Park Hyun-Young, Lee Jung Hyun, Lim Nam-Kyoo, Lim Do Sang, Hong Sung Ok, Park Mi-Jin, Lee Seon Young, Kim Geehyuk, Park Jae Kyung, Song Dae Sub, Chai Hee Youl, Kim Sung Soo, Lee Yeon-Kyeng, Park Hye Kyung, Kwon Jun-Wook, Jeong Eun Kyeong
COVID-19 National Emergency Response Center, Korea Centers for Disease Control and Prevention, Cheongju city 28159, South Korea.
Lancet Reg Health West Pac. 2020 Dec;5:100061. doi: 10.1016/j.lanwpc.2020.100061. Epub 2020 Nov 27.
More than 13,000 cases were reported to be infected with COVID-19 by RT-PCR in South Korea. Most studies report clinical characteristics of hospitalized patients with COVID-19; the full spectrum of disease severity has thus not yet been well described.
Using retrospective observational methods, this study analyzed factors affecting early clinical symptoms, clinical progress, and severity of disease for COVID-19 positive patients released from quarantine to provide information on establishing optimized care for new patients. The medical data of 7803 laboratory-confirmed patients who had been discharged or died by April 30, 2020 were analyzed using multivariate logistic regression analysis.
On admission, 7383 (94•5%) patients were asymptomatic or showed mild illness, and 372 (4•8%) patients were severe illness. Also, 48 (0 0•6%) were hospitalized with critically ill when diagnosed. Most patients with asymptomatic or mild illness on admission remained mild until discharge, 253 (3•4%) progressed to severe illness, and 83 (1•1%) died in hospital. However, the case fatality were 29•8% and 62•5% in severe and critically ill patients, respectively. At admission, 73•0% of hospitalized patients had symptoms; most common were cough (42•5%), sputum (28•8%), and fever (20•1%). Only 35•2% of laboratory confirmed patients admitted to the temporary care facility complained of symptoms. Increasing odds of being critically ill was associated with older age (OR 28•93, 95% CI 13•34-62•75 for age >70y, vs. age <50 y; <0•0001), being male (OR 2•15, 95% CI1•59-2•89; <0•0001), fever (OR 2•52, 95% CI 1.84-3•45; <0•0001), and shortness of breath (OR 7•40, 95% CI 5•37-10•19; <0•0001). Comorbid illness significantly increased risk of critical illness or death.
Most cases were discharged as asymptomatic or recovered from mild illness, and only 9•7% developed severe disease requiring oxygen therapy or more. Case fatality rate was 2•9%, and markedly increased in those over age 50. Risk factors such as age, sex, fever, shortness of breath, and underlying disease can be useful in predicting future clinical severity. Additionally, the number of confirmed asymptomatic COVID-19 patients significantly contribute to continued spread.
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韩国通过逆转录聚合酶链反应（RT-PCR）报告了超过13000例新冠肺炎感染病例。大多数研究报告了新冠肺炎住院患者的临床特征；因此，疾病严重程度的全貌尚未得到充分描述。
本研究采用回顾性观察方法，分析了从隔离中解除隔离的新冠肺炎阳性患者早期临床症状、临床进展和疾病严重程度的影响因素，以提供有关为新患者建立优化护理的信息。使用多因素逻辑回归分析对2020年4月30日前出院或死亡的7803例实验室确诊患者的医疗数据进行了分析。
入院时，7383例（94.5%）患者无症状或症状轻微，372例（4.8%）患者病情严重。此外，48例（0.6%）确诊时为危重症住院患者。大多数入院时无症状或症状轻微的患者直至出院时仍症状轻微，253例（3.4%）进展为重症，83例（1.1%）在医院死亡。然而，重症和危重症患者的病死率分别为29.8%和62.5%。入院时，73.0%的住院患者有症状；最常见的是咳嗽（42.5%）、咳痰（28.8%）和发热（20.1%）。只有35.2%入住临时护理机构的实验室确诊患者主诉有症状。年龄较大（70岁以上vs.50岁以下；OR 28.93，95%CI 13.34 - 62.75；P<0.0001）、男性（OR 2.15，95%CI 1.59 - 2.89；P<0.0001）、发热（OR 2.52，95%CI 1.84 - 3.45；P<0.0001）和呼吸急促（OR 7.40，95%CI 5.37 - 10.19；P<0.0001）与危重症几率增加相关。合并症显著增加了危重症或死亡风险。
大多数病例无症状出院或从轻症中康复，只有9.7%发展为需要氧疗或更高级治疗的重症。病死率为2.9%，50岁以上人群病死率显著增加。年龄、性别、发热、呼吸急促和基础疾病等危险因素有助于预测未来的临床严重程度。此外，确诊的无症状新冠肺炎患者数量对疫情持续传播有显著影响。
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