Readmission and Death After Initial Hospital Discharge Among Patients With COVID-19 in a Large Multihospital System

Donnelly, John P.; Wang, Xiao Qing; Iwashyna, Theodore J.; Prescott, Hallie C.

doi:10.1001/jama.2020.21465

Cited by 203 publications

(269 citation statements)

References 3 publications

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“…In a more recent study of 1,775 US veterans hospitalised with COVID-19, 20% were readmitted and 9% died within 60 days of discharge;[22] after restricting follow-up time in our study to the same duration, we found similar prevalence rates of 23% and 9%, respectively. The US study did not analyse organ-specific endpoints and was conducted in a specific population; we can thus now add that COVID-19 is associated with post-discharge manifestations in a range of organs in the general population.…”

Section: Discussionsupporting

confidence: 70%

Epidemiology of post-COVID syndrome following hospitalisation with coronavirus: a retrospective cohort study

Ayoubkhani

Khunti

Nafilyan

et al. 2021

Preprint

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ObjectivesThe epidemiology of post-COVID syndrome (PCS) is currently undefined. We quantified rates of organ-specific impairment following recovery from COVID-19 hospitalisation compared with those in a matched control group, and how the rate ratio (RR) varies by age, sex, and ethnicity.DesignObservational, retrospective, matched cohort study.SettingNHS hospitals in England.Participants47,780 individuals (mean age 65 years, 55% male) in hospital with COVID-19 and discharged alive by 31 August 2020, matched to controls on demographic and clinical characteristics.Outcome measuresRates of hospital readmission, all-cause mortality, and diagnoses of respiratory, cardiovascular, metabolic, kidney and liver diseases until 30 September 2020.ResultsMean follow-up time was 140 days for COVID-19 cases and 153 days for controls. 766 (95% confidence interval: 753 to 779) readmissions and 320 (312 to 328) deaths per 1,000 person-years were observed in COVID-19 cases, 3.5 (3.4 to 3.6) and 7.7 (7.2 to 8.3) times greater, respectively, than in controls. Rates of respiratory, diabetes and cardiovascular events were also significantly elevated in COVID-19 cases, at 770 (758 to 783), 127 (122 to 132) and 126 (121 to 131) events per 1,000 person-years, respectively. RRs were greater for individuals aged <70 than ≥ 70 years, and in ethnic minority groups than the White population, with the biggest differences observed for respiratory disease: 10.5 [9.7 to 11.4] for <70 years versus 4.6 [4.3 to 4.8] for ≥ 70 years, and 11.4 (9.8 to 13.3) for Non-White versus 5.2 (5.0 to 5.5) for White.ConclusionsIndividuals discharged from hospital following COVID-19 face elevated rates of multi-organ dysfunction compared with background levels, and the increase in risk is neither confined to the elderly nor uniform across ethnicities. The diagnosis, treatment and prevention of PCS require integrated rather than organ- or disease-specific approaches. Urgent research is required to establish risk factors for PCS.

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Section: Discussionsupporting

confidence: 70%

Epidemiology of post-COVID syndrome following hospitalisation with coronavirus: a retrospective cohort study

Ayoubkhani

Khunti

Nafilyan

et al. 2021

Preprint

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“…In a recent study of 1775 veterans in the United States admitted to hospital with covid-19, 20% were readmitted and 9% died within 60 days of discharge 25. After restricting follow-up in our study to the same length of time, we found similar prevalence rates of 23% and 9%, respectively.…”

Section: Discussionsupporting

confidence: 60%

Post-covid syndrome in individuals admitted to hospital with covid-19: retrospective cohort study

Ayoubkhani

Khunti

Nafilyan

et al. 2021

BMJ

652

557

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Objective To quantify rates of organ specific dysfunction in individuals with covid-19 after discharge from hospital compared with a matched control group from the general population. Design Retrospective cohort study. Setting NHS hospitals in England. Participants 47 780 individuals (mean age 65, 55% men) in hospital with covid-19 and discharged alive by 31 August 2020, exactly matched to controls from a pool of about 50 million people in England for personal and clinical characteristics from 10 years of electronic health records. Main outcome measures Rates of hospital readmission (or any admission for controls), all cause mortality, and diagnoses of respiratory, cardiovascular, metabolic, kidney, and liver diseases until 30 September 2020. Variations in rate ratios by age, sex, and ethnicity. Results Over a mean follow-up of 140 days, nearly a third of individuals who were discharged from hospital after acute covid-19 were readmitted (14 060 of 47 780) and more than 1 in 10 (5875) died after discharge, with these events occurring at rates four and eight times greater, respectively, than in the matched control group. Rates of respiratory disease (P<0.001), diabetes (P<0.001), and cardiovascular disease (P<0.001) were also significantly raised in patients with covid-19, with 770 (95% confidence interval 758 to 783), 127 (122 to 132), and 126 (121 to 131) diagnoses per 1000 person years, respectively. Rate ratios were greater for individuals aged less than 70 than for those aged 70 or older, and in ethnic minority groups compared with the white population, with the largest differences seen for respiratory disease (10.5 (95% confidence interval 9.7 to 11.4) for age less than 70 years v 4.6 (4.3 to 4.8) for age ≥70, and 11.4 (9.8 to 13.3) for non-white v 5.2 (5.0 to 5.5) for white individuals). Conclusions Individuals discharged from hospital after covid-19 had increased rates of multiorgan dysfunction compared with the expected risk in the general population. The increase in risk was not confined to the elderly and was not uniform across ethnicities. The diagnosis, treatment, and prevention of post-covid syndrome requires integrated rather than organ or disease specific approaches, and urgent research is needed to establish the risk factors.

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“…[5,6,[9][10][11] A few studies so far have described the utilisation of healthcare services after COVID-19, in particular hospitalisation. [7,8,[31][32][33] At two months, 9% to 20% of patients admitted for COVID-19 were found to require rehospitalisation, with a higher risk in individuals with comorbidities and older age. [7,8,[31][32][33] The observed rehospitalisation rate of about 10% in our study is broadly consistent with these estimates.…”

Section: Comparison With Other Studiesmentioning

confidence: 99%

“…[7,8,[31][32][33] At two months, 9% to 20% of patients admitted for COVID-19 were found to require rehospitalisation, with a higher risk in individuals with comorbidities and older age. [7,8,[31][32][33] The observed rehospitalisation rate of about 10% in our study is broadly consistent with these estimates. Chopra et al further reported that 78% of participants hospitalised for COVID-19 had seen a primary care physician after hospital discharge.…”

Section: Comparison With Other Studiesmentioning

confidence: 99%

“…[2][3][4] Several observational studies of mostly patients with prior hospital admission due to COVID-19 have examined the persistence of symptoms and development of complications. [5][6][7][8] A recent study suggested that up to 76% of these individuals may experience a wide range of persistent complaints, such as fatigue, dyspnoea, cough, and smell and taste disturbances, for at least six months after the initial infection. [5] In combination with the general psychological toll of the pandemic, persistent symptoms and resulting limitations in daily activities may have additionally intensified the risk of developing anxiety or depression.…”

Section: Introductionmentioning

confidence: 99%

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Burden of Post-COVID-19 Syndrome and Implications for Healthcare Service Planning: A Population-based Cohort Study

Menges

Ballouz

Anagnostopoulos

et al. 2021

Preprint

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ObjectiveTo assess the prevalence of impaired health status and physical and mental health symptoms among individuals at least six months after SARS-CoV-2 infection, and to characterise their healthcare utilisation.DesignPopulation-based prospective cohort study.SettingZurich SARS-CoV-2 Cohort, Zurich, Switzerland.Participants431 adults from the general population with PCR-confirmed SARS-CoV-2 infection reported to health authorities between 27 February 2020 and 05 August 2020.Main outcome measuresWe assessed the proportion of individuals reporting not having fully recovered since SARS-CoV-2 infection, the proportion reporting fatigue (assessed by Fatigue Assessment Scale), dyspnoea (assessed by mMRC dyspnoea scale) or depression (assessed by DASS-21) at six to eight months after diagnosis. We further evaluated the proportion of individuals with at least one healthcare contact since their acute illness. Multivariable logistic regression models were used to assess factors associated with the main outcomes.ResultsSymptoms were present in 385 (89%) participants at diagnosis and 81 (19%) were initially hospitalised. At six to eight months, 111 (26%) reported not having fully recovered. 233 (55%) participants reported symptoms of fatigue, 96 (25%) had at least grade 1 dyspnoea, and 111 (26%) had DASS-21 scores indicating symptoms of depression. 170 (40%) participants reported at least one general practitioner visit related to COVID-19 after acute illness, and 10% (8/81) of initially hospitalised individuals were rehospitalised. Individuals that have not fully recovered or suffer from fatigue, dyspnoea or depression were more likely to have further healthcare contacts. However, a third of individuals (37/111) that have not fully recovered did not seek further care.ConclusionIn our population-based study, a relevant proportion of individuals suffered from longer-term consequences after SARS-CoV-2 infection. Our findings indicate that a considerable number of individuals affected by post-COVID-19 syndrome is to be expected, and that a wide range of additional healthcare services and integrative approaches will be required to support the recovery of these individuals. Thus, the timely planning of resources and services for post-COVID-19 care will be necessary alongside public health measures to mitigate the effects of the pandemic.RegistrationISRCTN14990068

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Readmission and Death After Initial Hospital Discharge Among Patients With COVID-19 in a Large Multihospital System

Cited by 203 publications

References 3 publications

Epidemiology of post-COVID syndrome following hospitalisation with coronavirus: a retrospective cohort study

Epidemiology of post-COVID syndrome following hospitalisation with coronavirus: a retrospective cohort study

Post-covid syndrome in individuals admitted to hospital with covid-19: retrospective cohort study

Burden of Post-COVID-19 Syndrome and Implications for Healthcare Service Planning: A Population-based Cohort Study

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