Anatomy of comorbidity complexity of COVID-19: the case of hospitalized South Korean patients.

Abstract

Objectives\nWe aimed to examine how comorbidities are associated with outcome (illness severity or death) in hospitalized COVID-19 patients.\n\n\nMethods\nWe use data provided by Korea Disease Control & Prevention Agency, National Medical Center, which include the clinical and epidemiological patient data of all patients hospitalized with COVID-19, who were discharged on, or prior to, April 30, 2020, in South Korea. We conducted comorbidity network and multinomial logistic regression analyses to identify risk factors associated with the severity of and mortality from COVID-19 disease. The outcome variable is the categorized clinical severity scores (CSS): mild case (O2 treatment not needed), severe case (O2 treatment needed), and death.\n\n\nResults\nA total of 5,771 patients were included. In the fully adjusted model, chronic kidney disease (CKD); odds ratio, 2.59 [95% CI, 1.19 to 5.61] and chronic obstructive pulmonary disease (COPD); odds ratio, 3.19 [95% CI, 1.35 to 7.52] were significantly associated with case severity. The following were associated with an increased risk of death: CKD; odds ratio, 5.35 [95% CI, 2.00 to 14.31], Heart failure (HF) odds ratio, 3.15 [95% CI, 1.22 to 8.15], malignancy odds ratio, 3.38 [95% CI, 1.59 to 7.17], dementia odds ratio, 2.62 [95% CI, 1.45 to 4.73], and diabetes odds ratio, 2.26 [95% CI, 1.46 to 3.49]. Asthma and hypertension were associated with an increased risk of death, although this was not statistically significant.\n\n\nConclusion\nUnderlying diseases have different contributions to the severity of COVID-19 disease. To efficiently allocated limited medical resources, underlying comorbidities should be closely monitored, particularly chronic kidney disease (CKD), and chronic obstructive pulmonary disease (COPD), heart failure (HF) in the past.