What are the risk factors of hospital length of stay in the novel coronavirus pneumonia (COVID-19) patients? A survival analysis in southwest China

Abstract

Background The global epidemic of novel coronavirus pneumonia (COVID-19) has resulted in substantial healthcare resource consumption. Since patients’ hospital length of stay (LoS) is at stake in the process, an investigation of COVID-19 patients’ LoS and its risk factors becomes urgent for a better understanding of regional capabilities to cope with COVID-19 outbreaks. Methods First, we obtained retrospective data of confirmed COVID-19 patients in Sichuan province via National Notifiable Diseases Reporting System (NNDRS) and field surveys, including their demographic, epidemiological, clinical characteristics and LoS. Then we estimated the relationship between LoS and the possibly determinant factors, including demographic characteristics of confirmed patients, individual treatment behavior, local medical resources and hospital grade. The Kaplan-Meier method and the Cox Proportional Hazards Model were applied for single factor and multi-factor survival analysis. Results From January 16, 2020 to March 4, 2020, 538 human cases of COVID-19 infection were laboratory-confirmed, and were hospitalized for treatment, including 271 (50%) patients aged ≥ 45, 285 (53%) males, and 450 patients (84%) with mild symptoms. The median LoS was 19 (interquartile range (IQR): 14–23, range: 3–41) days. Univariate analysis showed that age and clinical grade were strongly related to LoS (P<0.01). Adjusted multivariate analysis showed that the longer LoS was associated with those aged ≥ 45 (Hazard ratio (HR): 0.74, 95% confidence interval (CI): 0.60–0.91), admission to provincial hospital (HR: 0.73, 95% CI: 0.54–0.99), and severe illness (HR: 0.66, 95% CI: 0.48–0.90). By contrast, the shorter LoS was linked with residential areas with more than 5.5 healthcare workers per 1,000 population (HR: 1.32, 95% CI: 1.05–1.65). Neither gender factor nor time interval from illness onset to diagnosis showed significant impact on LoS. Conclusions Understanding COVID-19 patients’ hospital LoS and its risk factors is critical for governments’ efficient allocation of resources in respective regions. In areas with older and more vulnerable population and in want of primary medical resources, early reserving and strengthening of the construction of multi-level medical institutions are strongly suggested to cope with COVID-19 outbreaks.

Factors Associated with Length of Hospital Stay among COVID-19 Patients in Saudi Arabia: A Retrospective Study during the First Pandemic Wave

“…Mahboub et al found that diagnosis at admission, painkiller usage, ventilator intubation, azithromycin usage, antiviral usage, anti-inflammatory agent usage, vitamin C usage, urea test results, platelet count, haemoglobin levels, dimer levels, and potassium levels were significant predictors of LoHS [ 39 ]. Moreover, Wang et al reported that age and clinical grade were strongly related to the length of stay ( p < 0.01) and that a longer LoHS was associated with ≥45 years of age, severe illness, and admission to a provincial hospital [ 40 ]. Our results of prolonged LoHS among patients with either severe or critical symptoms were aligned with Wang et al’s findings.…”

Fever, Tachypnea, and Monocyte Distribution Width Predicts Length of Stay for Patients with COVID-19: A Pioneer Study

“…Studies have reported mean LOSs of patients with COVID-19 of 5–17 days [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 ]; the differences in the reported values can be attributed to the times at which the studies were conducted (e.g., early 2020 vs. late 2021); severity, treatment guidelines, admission, and discharge criteria; regional prevalence of COVID-19; and even regional rates of COVID-19-related mortality [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 ]. More comprehensive information regarding the prediction of the LOSs of patients with COVID-19 can improve the efficiency of medical resource allocation and ameliorate prognosis [ 51 , 52 ].…”

Predictors of Basic Activity in Daily Living and Length of Hospitalization in Patients with COVID-19

“…There have been numerous studies that have tried to find the predictors of the length of hospitalization in COVID-19 patients [ 15 , 16 , 17 ]. However, a patient’s mobility status and muscle strength are rarely considered.…”

“…Thus, identifying risk factors of a prolonged hospitalization in patients with COVID-19 is also a crucial issue. There are numerous studies that have investigated the risk factors regarding a prolonged hospitalization period [ 15 , 16 , 17 ]. Wu et al [ 17 ] and Liu et al [ 15 ] discovered that high fever, bilateral pneumonia seen on a chest computed tomography, diabetes, and lymphopenia can all predict longer hospitalization.…”