Analysis of Clinical Criteria for Discharge Among Patients Hospitalized for COVID-19: Development and Validation of a Risk Prediction Model.

Autor: Schnipper JL; Hospital Medicine Unit, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA. jschnipper@bwh.harvard.edu.; Harvard Medical School, Boston, MA, USA. jschnipper@bwh.harvard.edu.; COVID-19 Consortium of HCA Healthcare and Academia for Research Generation (CHARGE), Nashville, TN, USA. jschnipper@bwh.harvard.edu., Oreper S; Division of Hospital Medicine, University of California, San Francisco, San Francisco, CA, USA.; COVID-19 Consortium of HCA Healthcare and Academia for Research Generation (CHARGE), Nashville, TN, USA., Hubbard CC; Division of Hospital Medicine, University of California, San Francisco, San Francisco, CA, USA.; COVID-19 Consortium of HCA Healthcare and Academia for Research Generation (CHARGE), Nashville, TN, USA., Kurbegov D; COVID-19 Consortium of HCA Healthcare and Academia for Research Generation (CHARGE), Nashville, TN, USA.; HCA Healthcare, Sarah Cannon Research Institute (SCRI), Nashville, TN, USA., Egloff SAA; COVID-19 Consortium of HCA Healthcare and Academia for Research Generation (CHARGE), Nashville, TN, USA.; HCA Healthcare, Sarah Cannon Research Institute (SCRI), Nashville, TN, USA.; HCA Healthcare, HCA Healthcare Research Institute (HRI), Kansas City, MO, USA., Najafi N; Division of Hospital Medicine, University of California, San Francisco, San Francisco, CA, USA.; COVID-19 Consortium of HCA Healthcare and Academia for Research Generation (CHARGE), Nashville, TN, USA., Valdes G; Division of Hospital Medicine, University of California, San Francisco, San Francisco, CA, USA.; COVID-19 Consortium of HCA Healthcare and Academia for Research Generation (CHARGE), Nashville, TN, USA., Siddiqui Z; Division of Hospital Medicine, John Hopkins University School of Medicine, Baltimore, MD, USA., O 'Leary KJ; Division of Hospital Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA., Horwitz LI; Department of Population Health, Department of Medicine, NYU Grossman School of Medicine; Center for Healthcare Innovation and Delivery Science, NYU Langone Health, New York City, NY, USA., Lee T; Division of Hospital Medicine, University of California, San Francisco, San Francisco, CA, USA.; COVID-19 Consortium of HCA Healthcare and Academia for Research Generation (CHARGE), Nashville, TN, USA., Auerbach AD; Division of Hospital Medicine, University of California, San Francisco, San Francisco, CA, USA.; COVID-19 Consortium of HCA Healthcare and Academia for Research Generation (CHARGE), Nashville, TN, USA.
Jazyk: angličtina
Zdroj: Journal of general internal medicine [J Gen Intern Med] 2024 Nov; Vol. 39 (14), pp. 2649-2661. Date of Electronic Publication: 2024 Jun 27.
DOI: 10.1007/s11606-024-08856-x
Abstrakt: Background: Patients hospitalized with COVID-19 can clinically deteriorate after a period of initial stability, making optimal timing of discharge a clinical and operational challenge.
Objective: To determine risks for post-discharge readmission and death among patients hospitalized with COVID-19.
Design: Multicenter retrospective observational cohort study, 2020-2021, with 30-day follow-up.
Participants: Adults admitted for care of COVID-19 respiratory disease between March 2, 2020, and February 11, 2021, to one of 180 US hospitals affiliated with the HCA Healthcare system.
Main Measures: Readmission to or death at an HCA hospital within 30 days of discharge was assessed. The area under the receiver operating characteristic curve (AUC) was calculated using an internal validation set (33% of the HCA cohort), and external validation was performed using similar data from six academic centers associated with a hospital medicine research network (HOMERuN).
Key Results: The final HCA cohort included 62,195 patients (mean age 61.9 years, 51.9% male), of whom 4704 (7.6%) were readmitted or died within 30 days of discharge. Independent risk factors for death or readmission included fever within 72 h of discharge; tachypnea, tachycardia, or lack of improvement in oxygen requirement in the last 24 h; lymphopenia or thrombocytopenia at the time of discharge; being ≤ 7 days since first positive test for SARS-CoV-2; HOSPITAL readmission risk score ≥ 5; and several comorbidities. Inpatient treatment with remdesivir or anticoagulation were associated with lower odds. The model's AUC for the internal validation set was 0.73 (95% CI 0.71-0.74) and 0.66 (95% CI 0.64 to 0.67) for the external validation set.
Conclusions: This large retrospective study identified several factors associated with post-discharge readmission or death in models which performed with good discrimination. Patients 7 or fewer days since test positivity and who demonstrate potentially reversible risk factors may benefit from delaying discharge until those risk factors resolve.
(© 2024. The Author(s).)
Databáze: MEDLINE
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