Readmission, death common among COVID-19 patients discharged from hospital

Incidence of multiorgan dysfunction is higher among individuals discharged from hospital after COVID-19 than among those in the general population, and this relative risk increase is not confined to the elderly and not uniform across ethnicities, a study has found.

“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,” the researchers said.

A total of 47,780 individuals (mean age 65 years, 55 percent men) with COVID-19 and discharged alive by 31 August 2020 were included in this retrospective cohort study and were 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.

The researchers then measured the rates of hospital readmission (or any admission for controls), all-cause mortality, and diagnoses of respiratory, cardiovascular, metabolic, kidney, and liver diseases until 31 September 2020. They also assessed variations in rate ratios by age, sex, and ethnicity.

Of the participants who were discharged after acute COVID-19, 14,060 were readmitted and 5,875 died after discharge over a mean follow-up of 140 days, with events occurring at rates four and eight times greater, respectively, than in matched controls. [BMJ 2021;372:n693]

Patients with COVID-19 also had higher rates of respiratory disease (p<0.001), diabetes (p<0.001), and cardiovascular disease (p<0.001), with 770 (95 percent confidence interval [CI], 758–783), 127 (95 percent CI, 122–132), and 126 (95 percent CI, 121–131) diagnoses per 1,000 person-years, respectively.

Rate ratios (RR) were higher for individuals aged <70 years than for those aged ≥70 years, as well as in ethnic minority groups than in the white population, with the largest differences observed for respiratory disease (<70 years: RR, 10.5, 95 percent CI, 9.7–11.4 vs ≥70 years: RR, 4.6, 95 percent CI, 4.3–4.8; nonwhite: RR, 11.4, 95 percent CI, 9.8–13.3 vs white: RR, 5.2, 95 percent CI, 5.0–5.5).

“Our results are consistent with proposed biological mechanisms associated with respiratory, cardiovascular, metabolic, renal, and hepatic involvement in COVID-19,” the researchers said. [BMJ 2020;370:m3001; J Thromb Thrombolysis 2020;50:512-524; N Engl J Med 2020;383:789-790; United European Gastroenterol J 2020;8:509-519; J Nephrol 2020;33:1213-1218]

A recent US study of 1,775 veterans with COVID-19 admitted to hospital reported that 20 percent were readmitted and 9 percent died within 60 days of discharge. The present study restricted follow-up to the same length of time and found similar prevalence rates of 23 percent and 9 percent, respectively. [JAMA 2021;325:304-306]

“The US study did not analyse organ-specific endpoints and was conducted in a specific population. Our study extends these findings as we found that COVID-19 was associated with dysfunction in a range of organs after discharge in a broader population of patients admitted to hospital,” the researchers said.

“Urgent research is needed to understand the risk factors for post-COVID syndrome so that treatment can be targeted better to demographically and clinically at-risk populations,” they noted.