with non-specific clinical features. This may result in misdiagnosis or delayed diagnosis, and lead to further transmission in the community. We aimed to derive early predictors to differentiate COVID-19 from influenza and dengue. The study comprised 126 patients with COVID-19, 171 with influenza and 180 with dengue, who presented within 5 days of symptom onset. All cases were confirmed by reverse transcriptase polymerase chain reaction tests. We used logistic regression models to identify demographics, clinical characteristics and laboratory markers in classifying COVID-19 versus influenza, and COVID-19 versus dengue. The performance of each model was evaluated using receiver operating characteristic (ROC) curves. Shortness of breath was the strongest predictor in the models for differentiating between COVID-19 and influenza, followed by diarrhoea. Higher lymphocyte count was predictive of COVID-19 versus influenza and versus dengue. In the model for differentiating between COVID-19 and dengue, patients with cough and higher platelet count were at increased odds of COVID-19, while headache, joint pain, skin rash and vomiting/nausea were indicative of dengue. The cross-validated area under the ROC curve for all four models was above 0.85. Clinical features and simple laboratory markers for differentiating COVID-19 from influenza and dengue are identified in this study which can be used by primary care physicians in resource limited settings to determine if further investigations or referrals would be required.
MeSH term(s)	Adult ; Area Under Curve ; COVID-19/complications ; COVID-19/pathology ; COVID-19/virology ; Cohort Studies ; Dengue/complications ; Dengue/pathology ; Dengue/virology ; Diagnosis, Differential ; Diarrhea/etiology ; Female ; Fever/etiology ; Humans ; Influenza, Human/complications ; Influenza, Human/pathology ; Influenza, Human/virology ; Lymphocyte Count ; Male ; Middle Aged ; Platelet Count ; RNA, Viral/analysis ; RNA, Viral/metabolism ; ROC Curve ; SARS-CoV-2/genetics ; SARS-CoV-2/isolation & purification ; Vomiting/etiology ; Young Adult
Chemical Substances	RNA, Viral
Language	English
Publishing date	2021-10-05
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2615211-3
ISSN	2045-2322 ; 2045-2322
ISSN (online)	2045-2322
ISSN	2045-2322
DOI	10.1038/s41598-021-99027-z
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