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Korean J Intern Med
. 2020 Sep 23.
doi: 10.3904/kjim.2020.329. Online ahead of print.
Clinical implication and risk factor of pneumonia development in mild COVID-19 patients
Hyun Woo Lee 1 , Seo-Young Yoon 1 , Jung-Kyu Lee 1 , Tae Yeon Park 1 , Deog Kyeom Kim 1 , Hee Soon Chung 1 , Eun Young Heo 1
Affiliations
- PMID: 32972121
- DOI: 10.3904/kjim.2020.329
Abstract
Background/aims: Although a majority of coronavirus disease 2019 (COVID-19) cases were characterized as mild, data assessing the development of pneumonia in mild COVID-19 patients are limited. We examined the significance of pneumonia development on clinical course in hospitalized patients with mild COVID-19.
Methods: A retrospective cohort study was conducted via medical record review between February 25, 2020, and April 11, 2020 in a single center. The impact of pneumonia development on time to viral clearance in mild COVID-19 patients was evaluated in unadjusted and adjusted analyses. Risk factors associated with the development of pneumonia were also identified.
Results: Among mild COVID-19 patients, pneumonia with chest radiographic findings developed in 26.8%. The time to pneumonia detection was a median of 8.0 days from the onset of symptoms and 3.5 days from hospital admission. Multivariable analysis to predict pneumonia development identified age≥65 (OR=3.15 [95% CI=1.14-8.73]), cough (OR=2.18 [95% CI=1.29-3.68]), dyspnea (OR=3.58 [95%CI=1.10-11.69]), and diarrhea (OR=2.69 [95% CI=1.51-4.78]) as significant variables. Time to negative conversion was longer in the mild COVID-19 patients who developed pneumonia (23.6 days vs. 18.4 days, p=0.003). In Kaplan-Meier estimation and multivariable Cox regression analyses, newly developed pneumonia was significantly related with delayed time to negative conversion in mild COVID-19 patients (Log-rank test, p=0.02; HR=2.90 [95% CI=1.06-7.97]).
Conclusion: Development of pneumonia delayed viral clearance in mild COVID-19 patients. Patients with older age or diarrhea may need to be closely monitored, given the increased risk of pneumonia.
Keywords: Coronavirus disease 2019 (COVID-19); Mortality; Negative conversion; Pneumonia; Risk factors.