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1.
J Med Internet Res ; 23(2): e26257, 2021 02 22.
Article in English | MEDLINE | ID: covidwho-1574035

ABSTRACT

BACKGROUND: As the COVID-19 pandemic continues, an initial risk-adapted allocation is crucial for managing medical resources and providing intensive care. OBJECTIVE: In this study, we aimed to identify factors that predict the overall survival rate for COVID-19 cases and develop a COVID-19 prognosis score (COPS) system based on these factors. In addition, disease severity and the length of hospital stay for patients with COVID-19 were analyzed. METHODS: We retrospectively analyzed a nationwide cohort of laboratory-confirmed COVID-19 cases between January and April 2020 in Korea. The cohort was split randomly into a development cohort and a validation cohort with a 2:1 ratio. In the development cohort (n=3729), we tried to identify factors associated with overall survival and develop a scoring system to predict the overall survival rate by using parameters identified by the Cox proportional hazard regression model with bootstrapping methods. In the validation cohort (n=1865), we evaluated the prediction accuracy using the area under the receiver operating characteristic curve. The score of each variable in the COPS system was rounded off following the log-scaled conversion of the adjusted hazard ratio. RESULTS: Among the 5594 patients included in this analysis, 234 (4.2%) died after receiving a COVID-19 diagnosis. In the development cohort, six parameters were significantly related to poor overall survival: older age, dementia, chronic renal failure, dyspnea, mental disturbance, and absolute lymphocyte count <1000/mm3. The following risk groups were formed: low-risk (score 0-2), intermediate-risk (score 3), high-risk (score 4), and very high-risk (score 5-7) groups. The COPS system yielded an area under the curve value of 0.918 for predicting the 14-day survival rate and 0.896 for predicting the 28-day survival rate in the validation cohort. Using the COPS system, 28-day survival rates were discriminatively estimated at 99.8%, 95.4%, 82.3%, and 55.1% in the low-risk, intermediate-risk, high-risk, and very high-risk groups, respectively, of the total cohort (P<.001). The length of hospital stay and disease severity were directly associated with overall survival (P<.001), and the hospital stay duration was significantly longer among survivors (mean 26.1, SD 10.7 days) than among nonsurvivors (mean 15.6, SD 13.3 days). CONCLUSIONS: The newly developed predictive COPS system may assist in making risk-adapted decisions for the allocation of medical resources, including intensive care, during the COVID-19 pandemic.


Subject(s)
COVID-19/diagnosis , COVID-19/mortality , Age Factors , Aged , Critical Care/statistics & numerical data , Dementia/epidemiology , Female , Humans , Kidney Failure, Chronic/epidemiology , Length of Stay/statistics & numerical data , Male , Middle Aged , Pandemics , Prognosis , Proportional Hazards Models , ROC Curve , Republic of Korea/epidemiology , Retrospective Studies , Risk Factors , Severity of Illness Index , Survival Rate
2.
Clin Infect Dis ; 73(7): e1855-e1862, 2021 10 05.
Article in English | MEDLINE | ID: covidwho-1455257

ABSTRACT

BACKGROUND: Increased body mass index (BMI) has been associated with a higher risk of severe coronavirus disease 2019 (COVID-19) infections. However, whether obesity is a risk factor for contracting COVID-19 has hardly been investigated so far. METHODS: We examined the association between BMI level and the risk of COVID-19 infection in a nationwide case-control study comprised of 3788 case patients confirmed to have COVID-19 between 24 January and 9 April 2020 and 15 152 controls matched by age and sex, who were aged 20 years or more and underwent National Health Insurance Service (NHIS) health examinations between 2015-2017, using data from the Korean NHIS with linkage to the Korea Centers for Disease Control and Prevention data. Our primary exposure of interest was BMI level, categorized into 4 groups: <18.5 (underweight), 18.5-22.9 (normal weight), 23-24.9 (overweight), and ≥25 kg/m2 (obese). RESULTS: Of the entire 18 940 study participants, 11 755 (62.1%) were women, and the mean age of the study participants was 53.7 years (standard deviation, 13.8). In multivariable logistic regression models adjusted for sociodemographic, comorbidity, laboratory, and medication data, there was a graded association between higher BMI levels and higher risk of COVID-19 infection. Compared to normal-weight individuals, the adjusted odds ratios in the overweight and obese individuals were 1.13 (95% confidence interval [CI], 1.03-1.25) and 1.26 (95% CI, 1.15-1.39), respectively. This association was robust across age and sex subgroups. CONCLUSIONS: Higher BMI levels were associated with a higher risk of contracting COVID-19.


Subject(s)
COVID-19 , Adult , Body Mass Index , Case-Control Studies , Female , Humans , Middle Aged , Republic of Korea/epidemiology , Risk Factors , SARS-CoV-2 , Young Adult
3.
Pharmaceutics ; 13(9)2021 Sep 19.
Article in English | MEDLINE | ID: covidwho-1430942

ABSTRACT

Coronavirus disease 2019 (COVID-19), caused by a new strain of coronavirus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is spreading rapidly worldwide. Nafamostat mesylate (NFM) suppresses transmembrane serine protease 2 and SARS-CoV-2 S protein-mediated fusion. In this study, pharmacokinetics and lung distribution of NFM, administered via intravenous and intratracheal routes, were determined using high performance liquid chromatography analysis of blood plasma, lung lumen using bronchoalveolar lavage fluid, and lung tissue. Intratracheal administration had higher drug delivery and longer residual time in the lung lumen and tissue, which are the main sites of action, than intravenous administration. We confirmed the effect of lecithin as a stabilizer through an ex vivo stability test. Lecithin acts as an inhibitor of carboxylesterase and delays NFM decomposition. We prepared inhalable microparticles with NFM, lecithin, and mannitol via the co-spray method. The formulation prepared using an NFM:lecithin:mannitol ratio of 1:1:100 had a small particle size and excellent aerodynamic performance. Spray dried microparticles containing NFM, lecithin, and mannitol (1:1:100) had the longest residual time in the lung tissue. In conclusion, NFM-inhalable microparticles were prepared and confirmed to be delivered into the respiratory tract, such as lung lumen and lung tissue, through in vitro and in vivo evaluations.

5.
Ann Med Surg (Lond) ; 65: 102358, 2021 May.
Article in English | MEDLINE | ID: covidwho-1225119

ABSTRACT

Introduction: Surgical spinal anesthesia is usually maintained for approximately 3 h with bupivacaine, but it is difficult to accurately predict the duration of surgery for each case. When an operation continues for an extended duration, regression of spinal anesthesia often leads to general anesthesia. Here we present a case of extended spinal anesthesia assisted by monitored anesthesia care. Case presentation: A 32-year-old male who suffered from persistent pain of the right knee was diagnosed with rupture of the right anterior cruciate ligament. Arthroscopic surgery of the right knee was conducted with spinal anesthesia. A local anesthetic mixture of 0.5% hyperbaric bupivacaine 12 mg with 50 µg of epinephrine was used. The surgery took longer than expected with a total anesthesia time of 402 minutes. In the final 30 minutes of surgery, spinal anesthesia regressed and the procedure was completed under monitored anesthesia care (MAC). Clinical discussion: When spinal anesthesia is on regression during the final stage of surgery, the application of MAC safely secures additional operation time. By adopting MAC, the patient avoided general anesthesia and had minimal physiological distress and a rapid recovery. Another benefit of MAC is the reduced consumption of resources. Further, by avoiding endotracheal intubation and mechanical ventilation, the risk of transmission of infectious agents is minimized. Conclusion: In situations where spinal anesthesia is regressing close to the end of a surgical procedure, the application of MAC has potential benefits over general anesthesia. These benefits are particularly relevant during the current COVID-19 pandemic.

6.
Nicotine Tob Res ; 23(10): 1787-1792, 2021 08 29.
Article in English | MEDLINE | ID: covidwho-1199496

ABSTRACT

INTRODUCTION: It is unclear whether smokers are more vulnerable to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. This study aimed to evaluate the association between smoking and the risk of SARS-CoV-2 infection. METHODS: A matched case-control study was conducted using a large nationwide database. The case group included patients with SARS-CoV-2 infection confirmed by the Korea Centers for Disease Control and Prevention, and the control group was randomly sampled from the general Korean population in the National Health Insurance Service database by matching sex, age, and region of residence. Conditional logistic regression models were used to investigate whether the risk of infection with SARS-CoV-2 was affected by smoking status. RESULTS: A total of 4167 patients with SARS-CoV-2 infection and 20 937 matched controls were enrolled. The proportion of ex-smokers and current smokers was 26.6% of the total participants. In multivariate analysis, smoking was not associated with an increased risk of SARS-CoV-2 infection (odds ratio [OR] = 0.56, confidence interval [CI] = 0.50-0.62). When ex-smokers and current smokers were analyzed separately, similar results were obtained (current smoker OR = 0.33, CI = 0.28-0.38; ex-smoker OR = 0.81, CI = 0.72-0.91). CONCLUSIONS: This study showed that smoking may not be associated with an increased risk of SARS-CoV-2 infection. Smoking tends to lower the risk of SARS-CoV-2 infection; however, these findings should be interpreted with caution. IMPLICATIONS: It is unclear whether smokers are more vulnerable to coronavirus disease 2019. In this large nationwide study in South Korea, smoking tended to lower the risk of infection with severe acute respiratory syndrome coronavirus 2. However, these findings should be interpreted with caution, and further confirmatory studies are required.


Subject(s)
COVID-19 , SARS-CoV-2 , Smoking , COVID-19/epidemiology , Case-Control Studies , Humans , Korea/epidemiology , Logistic Models , Risk Factors , Smoking/adverse effects , Smoking/epidemiology
7.
Expert Rev Respir Med ; 15(10): 1347-1354, 2021 10.
Article in English | MEDLINE | ID: covidwho-1196938

ABSTRACT

INTRODUCTION: Acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19) often leads to mortality. Outcomes of patients with COVID-19-related ARDS compared to ARDS unrelated to COVID-19 is not well characterized. AREAS COVERED: We performed a systematic review of PubMed, Scopus, and MedRxiv 11/1/2019 to 3/1/2021, including studies comparing outcomes in COVID-19-related ARDS (COVID-19 group) and ARDS unrelated to COVID-19 (ARDS group). Outcomes investigated were duration of mechanical ventilation-free days, intensive care unit (ICU) length-of-stay (LOS), hospital LOS, and mortality. Random effects models were fit for each outcome measure. Effect sizes were reported as pooled median differences of medians (MDMs), mean differences (MDs), or odds ratios (ORs). EXPERT OPINION: Ten studies with 2,281 patients met inclusion criteria (COVID-19: 861 [37.7%], ARDS: 1420 [62.3%]). There were no significant differences between the COVID-19 and ARDS groups for median number of mechanical ventilator-free days (MDM: -7.0 [95% CI: -14.8; 0.7], p = 0.075), ICU LOS (MD: 3.1 [95% CI: -5.9; 12.1], p = 0.501), hospital LOS (MD: 2.5 [95% CI: -5.6; 10.7], p = 0.542), or all-cause mortality (OR: 1.25 [95% CI: 0.78; 1.99], p = 0.361). Compared to the general ARDS population, results did not suggest worse outcomes in COVID-19-related ARDS.


Subject(s)
COVID-19 , Respiratory Distress Syndrome , Humans , Intensive Care Units , Respiration, Artificial , Respiratory Distress Syndrome/diagnosis , Respiratory Distress Syndrome/therapy , SARS-CoV-2
8.
Korean J Intern Med ; 36(3): 617-628, 2021 05.
Article in English | MEDLINE | ID: covidwho-1190537

ABSTRACT

BACKGROUND/AIMS: Although it is near concluded that renin-angiotensin system inhibitors do not have a harmful effect on coronavirus disease 2019 (COVID-19), there is no report about whether angiotensin receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACEIs) offer any protective role. This study aimed to compare the association of ARBs and ACEIs with COVID-19-related mortality. METHODS: All patients with COVID-19 in Korea between January 19 and April 16, 2020 were enrolled. The association of ARBs and ACEIs with mortality within 60 days were evaluated. A comparison of hazard ratio (HR) was performed between COVID-19 patients and a retrospective cohort of pneumonia patients hospitalized in 2019 in Korea. RESULTS: Among 10,448 COVID-19 patients, ARBs and ACEIs were prescribed in 1,231 (11.7%) and 57 (0.6%) patients, respectively. After adjusting for age, sex, and history of comorbidities, the ARB group showed neutral association (HR, 1.034; 95% CI, 0.765 to 1.399; p = 0.8270) and the ACEI groups showed no significant associations likely owing to the small population size (HR, 0.736; 95% CI, 0.314 to 1.726; p = 0.4810). When comparing HR between COVID-19 patients and a retrospective cohort of patients hospitalized with pneumonia in 2019, the trend of ACEIs showed similar benefits, whereas the protective effect of ARBs observed in the retrospective cohort was absent in COVID-19 patients. Meta-analyses showed significant positive correlation with survival of ACEIs, whereas a neutral association between ARBs and mortality. CONCLUSION: Although ARBs or ACEIs were not associated with fatal outcomes, potential beneficial effects of ARBs observed in pneumonia were attenuated in COVID-19.


Subject(s)
Angiotensin Receptor Antagonists/therapeutic use , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , COVID-19/diagnosis , COVID-19/mortality , Hypertension/drug therapy , Pneumonia, Viral/mortality , Pneumonia/drug therapy , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/complications , COVID-19/drug therapy , Child , Child, Preschool , Cohort Studies , Female , Humans , Hypertension/complications , Infant , Infant, Newborn , Male , Middle Aged , Pneumonia/diagnosis , Pneumonia, Viral/complications , Renin-Angiotensin System , Republic of Korea/epidemiology , Retrospective Studies , SARS-CoV-2 , Young Adult
9.
J Clin Med ; 10(7)2021 Apr 06.
Article in English | MEDLINE | ID: covidwho-1178301

ABSTRACT

Regular physical activity (PA) is known to reduce the risk of serious community-acquired infections. We examined the association of PA with the morbidity and mortality resulting from coronavirus disease (COVID-19) infection in the South Korean population. Patients who tested positive for severe acute respiratory coronavirus 2 and who underwent public health screening between 2014 and 2017 (n = 6288) were included. Age- and sex-matched controls (n = 125,772) were randomly selected from the Korean National Health Insurance Service database. Leisure-time PA was assessed using a self-reported questionnaire. The mean PA levels were lower in the patient than in the control group (558.2 ± 516.3 vs. 580.2 ± 525.7 metabolic equivalent of task (MET)-min/week, p = 0.001). Patients with moderate to vigorous PA (MVPA) were associated with a lower risk of COVID-19 morbidity (odds ratio (OR), 0.90; 95% confidence interval (CI), 0.86-0.95). In addition, a standard deviation (SD) increment in MET/week (525.3 MET-min/week) was associated with a 4% decrease in the risk of COVID-19 morbidity (OR, 0.96; 95% CI, 0.93-0.99). MVPA and an SD increment in MET/week were associated with lower mortality (MVPA: OR, 0.47; 95% CI, 0.26-0.87; per SD increment: OR, 0.65; 95% CI, 0.48-0.88). Higher levels of regular PA were associated with a lower risk of COVID-19 infection and mortality, highlighting the importance of maintaining appropriate levels of PA along with social distancing amid the COVID-19 pandemic.

10.
Thorax ; 76(9): 939-941, 2021 09.
Article in English | MEDLINE | ID: covidwho-1158124

ABSTRACT

Non-pharmaceutical interventions (NPIs) have been widely implemented to mitigate the spread of COVID-19. We assessed the effect of NPIs on hospitalisations for pneumonia, influenza, COPD and asthma. This retrospective, ecological study compared the weekly incidence of hospitalisation for four respiratory conditions before (January 2016-January 2020) and during (February-July 2020) the implementation of NPI against COVID-19. Hospitalisations for all four respiratory conditions decreased substantially during the intervention period. The cumulative incidence of admissions for COPD and asthma was 58% and 48% of the mean incidence during the 4 preceding years, respectively.


Subject(s)
Asthma/epidemiology , COVID-19/prevention & control , Influenza, Human/epidemiology , Patient Admission/statistics & numerical data , Pulmonary Disease, Chronic Obstructive/epidemiology , Administrative Claims, Healthcare/statistics & numerical data , Humans , Republic of Korea/epidemiology , Retrospective Studies , SARS-CoV-2
11.
J Korean Med Sci ; 36(9): e67, 2021 Mar 08.
Article in English | MEDLINE | ID: covidwho-1123769

ABSTRACT

BACKGROUND: Vaccines against coronavirus disease 2019 (COVID-19) are raising concerns about vaccine safety, particularly in the context of large-scale immunization. To address public concerns, we measured the baseline incidence rates of major conditions potentially related to vaccine-related adverse events (VAEs). We aimed to provide a basis for evaluating VAEs and verifying causality. METHODS: Conditions of interest were selected from the US Vaccine Adverse Event Reporting System Table of Reportable Events and a recent report from a European consortium on vaccine surveillance. We used the National Health Insurance Service database in Korea to identify the monthly numbers of cases with these conditions. Data from January 2006 to June 2020 were included. Prediction models were constructed from the observed incidences using an autoregressive integrated moving average. We predicted the incidences of the conditions and their respective 95% confidence intervals (CIs) for January through December 2021. In addition, subgroup analysis for the expected vaccination population was conducted. RESULTS: Mean values (95% CIs) of the predicted monthly incidence of vasovagal syncope, anaphylaxis, brachial neuritis, acute disseminated encephalomyelitis, Bell's palsy, Guillain-Barré syndrome, encephalopathy, optic neuritis, transverse myelitis, immune thrombocytopenic purpura, and systemic lupus erythematosus in 2021 were 23.89 (19.81-27.98), 4.72 (3.83-5.61), 57.62 (51.37-63.88), 0.03 (0.01-0.04), 8.58 (7.90-9.26), 0.26 (0.18-0.34), 2.13 (1.42-2.83), 1.65 (1.17-2.13), 0.19 (0.14-0.25), 0.75 (0.61-0.90), and 3.40 (2.79-4.01) cases per 100,000 respectively. The majority of the conditions showed an increasing trend with seasonal variations in their incidences. CONCLUSION: We measured the incidence of a total of 11 conditions that could potentially be associated with VAEs to predict the monthly incidence in 2021. In Korea, conditions that could potentially be related to VAEs occur on a regular basis, and an increasing trend is observed with seasonality.


Subject(s)
Product Surveillance, Postmarketing/methods , Vaccination/adverse effects , Anaphylaxis/diagnosis , Anaphylaxis/epidemiology , COVID-19/pathology , COVID-19/virology , Databases, Factual , Humans , Incidence , Models, Theoretical , National Health Programs , Product Surveillance, Postmarketing/statistics & numerical data , Republic of Korea/epidemiology , SARS-CoV-2/isolation & purification , Syncope, Vasovagal/diagnosis , Syncope, Vasovagal/epidemiology
12.
Int J Infect Dis ; 105: 588-594, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1108329

ABSTRACT

OBJECTIVES: This study aimed to identify the survival rate and explore factors affecting survival among early COVID-19 patients in South Korea. METHODS: Data reported by the Korea Disease Control and Prevention Agency (KDCA), up to 15 July, when COVID-19 was confirmed were used as research data in connection with the National Health Insurance Service's (NHIS) national health information database. The final analysis targets were 12,646 confirmed patients and 303 deaths. The survival rate of patients with COVID-19 was estimated through Kaplan-Meier survival analysis. Cox proportional hazard regression analysis was performed to search for factors affecting survival. RESULTS: When looking at the survival rate by age group for men and women, the 28-day survival rate for men aged >80 years was 77% and 73% at 42 days, while 83% and 81% for women. Men had a worse survival rate than women. For chronic diseases, the highest risk of mortality was observed in malignant neoplasms of the respiratory and urogenital systems, followed by diseases of the urinary system and diabetes. CONCLUSIONS: The number of COVID-19 deaths was highest the next day after initial diagnosis. The case fatality rate was high in males, older age, and chronic diseases.


Subject(s)
Big Data , COVID-19/mortality , SARS-CoV-2 , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , National Health Programs , Republic of Korea/epidemiology , Risk Factors , Survival Rate
13.
Cancers (Basel) ; 13(3)2021 Jan 26.
Article in English | MEDLINE | ID: covidwho-1050587

ABSTRACT

We aimed to identify whether lymphopenia is a reliable prognostic marker for COVID-19. Using data derived from a Korean nationwide longitudinal cohort of 5628 COVID-19 patients, we identified propensity-matched cohorts (n = 770) with group I of severe lymphopenia (absolute lymphocyte counts [ALC]: <500/mm3, n = 110), group II of mild-to-moderate lymphopenia (ALC: ≥500-<1000/mm3, n = 330), and group III, no lymphopenia (ALC: ≥1000/mm3, n = 330). A significantly higher mortality rate was associated with lymphopenia severity: 40% in group I, 22.7% in group II, and 13.0% in group III (p < 0.001). At 28 days, the estimated inferior overall survival associated with intensified lymphopenia: 62.7% in group I, 79.9% in group II, and 89.0% in group III (p < 0.001). Lymphopenia contributed significantly toward a greater need for interventions in all groups but at varying degrees: requirements of invasive ventilation, intensive oxygen supply, or adequate oxygen supply, respectively (p < 0.001). The lymphopenia intensity was independently associated with higher COVID-19 mortality in multivariable analysis; adjusted odds ratios of 5.63 (95% CI, 3.0-10.72), and 2.47 (95% CI, 1.5-4.13) for group I and group II, respectively. Lymphopenia and its severity levels may serve as reliable predictive factors for COVID-19 clinical outcomes; thus, lymphopenia may provide the prognostic granularity required for clinical use in the management of patients with COVID-19.

14.
Diabetes Metab J ; 44(6): 897-907, 2020 12.
Article in English | MEDLINE | ID: covidwho-1005674

ABSTRACT

BACKGROUND: This study aimed to determine the infection risk of coronavirus disease 2019 (COVID-19) in patients with diabetes (according to treatment method). METHODS: Claimed subjects to the Korean National Health Insurance claims database diagnosed with COVID-19 were included. Ten thousand sixty-nine patients with COVID-19 between January 28 and April 5, 2020, were included. Stratified random sampling of 1:5 was used to select the control group of COVID-19 patients. In total 50,587 subjects were selected as the control group. After deleting the missing values, 60,656 subjects were included. RESULTS: Adjusted odds ratio (OR) indicated that diabetic insulin users had a higher risk of COVID-19 than subjects without diabetes (OR, 1.25; 95% confidence interval [CI], 1.03 to 1.53; P=0.0278). In the subgroup analysis, infection risk was higher among diabetes male insulin users (OR, 1.42; 95% CI, 1.07 to 1.89), those between 40 and 59 years (OR, 1.66; 95% CI, 1.13 to 2.44). The infection risk was higher in diabetic insulin users with 2 to 4 years of morbidity (OR, 1.744; 95% CI, 1.003 to 3.044). CONCLUSION: Some diabetic patients with certain conditions would be associated with a higher risk of acquiring COVID-19, highlighting their need for special attention. Efforts are warranted to ensure that diabetic patients have minimal exposure to the virus. It is important to establish proactive care and screening tests for diabetic patients suspected with COVID-19 for timely disease diagnosis and management.


Subject(s)
COVID-19/economics , COVID-19/epidemiology , Diabetes Mellitus/economics , Diabetes Mellitus/epidemiology , Population Surveillance , Social Class , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/diagnosis , Databases, Factual/trends , Diabetes Mellitus/diagnosis , Female , Humans , Male , Middle Aged , National Health Programs/trends , Republic of Korea/epidemiology , Risk Factors , Young Adult
15.
Sci Rep ; 10(1): 18716, 2020 10 30.
Article in English | MEDLINE | ID: covidwho-894420

ABSTRACT

The rapid spread of COVID-19 has resulted in the shortage of medical resources, which necessitates accurate prognosis prediction to triage patients effectively. This study used the nationwide cohort of South Korea to develop a machine learning model to predict prognosis based on sociodemographic and medical information. Of 10,237 COVID-19 patients, 228 (2.2%) died, 7772 (75.9%) recovered, and 2237 (21.9%) were still in isolation or being treated at the last follow-up (April 16, 2020). The Cox proportional hazards regression analysis revealed that age > 70, male sex, moderate or severe disability, the presence of symptoms, nursing home residence, and comorbidities of diabetes mellitus (DM), chronic lung disease, or asthma were significantly associated with increased risk of mortality (p ≤ 0.047). For machine learning, the least absolute shrinkage and selection operator (LASSO), linear support vector machine (SVM), SVM with radial basis function kernel, random forest (RF), and k-nearest neighbors were tested. In prediction of mortality, LASSO and linear SVM demonstrated high sensitivities (90.7% [95% confidence interval: 83.3, 97.3] and 92.0% [85.9, 98.1], respectively) and specificities (91.4% [90.3, 92.5] and 91.8%, [90.7, 92.9], respectively) while maintaining high specificities > 90%, as well as high area under the receiver operating characteristics curves (0.963 [0.946, 0.979] and 0.962 [0.945, 0.979], respectively). The most significant predictors for LASSO included old age and preexisting DM or cancer; for RF they were old age, infection route (cluster infection or infection from personal contact), and underlying hypertension. The proposed prediction model may be helpful for the quick triage of patients without having to wait for the results of additional tests such as laboratory or radiologic studies, during a pandemic when limited medical resources must be wisely allocated without hesitation.


Subject(s)
Coronavirus Infections/mortality , Machine Learning , Pneumonia, Viral/mortality , Adult , Aged , Aged, 80 and over , COVID-19 , Female , Humans , Male , Middle Aged , Models, Statistical , Mortality/trends , Pandemics , Republic of Korea
16.
Int J Infect Dis ; 99: 266-268, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-695925

ABSTRACT

OBJECTIVES: To delineate clinical characteristics of asymptomatic and symptomatic patients confirmed with COVID-19 in South Korea. METHODS: Data were obtained from the Korean National Health Insurance Service database linked to the Korea Centers for Disease Control and Prevention data. RESULTS: Among 10,237 patients (mean [SD] age, 45.0 [19.8] years; 60.1% female) who met the eligibility criteria for the study, 6,350 (62.0%) patients were asymptomatic, and 3,887(38.0%) patients were symptomatic. The mean and median age were similar between asymptomatic and symptomatic patients. Notably, we observed a U-shaped association between age group and the proportion of asymptomatic patients, with the nadir at 57.3% in the 40-49 age group. This U-shaped distribution was largely similar between men and women. The overall prevalence of asymptomatic individuals was higher, regardless of sex, residential area, income levels, and comorbid conditions. CONCLUSIONS: In this national cohort of over 10,000 patients with COVID-19, more than 60% of all cases in South Korea reported no symptoms at the time of diagnosis. Expanding criteria for contact tracing and testing to capture potential transmission before symptom onset should be urgently considered to inform control strategies for COVID-19.


Subject(s)
Asymptomatic Infections , Betacoronavirus , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Adult , COVID-19 , Cohort Studies , Female , Humans , Male , Middle Aged , Pandemics , Republic of Korea/epidemiology , SARS-CoV-2 , Young Adult
17.
J Korean Med Sci ; 35(26): e243, 2020 Jul 06.
Article in English | MEDLINE | ID: covidwho-633958

ABSTRACT

BACKGROUND: Mortality of coronavirus disease 2019 (COVID-19) is a major concern for quarantine departments in all countries. This is because the mortality of infectious diseases determines the basic policy stance of measures to prevent infectious diseases. Early screening of high-risk groups and taking action are the basics of disease management. This study examined the correlation of comorbidities on the mortality of patients with COVID-19. METHODS: We constructed epidemiologic characteristics and medical history database based on the Korean National Health Insurance Service Big Data and linked COVID-19 registry data of Korea Centers for Disease Control & Prevention (KCDC) for this emergent observational cohort study. A total of 9,148 patients with confirmed COVID-19 were included. Mortalities by sex, age, district, income level and all range of comorbidities classified by International Classification of Diseases-10 based 298 categories were estimated. RESULTS: There were 3,556 male confirmed cases, 67 deaths, and crude death rate (CDR) of 1.88%. There were 5,592 females, 63 deaths, and CDR of 1.13%. The most confirmed cases were 1,352 patients between the ages of 20 to 24, followed by 25 to 29. As a result of multivariate logistic regression analysis that adjusted epidemiologic factors to view the risk of death, the odds ratio of death would be hemorrhagic conditions and other diseases of blood and blood-forming organs 3.88-fold (95% confidence interval [CI], 1.52-9.88), heart failure 3.17-fold (95% CI, 1.88-5.34), renal failure 3.07-fold (95% CI, 1.43-6.61), prostate malignant neoplasm 2.88-fold (95% CI, 1.01-8.22), acute myocardial infarction 2.38-fold (95% CI, 1.03-5.49), diabetes was 1.82-fold (95% CI, 1.25-2.67), and other ischemic heart disease 1.71-fold (95% CI, 1.09-2.66). CONCLUSION: We hope that this study could provide information on high risk groups for preemptive interventions. In the future, if a vaccine for COVID-19 is developed, it is expected that this study will be the basic data for recommending immunization by selecting those with chronic disease that had high risk of death, as recommended target diseases for vaccination.


Subject(s)
Comorbidity , Coronavirus Infections/epidemiology , Coronavirus Infections/mortality , Pneumonia, Viral/epidemiology , Pneumonia, Viral/mortality , Adult , Aged , Betacoronavirus , Big Data , COVID-19 , Chronic Disease/epidemiology , Chronic Disease/mortality , Coronavirus Infections/therapy , Female , Humans , Male , Middle Aged , National Health Programs , Pandemics , Pneumonia, Viral/therapy , Republic of Korea/epidemiology , Risk Factors , SARS-CoV-2 , Young Adult
19.
J Korean Med Sci ; 35(25): e232, 2020 Jun 29.
Article in English | MEDLINE | ID: covidwho-619779

ABSTRACT

BACKGROUND: There is a controversy whether it is safe to continue renin-angiotensin system blockers in patients with coronavirus disease 2019 (COVID-19). We analyzed big data to investigate whether angiotensin-converting enzyme inhibitors and/or angiotensin II receptor blockers have any significant effect on the risk of COVID-19. Population-based cohort study was conducted based on the prescription data from nationwide health insurance records. METHODS: We investigated the 1,374,381 residents aged ≥ 40 years living in Daegu, the epicenter of the COVID-19 outbreak, between February and March 2020. Prescriptions of antihypertensive medication during the year before the outbreak were extracted from the National Health Insurance Service registry. Medications were categorized by types and stratified by the medication possession ratios (MPRs) of antihypertensive medications after controlling for the potential confounders. The risk of COVID-19 was estimated using a difference in difference analysis. RESULTS: Females, older individuals, low-income earners, and recently hospitalized patients had a higher risk of infection. Patients with higher MPRs of antihypertensive medications had a consistently lower risk of COVID-19 than those with lower MPRs of antihypertensive medications and non-users. Among patients who showed complete compliance, there was a significantly lower risk of COVID-19 for those prescribed angiotensin II receptor blockers (relative risk [RR], 0.751; 95% confidence interval [CI], 0.587-0.960) or calcium channel blockers (RR, 0.768; 95% CI, 0.601-0.980). CONCLUSION: Renin-angiotensin system blockers or other antihypertensive medications do not increase the risk of COVID-19. Patients should not stop antihypertensive medications, including renin-angiotensin system blockers, because of concerns of COVID-19.


Subject(s)
Angiotensin Receptor Antagonists/therapeutic use , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Antihypertensive Agents/therapeutic use , Calcium Channel Blockers/therapeutic use , Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Adult , Aged , Aged, 80 and over , Angiotensin Receptor Antagonists/adverse effects , Angiotensin-Converting Enzyme 2 , Angiotensin-Converting Enzyme Inhibitors/adverse effects , Antihypertensive Agents/adverse effects , Betacoronavirus/drug effects , COVID-19 , Calcium Channel Blockers/adverse effects , Female , Humans , Hypertension/drug therapy , Male , Middle Aged , Pandemics , Peptidyl-Dipeptidase A/metabolism , Renin-Angiotensin System/drug effects , Republic of Korea/epidemiology , SARS-CoV-2
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