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

Kyongsik Yun; Jeong Seok Lee; Eun Young Kim; Himanshu Chandra; Baek-Lok Oh; Jihoon Oh

doi:10.3389/fmed.2020.583060

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

Front Med (Lausanne). 2020 Nov 19:7:583060. doi: 10.3389/fmed.2020.583060. eCollection 2020.

Authors

Kyongsik Yun¹, Jeong Seok Lee², Eun Young Kim³, Himanshu Chandra⁴, Baek-Lok Oh⁵, Jihoon Oh⁶

Affiliations

¹ Computation and Neural Systems, California Institute of Technology, Pasadena, CA, United States.
² GENOME INSIGHT Inc., Daejeon, South Korea.
³ Division of Trauma and Surgical Critical Care, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
⁴ Anderson School of Management, University of California, Los Angeles, Los Angeles, CA, United States.
⁵ Department of Ophthalmology, Seoul National University Hospital, Seoul, South Korea.
⁶ Department of Psychiatry, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.

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.