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?:abstract
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BACKGROUND Coronavirus disease 2019 (COVID-19) and heat related-illness are systemic febrile diseases. In the summer during the COVID-19 pandemic, a differential diagnosis between the two conditions is important. However, no studies have compared and distinguished heat-related illness from COVID-19. We aimed to compare the data between patients with early-stage heat-related illness and those with COVID-19. METHODS This retrospective observational study included 90 patients with early-stage heat-related illness selected from Heatstroke STUDY 2017-2019 (nationwide registries of heat-related illness in Japan) and 86 patients with laboratory-confirmed COVID-19 with complaints of fever or fatigue and were admitted to one of two hospitals in Tokyo, Japan. RESULTS Amongvital signs, systolic blood pressure (119 vs. 125 mmHg, p = 0.02), oxygen saturation (98% vs. 97%, p < 0.001), and body temperature (36.6 vs. 37.6 °C, p<0.001) showed significant between-group differences for the heatstroke and COVID-19 groups, respectively. Numerous intergroup differences in laboratory findings were present, including white blood cell counts (10.8 vs. 5.2 × 103/μL, p<0.001), creatinine (2.2 vs. 0.85 mg/dL, p<0.001), and C-reactive protein (0.2 vs. 2.8 mg/dL, p<0.001), although a logistic regression model achieved an area under the curve (AUC) of 0.966 using these three factors. A Random Forest machine learning model achieved accuracy, precision, recall, and AUC of 0.908, 0.976, 0.842, and 0.978, respectively. Creatinine was the most important feature of this model. CONCLUSIONS Acute kidney injury was associated with heat-related illness, which could be key in distinguishing or evaluating patients with fever in the summer during the COVID-19 pandemic.
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