Study Suggests High Numbers of Hospitalized COVID-19 Patients Require More Care

Optimism abounds globally since the advent of regulatory agency-approved (at least in some countries) vaccines against SARS-CoV-2.

However, such positive feelings, while understandable, may yet be a bit premature, given that the disease caused by the new coronavirus, COVID-19, still poses a significant clinical challenge. Indeed, this was highlighted by an analysis published on December 14 by the Journal of the American Medical Association, which found that 19.9% of patients 1775 hospitalized with severe infection who survived were readmitted to the hospital within 60 days of their initial discharge.

Unfortunately, 9.1% of these readmitted patients died during their second hospitalization.

“We found a very high rate of readmission or death among COVID-19 patients surviving to discharge within the first 60 days after leaving the hospital,” study coauthor John Donnelly, PhD, a Research Investigator in the Department of Learning Health Sciences at the University of Michigan Medical School, told Contagion®. “When compared with similar patients who were hospitalized for other serious conditions, we found that COVID-19 patients had better outcomes at 60 days but there was a period of high risk within the first 10 days after discharge where these patients had worse outcomes. These findings contribute to the growing literature showing that recovery following COVID-19 can be a bumpy road.”

For their research, Donnelly and his colleagues identified index hospitalizations for COVID-19 among veterans at 132 VA hospitals admitted between March 1 and June 1 and discharged (initially) between March 1 and July 1. In all, there were 2179 index hospitalizations, of which 31.1% (n=678) received ICU treatment, 12.8% (n=279) were mechanically ventilated, 14.1% (n=307) received vasopressors, and 81.5% (n=1,775) survived to (initial) discharge.

Of the 1775 who survived to initial discharge, 354 (19.9%) were readmitted and 162 (9.1%) died. According to the authors, survivors with 60-day readmission or death tended to be older, but otherwise similar to survivors who did not require readmission. Of those readmitted, the most common readmission diagnoses were COVID-19 (30.2%), sepsis (8.5%), pneumonia (3.1%), and heart failure (3.1%), the researchers said. During readmission, 22.6% were treated in the ICU, 7.1% were mechanically ventilated, and 7.9% received vasopressors.

Notably, when compared with 1799 patients hospitalized with non-COVID-19-associated pneumonia and 3,505 hospitalized due to heart failure (of whom 97.8% and 98.3%, respectively, survived to discharge), the COVID-19 survivors had lower rates of 60-day readmission (~27% vs 31.7% and 37%, respectively). However, COVID-19 survivors had higher rates of readmission or death within the first 10 days after discharge than matched survivors of pneumonia (13.4% vs 9.7%) and heart failure (13.9% vs 8.8%), the researchers found.

“This study and other recent publications have all pointed us in the same direction—focusing only on in-hospital outcomes will dramatically underestimate the total burden of COVID-19 incurred by individuals and health systems,” Donnelly said. “I think additional comparisons with other patient populations, particularly viral illnesses, will allow us to unpack this further and determine what aspects are unique to COVID-19.”