Clinical Characteristics and Disease Progression in Early-Stage COVID-19 Patients in South Korea

Abstract

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. The cohort comprised 293 patients with COVID-19 from 5 March 2020, to 18 March 2020. The Korea Centers for Disease Control and Prevention (KCDC) classification system was used to triage patients. 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. After adjusting for confounding variables, prior history of drug use, including ARB, ibuprofen, and DPP4i was not a risk factor associated with disease progression. Patients treated with lopinavir/ritonavir had significantly shorter progression-free survival than those not receiving lopinavir/ritonavir. KCDC classification I clearly distinguished the improvement/stabilization group from the progression group of COVID-19 patients (AUC 0.817; 95% CI, 0.740-0.895).

Keywords: Korea centers for disease control and prevention (KCDC) classification; angiotensin II receptor blockers (ARB); coronavirus disease-19 (COVID-19); ibuprofen; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Figure 1

Triage algorithm and KCDC classification criteria for clinical severity of COVID-19 in South Korea. Abbreviations: KCDC, Korea Centers for Disease Control and Prevention; RT-PCR, real-time reverse transcription polymerase chain reaction Figure legend: The Living Treatment Center is a quarantine facility for mild or asymptomatic COVID-19 patients who are unable to self-isolate at home. The patients were checked for vital signs twice a day and immediately transferred to hospitals if their symptoms worsened. If their symptoms resolved, the patient was tested according to the standards for lifting the quarantine. Certain state-run facilities and accommodations are designated as Living Treatment Centers and are supplied with medical staff, medical equipment (pulse oximetry device, thermometer, blood pressure monitor, CPR kit, chest X-ray radiograph, etc.), individual relief kits (underwear, toiletries, face masks, etc.), and hygiene kits (thermometer and medical supplies).

Figure 2

Kaplan–Meier survival analysis of progression-free survival (A,B) and proportion of patients requiring hospitalization (C,D) according to lopinavir/ritonavir treatment for patients with COVID-19 before and after propensity-score matching Figure legend: Patients treated with lopinavir/ritonavir group showed significantly lower progression-free survival than the without lopinavir/ritonavir group before and after propensity-score matching. but there was no statistical difference in discharge proportion between the two groups.