Severe COVID-19 Illness: Risk Factors and Its Burden on Critical Care Resources

Abstract

In South Korea, the first confirmed case of coronavirus 2019 (COVID-19) was detected on January 20, 2020. After a month, the number of confirmed cases surged, as community transmission occurred. The local hospitals experienced severe shortages in medical resources such as mechanical ventilators and extracorporeal membrane oxygenation (ECMO) equipment. With the medical claims data of 7,590 COVID-19 confirmed patients, this study examined how the demand for major medical resources and medications changed during the outbreak and subsequent stabilization period of COVID-19 in South Korea. We also aimed to investigate how the underlying diseases and demographic factors affect disease severity. Our findings revealed that the risk of being treated with a mechanical ventilator or ECMO (critical condition) was almost twice as high in men, and a previous history of hypertension, diabetes, and psychiatric diseases increased the risk for progressing to critical condition [Odds Ratio (95% CI), 1.60 (1.14-2.24); 1.55 (1.55-2.06); 1.73 (1.25-2.39), respectively]. Although chronic pulmonary disease did not significantly increase the risk for severity of the illness, patients with a Charlson comorbidity index score of ≥5 and those treated in an outbreak area had an increased risk of developing a critical condition [3.82 (3.82-8.15); 1.59 (1.20-2.09), respectively]. Our results may help clinicians predict the demand for medical resources during the spread of COVID-19 infection and identify patients who are likely to develop severe disease.

Keywords: COVID-19; ECMO—extracorporeal membrane oxygenation; hydroxychloroquine; severity; ventilator.

Figure 1

Utilization of medical resources during the spread of COVID-19. (A) Cumulative number of procedures of medical equipment (mechanical ventilator, extracorporeal membrane oxygenation, and continuous renal replacement therapy). (B) Cumulative number of medical imaging. (C) Cumulative number of medications. Number of COVID-19 confirmed patients and COVID-19 related deaths are based on the entire patients (n = 10,801, as of May 4, 2020), and graph of medical resources based on the dataset of the medical claims submitted to the Health Insurance Review and Assessment Service (n = 7,590).