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 10 publications

(16 citation statements)

References 21 publications

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“…Although the 6-month assessment found no significant difference in the proportion of patients with post-COVID-19 syndrome according to sex, the 12-month assessment showed a higher number of female patients with three or more symptoms when compared to male patients. This result is similar to that found in a cohort in the Amazon Region that identified female patients, non-white skin color, and high BMI as independent predictors of a higher number of symptoms in post-COVID-19 syndrome 22 , in agreement with other studies 11 , 13 , 23 .…”

Section: Discussionsupporting

confidence: 92%

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Post-COVID-19 syndrome among hospitalized COVID-19 patients: a cohort study assessing patients 6 and 12 months after hospital discharge

Rocha,

Andrade,

Melanda

et al. 2024

Cad. Saúde Pública

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Post-COVID-19 syndrome involves a variety of symptoms that last more than 12 weeks after COVID diagnosis. This study aimed to analyze post-COVID-19 syndrome among hospitalized COVID-19 patients 6 and 12 months after hospital discharge. This is an ambidirectional cohort study conducted with individuals who were discharged from three main hospitals in the capital of Mato Grosso State, Brazil, between October and December 2021 and January and March 2022. After data collection from medical records, the individuals were interviewed by telephone 6 and 12 months after hospital discharge, when they were asked about the presence of ongoing or new symptoms and when symptom frequency was evaluated according to sociodemographic and economic characteristics hospitalization, and health conditions. Of all 277 medical records evaluated, 259 patients were eligible to participate in the study, 190 patients six months after discharge and 160 patients 12 months after hospital discharge. At six months, 59% were female patients, 40% were aged 60 years or older, and 87.4% reported at least one symptom. At 12 months, 58.7% were female patients, 37.5% were aged 30 to 49 years, and 67.5% reported at least one symptom. Fatigue was the most common symptom 6 and 12 months after hospital discharge (55.3% and 40.6%, respectively), followed by memory problems (36.8%; 20%), and hair loss (26.8%; 11.2%). The prevalence of post-COVID-19 syndrome was higher among patients of older age, lower income, with hypertension, diabetes, and more severe infection during hospitalization. The risk factors for post-COVID-19 syndrome help understand the long-term effects and the importance of monitoring after the acute phase of the disease.

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Section: Discussionsupporting

confidence: 92%

“…According to estimates, persistent COVID-19 symptoms are observed in about one out of ten cases of the disease 10 ; however, in Brazil, a study conducted in São Paulo showed that 68% of hospitalized patients had at least one recurrent symptom related to COVID-19 11 months after diagnosis 11 .…”

Section: Introductionmentioning

confidence: 99%

Post-COVID-19 syndrome among hospitalized COVID-19 patients: a cohort study assessing patients 6 and 12 months after hospital discharge

Rocha,

Andrade,

Melanda

et al. 2024

Cad. Saúde Pública

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

Cited by 10 publications

References 21 publications

Post-COVID-19 syndrome among hospitalized COVID-19 patients: a cohort study assessing patients 6 and 12 months after hospital discharge

Post-COVID-19 syndrome among hospitalized COVID-19 patients: a cohort study assessing patients 6 and 12 months after hospital discharge

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

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