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Clinical Characteristics and Disease Progression in Early-Stage COVID-19 Patients in South Korea: The Retrospective Cohort Study
39 Pages Posted: 1 Jun 2020
More...Abstract
Background: A rapid increase in the number of patients with coronavirus disease 19 (COVID-19) may overwhelm the available medical resources. We aimed to evaluate risk factors for disease severity in the early stages of COVID-19.
Methods: The cohort comprised 293 patients with confirmed COVID-19 from March 5, 2020, to March 18, 2020. Patients with asymptomatic infection and those at early stages of symptomatic disease were identified. The Korea Centers for Disease Control and Prevention (KCDC) classification system was used to triage patients with COVID-19. The clinical course was summarized, including the impact of drugs ( angiotensin Ⅱ receptor blockers [ARB], ibuprofen, and dipeptidyl peptidase-4 inhibitors [DPP4i]), and the therapeutic effect of lopinavir/ritonavir.
Findings: Of 293 patients, 36 (12·3%) cases were classified as progressive disease (progression group). Compared with the improvement/stabilization group, the progression group was older (p < 0·0001) and more likely to have comorbidities such as hypertension (p = 0·0040) or diabetes mellitus (p < 0·0001). After adjusting for confounding variables using propensity-score matching, prior history of drug use, including ARB, ibuprofen, and DPP4i, was not statistically different between the two groups. Patients treated with lopinavir/ritonavir had significantly shorter progression-free survival than those not receiving lopinavir/ritonavir. The area under the curve for KCDC classification Ⅰ was 0·817 (95% CI, 0·740-0·895).
Interpretation: Prior history of drug use, including ARBs, ibuprofen, or DPP4is, was not a risk factor for disease progression. KCDC classification Ⅰ clearly distinguished the improvement/stabilization group from the progression group of COVID-19 patients.
Funding Statement: This research received no specific grant.
Declaration of Interests: The authors declare that there are no specific conflicts of interest.
Ethics Approval Statement: This retrospective cohort study was approved by the Institutional Review Board of the Korean Military Medical Association (Seongnam-si, Gyeonggi-do, South Korea) (AFMC-20-IRB-020).
Keywords: Coronavirus disease-19 (COVID-19); Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); Angiotensin Ⅱ receptor blockers (ARB); Ibuprofen; Korea Centers for Disease Control and Prevention (KCDC) classification
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