Background This study aimed to determine the parameters for worsening oxygenation in non-severe coronavirus disease 2019 (COVID-19) pneumonia. Methods This retrospective cohort study included cases of confirmed COVID-19 pneumonia in a public hospital in South Korea. The worsening oxygenation group was defined as that with SpO 2 ≤94% or received oxygen or mechanical ventilation (MV) throughout the clinical course versus the non-worsening oxygenation group that did not experience any respiratory event. Parameters were compared, and the extent of viral pneumonia from an initial chest computed tomography (CT) was calculated using artificial intelligence (AI) and measured visually by a radiologist. Results We included 136 patients, with 32 (23.5%) patients in the worsening oxygenation group; of whom, two needed MV and one died. Initial vital signs and duration of symptoms showed no difference between the two groups; however, univariate logistic regression analysis revealed that a variety of parameters on admission were associated with an increased risk of a desaturation event. A subset of patients was studied to eliminate potential bias, that ferritin ≥280 μg/L (p=0.029), lactate dehydrogenase ≥240 U/L (p=0.029), pneumonia volume (p=0.021), and extent (p=0.030) by AI, and visual severity scores (p=0.042) were the predictive parameters for worsening oxygenation in a sex-, age-, and comorbid illness-matched case-control study using propensity score (n=52). Conclusion Our study suggests that initial CT evaluated by AI or visual severity scoring as well as serum markers of inflammation on admission are significantly associated with worsening oxygenation in this COVID-19 pneumonia cohort.

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Background: This study aimed to determine parameters for worsening oxygenation in mild COVID-19 pneumonia.Methods: This retrospective cohort study included confirmed COVID-19 pneumonia in a single public hospital in South Korea from January to April 2020. Parameters were compared between the two groups on the basis of clinical course: the desaturation group was defined as those with oxygen saturation ≤ 94% on ambient air, or received oxygen or mechanical ventilation (MV) throughout the clinical course versus the nonevent group who were without any respiratory event up to 28 days. The severity and extent of viral pneumonia from an initial single chest CT were calculated using artificial intelligence (AI) algorithms and measured visually by a radiologist. Results: We included 136 patients with 32 (23.5%) in the desaturation group, of whom two needed MV and one died. Initial vital signs and duration of symptoms showed no difference between the two groups, however, univariate logistic regression analysis revealed that a variety of parameters at admission were associated with an increased risk of a desaturation event. In a sex-, age-, and comorbid illness-matched case-control study, ferritin ≥ 280 μg/L (OR 3.600, 95% CI 1.142-11.346; p=0.029), LDH≥ 240 U/L (OR 3.600, 95% CI 1.142-11.346; p=0.029), pneumonia burden (OR 1.010, 95% CI 1.002-1.019; p=0.021), and extent (OR 1.194, 95% CI 1.017-1.401; p=0.030) by AI, and visual severity scores (OR 1.146, 95% CI 1.005-1.307; p=0.042) were the predictive parameters for worsening clinical course with desaturation. Conclusion: Our study presents initial CT parameters measured by AI or visual severity scoring as well as serum markers of inflammation at admission as the best parameters for predicting worsening oxygenation in the COVID-19 pneumonia cohort. Initial chest CT scans may help clinicians diagnose viral pneumonia and evaluate the prognosis in mild COVID-19.

Background Robust evidenced treatment strategy for Coronavirus disease 2019 (COVID-19) has not been established yet. Early, targeted, comprehensive management approach can be essential. Methods A lopinavir/ritonavir (LPV/r)-based antiviral treatment was administered to the patients with computed tomography (CT)-documented pneumonia. Medical records of patients with COVID-19, previously discharged or hospitalized for ≥ 21 days at the Seoul Medical Center from January 29 to April 15, 2020 were reviewed to analyze clinical and virological outcomes. Patients were divided into two groups (PCR-Negative conversion group vs. Non-negative conversion group and requiring oxygen group vs. Non-requiring oxygen group). Results In total, 136 patients with a mean age of 41.8 ± 18.2 years were included with median 3-day delay of hospitalization after illness. Thirteen (9.56%) were initially asymptomatic, and 5 (3.67%) were persistently asymptomatic. Eighty-five (62.5%) had CT-documented pneumonia, 94% of whom received LPV/r treatments. A total of 53 patients (38.97%) had negative polymerase chain reaction (PCR) results within 28 days. Eight (9.4%) out of 85 pneumonic patients received oxygen supplementation. Patients with initial lower respiratory symptoms showed significant delay in PCR negative conversion (> 28 days) (odds ratio [OR] 0.166; 95% confidence interval [CI] 0.067–0.477; P < 0.001). However, antiviral treatment for pneumonic patients was significantly related with early conversion within 28 days (OR 3.049; 95% CI 1.128–8.243; P = 0.028). Increasing age increased the likelihood of oxygen supplementation requirement in the pneumonic patient group (OR 1.108; 95% CI 1.021–1.202; P = 0.014). Conclusions Early, pneumonia targeted LPV/r-based antiviral therapy resulted in a significantly higher probability of negative conversion of PCR within 28 days compared to symptomatic treatment.