J Korean Med Sci.  2021 Jan;36(1):e12. 10.3346/jkms.2021.36.e12.

Clinical Characteristics and Outcomes of COVID-19 Cohort Patients in Daegu Metropolitan City Outbreak in 2020

Affiliations
  • 1Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
  • 2Daegu Medical Center, Daegu, Korea
  • 3Department of Clinical Pathology, School of Medicine, Kyungpook National University, Daegu, Korea
  • 4Department of Public Health, Kyungpook National University Hospital, Daegu, Korea
  • 5Department of Preventive Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
  • 6Korea Workers' Compensation & Welfare Services Daegu Hospital, Daegu, Korea
  • 7Interdisciplinary Program in Bioinformatics, Seoul National University, Seoul, Korea
  • 8Department of Statistics, College of Natural Science, Seoul National University, Seoul, Korea

Abstract

Background
A coronavirus disease 2019 (COVID-19) outbreak started in February 2020 and was controlled at the end of March 2020 in Daegu, the epicenter of the coronavirus outbreak in Korea. The aim of this study was to describe the clinical course and outcomes of patients with COVID-19 in Daegu.
Methods
In collaboration with Daegu Metropolitan City and Korean Center for Diseases Control, we conducted a retrospective, multicenter cohort study. Demographic, clinical, treatment, and laboratory data, including viral RNA detection, were obtained from the electronic medical records and cohort database and compared between survivors and non-survivors. We used univariate and multi-variable logistic regression methods and Cox regression model and performed Kaplan–Meier analysis to determine the risk factors associated with the 28-day mortality and release from isolation among the patients.
Results
In this study, 7,057 laboratory-confirmed patients with COVID-19 (total cohort) who had been diagnosed from February 18 to July 10, 2020 were included. Of the total cohort, 5,467 were asymptomatic to mild patients (77.4%) (asymptomatic 30.6% and mild 46.8%), 985 moderate (14.0%), 380 severe (5.4%), and 225 critical (3.2%). The mortality of the patients was 2.5% (179/7,057). The Cox regression hazard model for the patients with available clinical information (core cohort) (n = 2,254) showed the risk factors for 28-day mortality: age > 70 (hazard ratio [HR], 4.219, P = 0.002), need for O 2 supply at admission (HR, 2.995; P = 0.001), fever (> 37.5°C) (HR, 2.808; P = 0.001), diabetes (HR, 2.119; P = 0.008), cancer (HR, 3.043; P = 0.011), dementia (HR, 5.252; P = 0.008), neurological disease (HR, 2.084; P = 0.039), heart failure (HR, 3.234;P = 0.012), and hypertension (HR, 2.160; P = 0.017). The median duration for release from isolation was 33 days (interquartile range, 24.0–46.0) in survivors. The Cox proportional hazard model for the long duration of isolation included severity, age > 70, and dementia.
Conclusion
Overall, asymptomatic to mild patients were approximately 77% of the total cohort (asymptomatic, 30.6%). The case fatality rate was 2.5%. Risk factors, including older age, need for O 2 supply, dementia, and neurological disorder at admission, could help clinicians to identify COVID-19 patients with poor prognosis at an early stage.

Keyword

COVID-19; Outcome; Outbreak; Mortality; Case Fatality Rate

Figure

  • Fig. 1 Patient flow diagram of 2,254 confirmed patients with coronavirus disease 2019 from the core cohort for the analysis of the clinical course and outcome.KCDC = Korea Centers for Diseases Control and Prevention, PCR = polymerase chain reaction.

  • Fig. 2 A pie graph of the distribution of severity (five categories) of patients with coronavirus disease 2019 from the (A) total cohort (n = 7,057) and (B) core cohort (n = 2,254).

  • Fig. 3 Distribution of symptoms and signs of patients with coronavirus disease 2019.

  • Fig. 4 Kaplan–Meier plots with log-rank tests for the risk factors of the 28-day mortality in coronavirus disease 2019 patients: age ≥ 70, diabetes, need for O2 supply at admission, and infiltration on chest X-ray at initial diagnosis.


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Reference

1. Kim JH, An AR, Min PK, Bitton A, Gawande AA. How South Korea responded to the COVID-19 outbreak in Daegu. NEJM Catal Innov Care Deliv. 2020; 1(4):1–14.
Article
2. Lee Y, Min P, Lee S, Kim SW. Prevalence and duration of acute loss of smell or taste in COVID-19 patients. J Korean Med Sci. 2020; 35(18):e174. PMID: 32383370.
Article
3. Kim SW, Lee KS, Kim K, Lee JJ, Kim JY. Daegu Medical Association. A brief telephone severity scoring system and therapeutic living centers solved acute hospital-bed shortage during the COVID-19 outbreak in Daegu, Korea. J Korean Med Sci. 2020; 35(15):e152. PMID: 32301298.
Article
4. Sung HK, Kim JY, Heo J, Seo H, Jang YS, Kim H, et al. Clinical course and outcomes of 3,060 patients with coronavirus disease 2019 in Korea, January–May 2020. J Korean Med Sci. 2020; 35(30):e280. PMID: 32743995.
Article
5. Park Y, Huh IS, Lee J, Kang CR, Cho SI, Ham HJ, et al. Application of testing-tracing-treatment strategy in response to the COVID-19 outbreak in Seoul, Korea. J Korean Med Sci. 2020; 35(45):e396. PMID: 33230987.
Article
6. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020; 382(18):1708–1720. PMID: 32109013.
7. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020; 395(10229):1054–1062. PMID: 32171076.
Article
8. Zhu FC, Guan XH, Li YH, Huang JY, Jiang T, Hou LH, et al. Immunogenicity and safety of a recombinant adenovirus type-5-vectored COVID-19 vaccine in healthy adults aged 18 years or older: a randomised, double-blind, placebo-controlled, phase 2 trial. Lancet. 2020; 396(10249):479–488. PMID: 32702299.
Article
9. Epidemiology Working Group for NCIP Epidemic Response, Chinese Center for Disease Control and Prevention. The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China. Zhonghua Liu Xing Bing Xue Za Zhi. 2020; 41(2):145–151. PMID: 32064853.
10. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020; 395(10223):507–513. PMID: 32007143.
Article
11. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020; 382(18):1708–1720. PMID: 32109013.
12. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020; 395(10223):497–506. PMID: 31986264.
Article
13. Kim ES, Chin BS, Kang CK, Kim NJ, Kang YM, Choi JP, et al. Clinical course and outcomes of patients with severe acute respiratory syndrome coronavirus 2 infection: a preliminary report of the first 28 patients from the Korean Cohort Study on COVID-19. J Korean Med Sci. 2020; 35(13):e142. PMID: 32242348.
Article
14. Lechien JR, Chiesa-Estomba CM, De Siati DR, Horoi M, Le Bon SD, Rodriguez A, et al. Olfactory and gustatory dysfunctions as a clinical presentation of mild-to-moderate forms of the coronavirus disease (COVID-19): a multicenter European study. Eur Arch Otorhinolaryngol. 2020; 277(8):2251–2261. PMID: 32253535.
Article
15. Giacomelli A, Pezzati L, Conti F, Bernacchia D, Siano M, Oreni L, et al. Self-reported olfactory and taste disorders in SARS-CoV-2 patients: a cross-sectional study. Clin Infect Dis. 2020.
16. Eliezer M, Hautefort C, Hamel AL, Verillaud B, Herman P, Houdart E, et al. Sudden and complete olfactory loss function as a possible symptom of COVID-19. JAMA Otolaryngol Head Neck Surg. 2020; 146(7):674–675. PMID: 32267483.
17. Jang Y, Son HJ, Lee S, Lee EJ, Kim TH, Park SY. Olfactory and taste disorder: The first and only sign in a patient with SARS-CoV-2 pneumonia. Infect Control Hosp Epidemiol. 2020; 41(9):1103. PMID: 32307026.
Article
18. Stokes EK, Zambrano LD, Anderson KN, Marder EP, Raz KM, El Burai Felix S, et al. Coronavirus Disease 2019 Case Surveillance — United States, January 22–May 30, 2020. MMWR Morb Mortal Wkly Rep. 2020; 69(24):759–765. PMID: 32555134.
Article
19. Ooi EE, Low JG. Asymptomatic SARS-CoV-2 infection. Lancet Infect Dis. 2020; 20(9):996–998. PMID: 32539989.
Article
20. Oran DP, Topol EJ. Prevalence of asymptomatic SARS-CoV-2 infection: a narrative review. Ann Intern Med. 2020; 173(5):362–367. PMID: 32491919.
21. Meyerowitz-Katz G, Merone L. A systematic review and meta-analysis of published research data on COVID-19 infection fatality rates. Int J Infect Dis. 2020; 101:138–148. PMID: 33007452.
Article
22. Kenyon C. COVID-19 Infection fatality rate associated with incidence-a population-level analysis of 19 Spanish autonomous communities. Biology (Basel). 2020; 9(6):128.
Article
23. Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA. 2020; 323(13):1239–1242. PMID: 32091533.
24. Williamson EJ, Walker AJ, Bhaskaran K, Bacon S, Bates C, Morton CE, et al. Factors associated with COVID-19-related death using OpenSAFELY. Nature. 2020; 584(7821):430–436. PMID: 32640463.
Article
25. Deng G, Yin M, Chen X, Zeng F. Clinical determinants for fatality of 44,672 patients with COVID-19. Crit Care. 2020; 24(1):179. PMID: 32345311.
Article
26. Hariyanto TI, Putri C, Situmeang RF, Kurniawan A. Dementia is a predictor for mortality outcome from coronavirus disease 2019 (COVID-19) infection. Eur Arch Psychiatry Clin Neurosci. Forthcoming 2020. DOI: 10.1007/s00406-020-01205-z.
Article
27. Moon SS, Lee K, Park J, Yun S, Lee YS, Lee DS. Clinical characteristics and mortality predictors of COVID-19 patients hospitalized at nationally-designated treatment hospitals. J Korean Med Sci. 2020; 35(36):e328. PMID: 32924343.
Article
28. Lee JY, Hong SW, Hyun M, Park JS, Lee JH, Suh YS, et al. Epidemiological and clinical characteristics of coronavirus disease 2019 in Daegu, South Korea. Int J Infect Dis. 2020; 98:462–466. PMID: 32702415.
Article
29. Wölfel R, Corman VM, Guggemos W, Seilmaier M, Zange S, Müller MA, et al. Virological assessment of hospitalized patients with COVID-2019. Nature. 2020; 581(7809):465–469. PMID: 32235945.
Article
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