Clinical Characteristics of COVID-19: Clinical Dynamics of Mild Severe Acute Respiratory Syndrome Coronavirus 2 Infection Detected by Early Active Surveillance

• DOI: 10.3346/jkms.2020.35.e297
• Publication Date: 2020-08-11T06:29:10Z
• Authors: Hyeon Jeong Suh; Deok Hee Kim; Eun Young Heo; Hyun Woo Lee; Jung-Kyu Lee; Chang-Seop Lee; Mijeong Kim; Yong Duk Jeon; Jin-Won Chung; Young Keun Kim; Pyo Jin Shin; Mi Suk Lee; Jin Suk Kang; Myung Jin Lee; Baek-Nam Kim; Sang-Won Park
• Keywords: Adult; Male; SARS-CoV-2; Pneumonia, Viral; COVID-19; Middle Aged; Viral Load; Real-Time Polymerase Chain Reaction; 3. Good health; Oxygen; Betacoronavirus; 03 medical and health sciences; Early Diagnosis; 0302 clinical medicine; Humans; Original Article; Female; Coronavirus Infections; Pandemics; Aged

There is limited information describing the presenting characteristics and dynamic clinical changes in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection diagnosed in the early phase of illness. This study is a case series of patients with coronavirus disease 2019 (COVID-19) admitted to 11 hospitals in Korea.Patients with confirmed SARS-CoV-2 infection by positive polymerase chain reaction (PCR) testing of respiratory specimens by active surveillance that were finally discharged between February 20 and April 30, 2020 were included. Patients were classified into mild and non-mild groups on initial admission according to oxygen demand and Sequential Organ Failure Assessment score, and the mild group was followed up and subgrouped into non-aggravation and aggravation groups.A total of 161 patients with SARS-CoV2 infection were enrolled. Among the mild group of 136 patients, 11.7% of patients experienced clinical aggravation during hospitalization, but there was no initial clinical parameter on admission predicting their aggravation. Fever (odds ratio [OR], 4.56), thrombocytopenia (OR, 12.87), fever (OR, 27.22) and lactate dehydrogenase (LDH) > 300 U/L (OR, 18.35), and CRP > 1 mg/dL (OR, 11.31) significantly indicated aggravation in the 1st, 2nd, 3rd, and 4th 5-day periods, respectively. PCR positivity lasted for a median of 22 days and 32 days after the onset of illness in the non-aggravation and aggravation groups, respectively.Old age was associated with early severe presentation. Clinical aggravation among asymptomatic or mild patients could not be predicted initially but was heralded by fever and several laboratory markers during the clinical course.