Hospital readmissions of discharged patients with COVID-19

Abstract

Background. COVID-19 infection has led to an overwhelming effort by health institutions to meet the high demand for hospital admissions. Aim. To analyse the clinical variables associated with readmission of patients who had previously been discharged after admission for COVID-19. Design and methods. We studied a retrospective cohort of patients with laboratory-confirmed SARS-CoV-2 infection who were admitted and subsequently discharged alive. We then conducted a nested case-control study paired (1:1 ratio) by age, sex and period of admission. Results. Out of 1368 patients who were discharged during the study period, 61 patients (4.4%) were readmitted. Immunocompromised patients were at increased risk for readmission. There was also a trend towards a higher probability of readmission in hypertensive patients (p=0.07). Cases had had a shorter hospital stay and a higher prevalence of fever during the 48 hours prior to discharge. There were no significant differences in oxygen levels measured at admission and discharge by pulse oximetry intra-subject or between the groups. Neutrophil/lymphocyte ratio at hospital admission tended to be higher in cases than in controls (p=0.06). The motive for readmission in 10 patients (16.4%), was a thrombotic event in venous or arterial territory (p<0.001). Neither glucocorticoids nor anticoagulants prescribed at hospital discharge were associated with a lower readmission rate. Conclusions. The rate of readmission after discharge from hospital for COVID-19 was low. Immunocompromised patients and those presenting with fever during the 48 hours prior to discharge are at greater risk of readmission to hospital.

Analysis of Risk Factors on Readmission Cases of COVID-19 in the Republic of Korea: Using Nationwide Health Claims Data

“…A study in Switzerland that observed the characteristics of two readmitted patients reported that the patients had coronary artery disease, atrial fibrillation, and aortic stenosis as underlying diseases [29], and a recent study on patients readmitted with COVID-19 to five hospitals in New York City reported that the probability of readmission is higher in patients with hypertension and chronic obstructive pulmonary disease [5]. The finding that the rate of readmission is higher for patients with hypertension as the underlying disease was also confirmed in a study in Spain [19]. In addition, a study on readmitted patients in Wuhan, China reported that patients with pulmonary fibrosis as the underlying disease had a higher risk of readmission [3].…”

“…By gender, men were 1.340 times more likely to be readmitted due to COVID-19 than women. Somani S et al found that out of 103 readmitted patients, 65 were men, two times more than women [5], and a study by Lina Marcela Parra Ramírez et al on COVID-19 readmitted patients showed that more men were readmitted due to COVID-19 [19]. Previous studies found differences in the effects of COVID-19 by gender.…”

“…Lastly, the length of stay at the time of first admission was shorter in the readmitted patients (OR: 0.945, 95% CI: 0.933-0.958). A recent study in Spain by Lina Marcela Parra Ramírez et al reported that the duration of symptom onset and the length of stay was shorter in the readmitted patient group [19]. This may suggest improper patient care after discharge [5] or hasty discharge before complete recovery [18].…”

“…The novel coronavirus disease (COVID- 19), which originated in China in December 2019, had recorded 6,535,354 confirmed cases and 387,155 deaths globally as of 15 May, 2020 [1]. South Korea saw a decline in the number of confirmed cases from the peak of 595 new cases on March 1, but the number has been increasing recently, especially around the capital region [2].…”

Immunoinflammatory, Thrombohaemostatic, and Cardiovascular Mechanisms in COVID-19

“…74 Furthermore, arterial or venous thrombosis accounted for 16.4% of COVID-19 hospital readmissions in a cohort of 1,368 patients likely influencing ischemic conditions in severe cases. 118 Preexisting cardiovascular comorbidities including hypertension and diabetes were associated with COVID-19 case severity, which likely exacerbate heart failure and other cardiac injuries. 4,17,19…”