How closely is COVID-19 related to HCoV, SARS, and MERS? : Clinical comparison of coronavirus infections and identification of risk factors influencing the COVID-19 severity using common data model (CDM)
Authors: Kim Yeon Hee , Ko Ye-Hee , Kim Sooyoung , Kim Kwangsoo 
Published: November 2020

Background

South Korea was one of the epicenters for both the 2015 Middle East Respiratory Syndrome and 2019 COVID-19 outbreaks. However, there has been a lack of published literature, especially using the Electronic Medical Records (EMR), that provides a comparative summary of the prognostic factors present in the coronavirus-derived diseases. Therefore, in this study, we aimed to evaluate the distinct clinical traits between the infected patients of different coronaviruses to observe the extent of resemblance within the clinical features and to identify unique factors by disease severity that may influence the prognosis of COVID-19 patients.

Methods

We utilized the common data model (CDM), which is the database that houses the standardized EMR. We set COVID-19 as a reference group in comparative analyses. For statistical methods, we used Levene’s test, one-way Anova test, Scheffe post-hoc test, Games-howell post-hoc test, and Student’s t-test for continuous variables, and chi-squared test and Fisher’s exact test for categorical variables. With the variables that reflected similarity in more than two comparisons between the disease groups yet significantly different between the COVID-19 severity groups, we performed univariate logistic regression to identify which common manifestations in coronaviruses are risk factors for severe COVID-19 outcomes.

Findings

We collected the records of 2840 COVID-19 patients, 67 MERS patients (several suspected cases included), 43 SARS suspected patients, and 87 HCoV patients. We found that a significantly higher number of COVID-19 patients had been diagnosed with comorbidities compared to the MERS and HCoV groups (48.5% vs. 10.4 %, p < 0.001 and 48.5% vs. 35.6%, p < 0.05) and also that the non-mild COVID-19 patients reported more comorbidities than the mild group (55.7% vs. 47.8%, p < 0.05). There were overall increases in the levels of fibrinogen in both sets of disease and severity groups. The univariate logistic regression showed that the male sex (OR: 1.66; CI: 1.29-2.13, p < 0.001), blood type A (OR: 1.80; CI: 1.40-2.31, p < 0.001), renal disease (OR: 3.27; CI: 2.34-4.55, p < 0.001), decreased creatinine level (OR: 2.05; CI: 1.45-2.88, p < 0.001), and elevated fibrinogen level (OR: 1.59, CI: 1.21-2.09, p < 0.001) are associated with the severe COVID-19 prognosis, whereas the patients reporting gastrointestinal symptoms (OR: 0.42; CI: 0.23-0.72, p < 0.01) and increased alkaline phosphatase (OR: 0.73; CI: 0.56-0.94, p < 0.05) are more less likely to experience complications and other severe outcomes from the SARS-CoV-2 infection.

Interpretation

The present study observed the highest resemblance between the COVID-19 and SARS groups as clinical manifestations that were present in SARS group were linked to the severity of COVID-19. In particular, male individuals with blood type A and previous diagnosis of kidney failure were shown to be more susceptible to developing the poorer outcomes during COVID-19 infection, with a presentation of elevated level of fibrinogen.