Frequency and factors associated with hospital readmission after COVID-19 hospitalization: the importance of post-COVID diarrhea

Freire, Maristela Pinheiro; Oliveira, Maura Salaroli de; Magri, Marcello Mihailenko Chaves; Tavares, Bruno de Melo; Marinho, Igor Maia; Nastri, Ana Catharina de Seixas Santos; Busatto, Geraldo F.; Levin, Anna S.

doi:10.1016/j.clinsp.2022.100061

Cited by 9 publications

(3 citation statements)

References 21 publications

(24 reference statements)

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“…По данным литературы, повторные госпитализации в единичных случаях происходят вследствие развития острого гастроэнтерита, Clostridium difficile ассоциированного колита [6,10,23,29]. Исследование, в ходе которого осуществлялось наблюдение за пациентами, выписанными из стационара после COVID-19, показало, что 22% жалуются на персистирующую диарею, а наличие диареи после выписки существенно увеличивает риск повторной госпитализации [7]. При этом примерно половина пациентов, повторно поступаю щих в стационар по поводу инфекций (пневмония, инфекция мочевыводящих путей, симптомы острой респираторной вирусной инфекции), сообщают о наличии у них жидкого частого стула [7].…”

Section: Covid-19unclassified

“…Исследование, в ходе которого осуществлялось наблюдение за пациентами, выписанными из стационара после COVID-19, показало, что 22% жалуются на персистирующую диарею, а наличие диареи после выписки существенно увеличивает риск повторной госпитализации [7]. При этом примерно половина пациентов, повторно поступаю щих в стационар по поводу инфекций (пневмония, инфекция мочевыводящих путей, симптомы острой респираторной вирусной инфекции), сообщают о наличии у них жидкого частого стула [7]. Возможно, антибиотик-ассоциированная диарея является недооцененным фактором, вносящим значимый вклад в частоту и в причины повторного направления в стационар.…”

Section: Covid-19unclassified

“…При этом более 85% повторных госпитализаций случаются в течение месяца после выписки [4,5]. Мужской пол, принадлежность к старшим возрастным группам, ожирение и ряд сопутствующих хронических заболеваний, глюкокортикоидная терапия и некоторые данные лабораторных исследований ассоциированы с повышенным риском повторного стационарного лечения [3,[6][7][8][9][10][11]. В исследованиях, где большинство включенных в анализ пациентов были мужчинами и/или старческого возраста, были получены наибольшие значения удельного веса повторных госпитализаций -20-27% [8,12,13].…”

Section: Introductionunclassified

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Hospital readmissions of patients with COVID-19: causes, features, outcomes

et al. 2023

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Introduction. On average, 10% of patients hospitalized due to new coronavirus infection (COVID-19) will be readmitted. To date, the reasons for readmission and the characteristics of these cases are not fully presented.The aim of the study was to analyze readmissions of COVID-19 patients to identify the causes of readmission, clinical features, examination data and treatment outcomes.Materials and methods. The study was performed retrospectively by using electronic records of the medical cases of the St. Petersburg City Hospital of St. George. Inclusion criteria: 1) the presence of two or more hospitalizations during 2020–2021; 2) COVID-19 confirmed by polymerase chain reaction within 14 days before or during the first hospitalization, or the detection of changes in the lungs with a high probability associated with COVID-19 during primary computed tomography. One hundred and two people met the specified criteria.Results. In 85% of cases, the cause of re-admission was symptoms of respiratory infection; in 13% – thrombotic events (pulmonary embolism, acute cerebrovascular accident, deep vein thrombosis of the lower extremities); 12% – severe pain syndrome of various localizations; 11% - infectious and inflammatory processes; 9% – antibiotic-associated diarrhea; 5% – atrial fibrillation and less often other pathologies. Patients with respiratory symptoms had a high degree of respiratory failure, an increase in the volume of affected lung tissue and an increase in the content of various markers of inflammation in the blood when compared with the data of the initial examination. Nine percent of patients died during hospitalization.Conclusions. The leading cause of repeated inpatient treatment of COVID-19 patients were symptoms of reactivation of the infection with a number of indicators of a greater severity of this “second wave” of the disease. Further studies are required to reduce the risk of repeated inpatient treatment.

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Section: Covid-19unclassified

Section: Introductionunclassified

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Hospital readmissions of patients with COVID-19: causes, features, outcomes

et al. 2023

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Long-term outcomes of hospitalized SARS-CoV-2/COVID-19 patients with and without neurological involvement: 3-year follow-up assessment

Eligulashvili,

Gordon,

Lee

et al. 2023

Preprint

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Background and Objectives: Acute neurological manifestations are a common complication of acute COVID-19 disease. This study investigated the 3-year outcomes of patients with and without significant neurological manifestations during initial COVID-19 hospitalization. Methods: Patients infected by SARS-CoV-2 between March 1 and April 16, 2020 and hospitalized in the Montefiore Health System in the Bronx, an epicenter of the early pandemic, were included. Follow-up data was captured up to January 23, 2023 (3 years post COVID-19). This cohort consisted of 414 COVID-19 patients with significant neurological manifestations and 1199 propensity-matched COVID-19 patients without neurological manifestations. Primary outcomes were mortality, stroke, heart attack, major adverse cardiovascular events (MACE), reinfection, and hospital readmission post-discharge. Secondary outcomes were clinical neuroimaging findings (hemorrhage, active stroke, prior stroke, mass effect, and microhemorrhage, white-matter changes, microvascular disease, and volume loss). Predictive models were used to identify risk factors of mortality post-discharge. Results: More patients in the neurological cohort were discharged to acute rehabilitation (10.54% vs 3.68%, p<0.0001), skilled nursing facilities (30.67% vs 20.78%, p=0.0002) and fewer to home (55.27% vs 70.21%, p<0.0001) compared to the matched controls. Incidence of readmission for any medical reason (65.70% vs 60.72%, p=0.036), stroke (6.28% vs 2.34%, p<0.0001), and MACE (20.53% vs 16.51%, p=0.032) was higher in the neurological cohort post-discharge. Neurological patients were more likely to die post-discharge (58 (14.01%) vs 94 (7.84%), p=0.0001) compared to controls (HR=2.346, 95% CI=(1.586, 3.470), p<0.0001). The major causes of death post-discharge were heart disease (14.47%), sepsis (13.82%), influenza and pneumonia (11.18%), COVID-19 (8.55%) and acute respiratory distress syndrome (7.89%). Factors associated with mortality after leaving the hospital were belonging to the neurological cohort (OR=1.802 (1.237, 2.608), p=0.002), discharge disposition (OR=1.508, 95% CI=(1.276, 1.775), p<0.0001), congestive heart failure (OR=2.281 (1.429, 3.593), p=0.0004), higher COVID-19 severity score (OR=1.177 (1.062, 1.304), p=0.002), and older age (OR=1.027 (1.010, 1.044), p=0.002). There were no group differences in gross radiological findings, except the neurological cohort showed significantly more age-adjusted brain volume loss (p<0.05) compared to controls. Discussion: COVID-19 patients with neurological manifestations have worse long-term outcomes compared to matched controls. These findings raise awareness and the need for closer monitoring and timely interventions for COVID-19 patients with neurological manifestations.

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Long-term outcomes of hospitalized patients with SARS-CoV-2/COVID-19 with and without neurological involvement: 3-year follow-up assessment

Eligulashvili,

Gordon,

Lee

et al. 2024

PLoS Med

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Background Acute neurological manifestation is a common complication of acute Coronavirus Disease 2019 (COVID-19) disease. This retrospective cohort study investigated the 3-year outcomes of patients with and without significant neurological manifestations during initial COVID-19 hospitalization. Methods and findings Patients hospitalized for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection between 03/01/2020 and 4/16/2020 in the Montefiore Health System in the Bronx, an epicenter of the early pandemic, were included. Follow-up data was captured up to 01/23/2023 (3 years post-COVID-19). This cohort consisted of 414 patients with COVID-19 with significant neurological manifestations and 1,199 propensity-matched patients (for age and COVID-19 severity score) with COVID-19 without neurological manifestations. Neurological involvement during the acute phase included acute stroke, new or recrudescent seizures, anatomic brain lesions, presence of altered mentation with evidence for impaired cognition or arousal, and neuro-COVID-19 complex (headache, anosmia, ageusia, chemesthesis, vertigo, presyncope, paresthesias, cranial nerve abnormalities, ataxia, dysautonomia, and skeletal muscle injury with normal orientation and arousal signs). There were no significant group differences in female sex composition (44.93% versus 48.21%, p = 0.249), ICU and IMV status, white, not Hispanic (6.52% versus 7.84%, p = 0.380), and Hispanic (33.57% versus 38.20%, p = 0.093), except black non-Hispanic (42.51% versus 36.03%, p = 0.019). Primary outcomes were mortality, stroke, heart attack, major adverse cardiovascular events (MACE), reinfection, and hospital readmission post-discharge. Secondary outcomes were neuroimaging findings (hemorrhage, active and prior stroke, mass effect, microhemorrhages, white matter changes, microvascular disease (MVD), and volume loss). More patients in the neurological cohort were discharged to acute rehabilitation (10.39% versus 3.34%, p < 0.001) or skilled nursing facilities (35.75% versus 25.35%, p < 0.001) and fewer to home (50.24% versus 66.64%, p < 0.001) than matched controls. Incidence of readmission for any reason (65.70% versus 60.72%, p = 0.036), stroke (6.28% versus 2.34%, p < 0.001), and MACE (20.53% versus 16.51%, p = 0.032) was higher in the neurological cohort post-discharge. Per Kaplan–Meier univariate survival curve analysis, such patients in the neurological cohort were more likely to die post-discharge compared to controls (hazard ratio: 2.346, (95% confidence interval (CI) [1.586, 3.470]; p < 0.001)). Across both cohorts, the major causes of death post-discharge were heart disease (13.79% neurological, 15.38% control), sepsis (8.63%, 17.58%), influenza and pneumonia (13.79%, 9.89%), COVID-19 (10.34%, 7.69%), and acute respiratory distress syndrome (ARDS) (10.34%, 6.59%). Factors associated with mortality after leaving the hospital involved the neurological cohort (odds ratio (OR): 1.802 (95% CI [1.237, 2.608]; p = 0.002)), discharge disposition (OR: 1.508 (95% CI [1.276, 1.775]; p < 0.001)), congestive heart failure (OR: 2.281 (95% CI [1.429, 3.593]; p < 0.001)), higher COVID-19 severity score (OR: 1.177 (95% CI [1.062, 1.304]; p = 0.002)), and older age (OR: 1.027 (95% CI [1.010, 1.044]; p = 0.002)). There were no group differences in radiological findings, except that the neurological cohort showed significantly more age-adjusted brain volume loss (p = 0.045) than controls. The study’s patient cohort was limited to patients infected with COVID-19 during the first wave of the pandemic, when hospitals were overburdened, vaccines were not yet available, and treatments were limited. Patient profiles might differ when interrogating subsequent waves. Conclusions Patients with COVID-19 with neurological manifestations had worse long-term outcomes compared to matched controls. These findings raise awareness and the need for closer monitoring and timely interventions for patients with COVID-19 with neurological manifestations, as their disease course involving initial neurological manifestations is associated with enhanced morbidity and mortality.

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Frequency and factors associated with hospital readmission after COVID-19 hospitalization: the importance of post-COVID diarrhea

Cited by 9 publications

References 21 publications

Hospital readmissions of patients with COVID-19: causes, features, outcomes

Hospital readmissions of patients with COVID-19: causes, features, outcomes

Long-term outcomes of hospitalized SARS-CoV-2/COVID-19 patients with and without neurological involvement: 3-year follow-up assessment

Long-term outcomes of hospitalized patients with SARS-CoV-2/COVID-19 with and without neurological involvement: 3-year follow-up assessment

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