The First 10 Days After Discharge Are Most Dangerous for COVID-19 Patients
Compared with patients with pneumonia and heart failure, patients with COVID-19 experience higher rates of readmission or death within the first 10 days following hospital discharge, according to new data.
To better understand the outcomes following hospitalization of COVID-19, the researchers conducted a study to measure the rate of readmission, reasons for readmission, and death rate following discharge. The study was conducted using data from 132 hospitals in the Veterans Affairs (VA) health care system. Patients included in the study were diagnosed with COVID-19 in the hospital or those who were diagnosed up to 14 days before or 7 days after hospitalization.
The researchers identified comparison cohorts in patients who were hospitalized with non-COVID pneumonia and heart failure within the same period. Demographics, use of the intensive care unit (ICU), length of hospitalization, invasive mechanical ventilation, and use of vasopressors were collected from the 3 different cohorts.
In total, 2179 patients were hospitalized for COVID-19 during the study period. The ICU contained 31.1% of the participants, 12.8% of the participants were mechanically ventilated, 14.1% of the participants received vasopressors, and 81.5% of participants survived to be discharged.
Within the 60-day discharge period, 19.9% of participants were readmitted, 9.1% had died, and 27.0% were readmitted or died. The most common diagnoses upon readmission was COVID-19 (30.2%), followed by sepsis, pneumonia, and heart failure. Upon readmission, 22.6% of the participants were in the ICU, 7.1% required mechanical ventilation, and 7.9% received vasopressors.
Comparing these results with results from the other cohorts, 97.8% of participants with pneumonia and 98.3% of participants with heart failure survived to discharge. At the 60-day readmission mark, participants with COVID-19 had lower rates of readmission compared with participants who had pneumonia (26.1% vs 31.7%) and heart failure (27.0% vs 37.0%).
However, within the first 10 days following discharge, participants with COVID-19 had a higher rate of readmission or death compared with patients with pneumonia (13.4% vs 9.7%) and heart failure (13.9% vs. 8.8%).
This increase in readmission and death within 10 days following hospital discharge suggests a period of increased risk for clinical deterioration. Of note, as the study took place at VA hospitals, most patients were older and male; these patient populations may already be at higher risk for severe COVID-19.
—Audrey Amos, PharmD
Reference:
Donnelly JP, Wang XQ, Iwashyna TJ, et al. Readmission and death after initial hospital discharge among patients with COVID-10 in a large multihospital system. JAMA. December 14, 2020. doi:10.1001/jama.2020.21465