{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T12:15:43Z","timestamp":1792066543299,"version":"4.4.0"},"reference-count":35,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2021,7,19]],"date-time":"2021-07-19T00:00:00Z","timestamp":1626652800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>Underlying diseases might be risk factors for poor prognosis in patients with coronavirus disease (COVID-19); however, we still do not know whether these diseases are independent factors affecting prognosis, which type of underlying diseases are risk factors, and which type of clinical outcomes are affected. We retrospectively reviewed cohort data from 7,590 de-identified patients with COVID-19 who were diagnosed using severe acute respiratory syndrome-coronavirus-2 RNA polymerase chain reaction test up to May 15, 2020. We used linked-medical claims data provided by the Health Insurance Review and Assessment Service in South Korea. Underlying diseases were identified using the diagnostic codes in the patients\u2019 files from January 1, 2019 to December 31, 2019. The total mortality rate was 3.0% in patients with COVID-19. After adjusting for age, sex, and concomitant chronic conditions, we found that congestive heart failure, chronic pulmonary diseases, diabetes without chronic complications, renal diseases, and malignancy were factors that significantly increased the cost of treatment. Cerebrovascular disease, chronic pulmonary disease, and paralysis were found to be independent factors significant in prolonging hospital stay. Diabetes with chronic complications was independently associated with intensive care unit admission. In addition, underlying congestive heart failure (odds ratio [OR], 1.724; <jats:italic>P<\/jats:italic> = 0.003), dementia (OR, 1.598; <jats:italic>P<\/jats:italic> = 0.012), diabetes with and without chronic complications (OR, 1.821; <jats:italic>P<\/jats:italic> = 0.002 and OR, 1.518; <jats:italic>P<\/jats:italic> = 0.022, respectively), renal disease (OR, 2.299; <jats:italic>P<\/jats:italic> = 0.002), and malignancy (OR, 1.529; <jats:italic>P<\/jats:italic> = 0.039) were significant factors associated with death, even after adjustments. Underlying diseases were significant independent factors of the poor prognosis in patients with COVID-19. The effects were variable according to the type of underlying disease and clinical outcome. Therefore, patients with COVID-19 with underlying diseases should be monitored more closely because they are more at risk of a poor prognosis.<\/jats:p>","DOI":"10.1371\/journal.pone.0254258","type":"journal-article","created":{"date-parts":[[2021,7,19]],"date-time":"2021-07-19T17:36:50Z","timestamp":1626716210000},"page":"e0254258","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":33,"title":["Variable effects of underlying diseases on the prognosis of patients with COVID-19"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6131-691X","authenticated-orcid":true,"given":"Yong Jun","family":"Choi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ju-Young","family":"Park","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hye Sun","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin","family":"Suh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeung Yoon","family":"Song","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1525-1745","authenticated-orcid":true,"given":"Min-Kwang","family":"Byun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jae Hwa","family":"Cho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyung Jung","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1862-1003","authenticated-orcid":true,"given":"Hye Jung","family":"Park","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,7,19]]},"reference":[{"key":"pone.0254258.ref001","doi-asserted-by":"crossref","first-page":"1181","DOI":"10.3390\/nu12041181","article-title":"Optimal Nutritional Status for a Well-Functioning Immune System Is an Important Factor to Protect against Viral Infections","volume":"12","author":"PC Calder","year":"2020","journal-title":"Nutrients"},{"key":"pone.0254258.ref002","doi-asserted-by":"crossref","first-page":"e00705","DOI":"10.1002\/prp2.705","article-title":"Drug-drug interactions with candidate medications used for COVID-19 treatment: An overview","volume":"9","author":"H Rezaee","year":"2021","journal-title":"Pharmacology Research & Perspectives"},{"key":"pone.0254258.ref003","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1093\/gerona\/62.3.296","article-title":"Comorbidity in older adults: nosology of impairment, diseases, and conditions","volume":"62","author":"A Karlamangla","year":"2007","journal-title":"J Gerontol A Biol Sci Med Sci"},{"key":"pone.0254258.ref004","first-page":"e35","article-title":"Prevalence of Underlying Diseases in Hospitalized Patients with COVID-19: a Systematic Review and Meta-Analysis","volume":"8","author":"A Emami","year":"2020","journal-title":"Arch Acad Emerg Med"},{"key":"pone.0254258.ref005","first-page":"1","article-title":"Mortality Rate of Infection With COVID-19 in Korea From the Perspective of Underlying Disease","volume":"2020","author":"YJ Kang","journal-title":"Disaster Med Public Health Prep"},{"key":"pone.0254258.ref006","doi-asserted-by":"crossref","first-page":"1715","DOI":"10.1016\/S0140-6736(20)30854-0","article-title":"Estimating excess 1-year mortality associated with the COVID-19 pandemic according to underlying conditions and age: a population-based cohort study","volume":"395","author":"A Banerjee","year":"2020","journal-title":"Lancet"},{"key":"pone.0254258.ref007","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/0021-9681(87)90171-8","article-title":"A new method of classifying prognostic comorbidity in longitudinal studies: development and validation","volume":"40","author":"ME Charlson","year":"1987","journal-title":"J Chronic Dis"},{"key":"pone.0254258.ref008","doi-asserted-by":"crossref","first-page":"1130","DOI":"10.1097\/01.mlr.0000182534.19832.83","article-title":"Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data","volume":"43","author":"H Quan","year":"2005","journal-title":"Med Care"},{"key":"pone.0254258.ref009","doi-asserted-by":"crossref","first-page":"1526","DOI":"10.2215\/CJN.00950208","article-title":"Aspects of immune dysfunction in end-stage renal disease","volume":"3","author":"S Kato","year":"2008","journal-title":"Clin J Am Soc Nephrol"},{"key":"pone.0254258.ref010","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1016\/j.dsx.2020.04.004","article-title":"Diabetes in COVID-19: Prevalence, pathophysiology, prognosis and practical considerations","volume":"14","author":"AK Singh","year":"2020","journal-title":"Diabetes Metab Syndr"},{"key":"pone.0254258.ref011","doi-asserted-by":"crossref","first-page":"108142","DOI":"10.1016\/j.diabres.2020.108142","article-title":"COVID-19 and diabetes: Knowledge in progress","volume":"162","author":"A Hussain","year":"2020","journal-title":"Diabetes Research and Clinical Practice"},{"key":"pone.0254258.ref012","doi-asserted-by":"crossref","first-page":"E736","DOI":"10.1152\/ajpendo.00124.2020","article-title":"COVID-19 pandemic, coronaviruses, and diabetes mellitus","volume":"318","author":"R Muniyappa","year":"2020","journal-title":"Am J Physiol Endocrinol Metab"},{"key":"pone.0254258.ref013","doi-asserted-by":"crossref","first-page":"6049","DOI":"10.18632\/aging.103000","article-title":"Does comorbidity increase the risk of patients with COVID-19: evidence from meta-analysis","volume":"12","author":"B Wang","year":"2020","journal-title":"Aging (Albany NY)"},{"key":"pone.0254258.ref014","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1111\/j.1464-5491.2006.01861.x","article-title":"Plasma glucose levels and diabetes are independent predictors for mortality and morbidity in patients with SARS","volume":"23","author":"JK Yang","year":"2006","journal-title":"Diabet Med"},{"key":"pone.0254258.ref015","doi-asserted-by":"crossref","DOI":"10.1172\/jci.insight.131774","article-title":"Comorbid diabetes results in immune dysregulation and enhanced disease severity following MERS-CoV infection","volume":"4","author":"KA Kulcsar","year":"2019","journal-title":"JCI Insight"},{"key":"pone.0254258.ref016","first-page":"4956","article-title":"Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection: epidemiology, pathogenesis and clinical characteristics","volume":"22","author":"MS Nassar","year":"2018","journal-title":"Eur Rev Med Pharmacol Sci"},{"key":"pone.0254258.ref017","doi-asserted-by":"crossref","first-page":"1838","DOI":"10.1016\/S0140-6736(98)09286-1","article-title":"Endotoxin and immune activation in chronic heart failure: a prospective cohort study","volume":"353","author":"J Niebauer","year":"1999","journal-title":"Lancet"},{"key":"pone.0254258.ref018","first-page":"1","article-title":"Clinical Presentation of COVID19 in Dementia Patients","author":"A Bianchetti","year":"2020","journal-title":"J Nutr Health Aging"},{"key":"pone.0254258.ref019","article-title":"APOE e4 genotype predicts severe COVID-19 in the UK Biobank community cohort","author":"C-L Kuo","journal-title":"The Journals of Gerontology: Series A"},{"key":"pone.0254258.ref020","doi-asserted-by":"crossref","first-page":"1015","DOI":"10.5858\/1999-123-1015-IIAC","article-title":"Infection, immunity, and cancer","volume":"123","author":"DH Persing","year":"1999","journal-title":"Arch Pathol Lab Med"},{"key":"pone.0254258.ref021","doi-asserted-by":"crossref","first-page":"1903","DOI":"10.1200\/JCO.1991.9.10.1903","article-title":"Herpes simplex virus infection in the immunocompromised cancer patient","volume":"9","author":"CI Bustamante","year":"1991","journal-title":"J Clin Oncol"},{"key":"pone.0254258.ref022","article-title":"Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China","author":"D Wang","year":"2020","journal-title":"JAMA"},{"key":"pone.0254258.ref023","first-page":"e314","article-title":"COVID-19 in patients with HIV: clinical case series. The lancet","volume":"7","author":"JL Blanco","year":"2020","journal-title":"HIV"},{"key":"pone.0254258.ref024","doi-asserted-by":"crossref","first-page":"846","DOI":"10.1007\/s00134-020-05991-x","article-title":"Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China","volume":"46","author":"Q Ruan","year":"2020","journal-title":"Intensive Care Med"},{"key":"pone.0254258.ref025","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1097\/CM9.0000000000000744","article-title":"Clinical characteristics of novel coronavirus cases in tertiary hospitals in Hubei Province","volume":"133","author":"K Liu","year":"2020","journal-title":"Chin Med J (Engl)"},{"key":"pone.0254258.ref026","doi-asserted-by":"crossref","first-page":"1708","DOI":"10.1056\/NEJMoa2002032","article-title":"Clinical Characteristics of Coronavirus Disease 2019 in China","volume":"382","author":"W-j Guan","year":"2020","journal-title":"New England Journal of Medicine"},{"key":"pone.0254258.ref027","doi-asserted-by":"crossref","first-page":"1054","DOI":"10.1016\/S0140-6736(20)30566-3","article-title":"Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study","volume":"395","author":"F Zhou","year":"2020","journal-title":"Lancet"},{"key":"pone.0254258.ref028","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1016\/S0140-6736(20)30183-5","article-title":"Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China","volume":"395","author":"C Huang","year":"2020","journal-title":"Lancet"},{"key":"pone.0254258.ref029","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1186\/s13293-020-00304-9","article-title":"Impact of sex and gender on COVID-19 outcomes in Europe","volume":"11","author":"C Gebhard","year":"2020","journal-title":"Biology of Sex Differences"},{"key":"pone.0254258.ref030","article-title":"Clinical characteristics of refractory COVID-19 pneumonia in Wuhan, China","author":"P Mo","year":"2020","journal-title":"Clinical Infectious Diseases"},{"key":"pone.0254258.ref031","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1016\/j.cell.2020.02.052","article-title":"SARS-CoV-2 Cell Entry Depends on ACE2 and TMPRSS2 and Is Blocked by a Clinically Proven Protease Inhibitor","volume":"181","author":"M Hoffmann","year":"2020","journal-title":"Cell"},{"key":"pone.0254258.ref032","doi-asserted-by":"crossref","first-page":"L84","DOI":"10.1152\/ajplung.00071.2009","article-title":"Ectodomain shedding of angiotensin converting enzyme 2 in human airway epithelia","volume":"297","author":"HP Jia","year":"2009","journal-title":"Am J Physiol Lung Cell Mol Physiol"},{"key":"pone.0254258.ref033","doi-asserted-by":"crossref","first-page":"672","DOI":"10.1016\/S0008-6363(01)00479-5","article-title":"Renin angiotensin system and gender differences in the cardiovascular system","volume":"53","author":"M Fischer","year":"2002","journal-title":"Cardiovasc Res"},{"key":"pone.0254258.ref034","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1038\/nrd2032","article-title":"Therapeutic implications of the gender-specific aspects of cardiovascular disease","volume":"5","author":"V. Regitz-Zagrosek","year":"2006","journal-title":"Nat Rev Drug Discov"},{"key":"pone.0254258.ref035","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1186\/2042-6410-1-6","article-title":"Sex differences in renal angiotensin converting enzyme 2 (ACE2) activity are 17\u03b2-oestradiol-dependent and sex chromosome-independent","volume":"1","author":"J Liu","year":"2010","journal-title":"Biol Sex Differ"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0254258","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,7,19]],"date-time":"2021-07-19T17:37:22Z","timestamp":1626716242000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0254258"}},"subtitle":[],"editor":[{"given":"Xia","family":"Jin","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2021,7,19]]},"references-count":35,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2021,7,19]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0254258","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,7,19]]}}}