Estimating COVID-19 Infection and Severity Risks in Patients with Chronic Rhinosinusitis: A Korean Nationwide Cohort Study

Seung Won Lee; So Young Kim; Sung Yong Moon; Jee Myung Yang; Eun Kyo Ha; Hye Mi Jee; Jae Il Shin; Seong Ho Cho; Dong Keon Yon; Dong In Suh

doi:10.1016/j.jaip.2021.03.044

Estimating COVID-19 Infection and Severity Risks in Patients with Chronic Rhinosinusitis: A Korean Nationwide Cohort Study

J Allergy Clin Immunol Pract. 2021 Jun;9(6):2262-2271.e2. doi: 10.1016/j.jaip.2021.03.044. Epub 2021 Apr 28.

Authors

Seung Won Lee¹, So Young Kim², Sung Yong Moon¹, Jee Myung Yang³, Eun Kyo Ha⁴, Hye Mi Jee⁵, Jae Il Shin⁶, Seong Ho Cho⁷, Dong Keon Yon⁸, Dong In Suh⁹

Affiliations

¹ Department of Data Science, Sejong University College of Software Convergence, Seoul, South Korea.
² Department of Otorhinolaryngology-Head and Neck Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, South Korea. Electronic address: sossi81@hanmail.net.
³ Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
⁴ Department of Pediatrics, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea.
⁵ Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, South Korea.
⁶ Department of Pediatrics, Yonsei University College of Medicine, Seoul, South Korea.
⁷ Division of Allergy-Immunology, University of South Florida Morsani College of Medicine, Tampa, Fla.
⁸ Department of Pediatrics, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea. Electronic address: yonkkang@gmail.com.
⁹ Department of Pediatrics, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea. Electronic address: dongins0@snu.ac.kr.

Abstract

Background: Basic studies suggest that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can affect chronic rhinosinusitis (CRS), but there is unclear real-world evidence regarding the association of underlying CRS with the risk for SARS-CoV-2 infection and severe coronavirus disease 19 (COVID-19).

Objective: We aimed to determine whether CRS is associated with increased risk for SARS-CoV-2 infection and severe COVID-19.

Methods: Altogether, 219,959 adult patients who tested for SARS-CoV-2 in South Korea from January 1 to May 15, 2020 (excluding self-referral) were identified in this nested case-control study with propensity score matching. Data on SARS-CoV-2 test results and COVID-19 worsened outcomes (ie, the need for oxygen therapy, intensive care, or mechanical ventilation, and death) were obtained from the Health Insurance Review and Assessment Service of Korea.

Results: In this matched cohort, 380 of 12,217 patients with CRS (3.1%) tested positive for SARS-CoV-2 infection, compared with 310 patients without CRS (2.5%; adjusted odds ratio = 1.22; 95% confidence interval, 1.04-1.42). Moreover, 60 of 286 COVID-19 patients with CRS (21.0%) had severe COVID-19 outcomes, compared with 38 without CRS (13.3%; adjusted odds ratio = 1.71; 95% confidence interval, 1.09-2.71). Subgroup analysis identified that CRS patients with an absence of nasal polyps, prior intranasal corticosteroid use, or nonatopic type had a greater risk for SARS-CoV-2 infection and severe COVID-19 outcomes.

Conclusions: In patients with CRS, prior intranasal corticosteroid use, the absence of nasal polyps, or nonatopic type was associated with increased risk for SARS-CoV-2 infection and severe COVID-19 in the Korean nationwide cohort. Clinicians should be cautious in determining prognosis and care for patients with CRS amid the COVID-19 pandemic.

Keywords: COVID-19; Chronic rhinosinusitis; Intranasal corticosteroids; Nasal polyp; Severe acute respiratory syndrome 2.

MeSH terms

Adult
COVID-19*
Case-Control Studies
Cohort Studies
Humans
Pandemics*
Republic of Korea / epidemiology
SARS-CoV-2