After COVID-19 care: The risk of readmission and death is highest in the first ten days after discharge, the study says

Even like COVID-19 The pandemic continues to explode, death rates due to this disease have fallen in many parts of the world. And yet, many patients recovering COVID-19 they tend to have some complications, even if they had a mild illness.

The concept of long COVID is rapidly gaining popularity, as not only do patients tend to have prolonged or persistent symptoms even after obtaining two consecutive negative results. COVID-19 test results, but also because rehospitalizations and deaths continue to occur due to post-COVID complications.

A new study published in JAMA suggests that the greatest risk for a COVID-19 The patient’s health will probably be within 10 days of discharge from the hospital, so proper care and monitoring of patients’ health are very important at this early stage of recovery.

Peak post-COVID morbidity and mortality risks

The study was conducted by researchers based at the University of Michigan and Veteran Affairs Ann Arbor Healthcare System. Noting that there are limited data on initial outcomes after hospitalization, the researchers aimed to measure the readmission rate, the reasons for readmission and the death rate after discharge among patients with COVID-19 .

To do this, they used a two-way approach:

First, they collected data on the hospitalization of veterans with COVID-19 of 132 VA hospitals. Patients admitted between March and June 2020 and discharged between March and July 2020 were included in this study.

Second, they identified veterans hospitalized at the same lengths due to non-COVID pneumonia and heart failure. The researchers focused on data on length of hospital stay, use of an intensive care unit (ICU), reliance on invasive mechanical ventilation, and the need for vasopressors (drugs used to treat very low blood pressure).

They then measured the risks of readmission and death, up to 60 days after discharge COVID-19 survivors and also calculated readmission hazard ratios for 10, 20, 20-40 and 40-60 days after discharge.

Common reasons for readmission and death

The researchers collected data on 2,179 veteran hospitalizations for COVID-19 , of which 678 patients were treated in the ICU, 279 had to access mechanical ventilators, 307 received vasopressors and 1,775 survived the disease to be finally discharged. Of these survivors, 354 (19.9%) were readmitted, 162 (9.1%) died and 479 (27%) were readmitted or died within 60 days of discharge.

The most common reasons for the readmission and death of survivors were COVID-19 reinfection, sepsis, pneumonia and heart failure. During readmission, 22.6 percent of these patients had to be treated in intensive care, 7.1 percent were mechanically ventilated and 7.9 percent received vasopressors.

In the other cohort of veterans with non-COVID hospitalizations, 2,156 patients had pneumonia and 4,269 had heart failure, of which 97.8 percent and 98.3 percent, respectively, survived and were discharged after treatment. After excluding deceased patients, the health outcomes of 1,799 patients with pneumonia and 3,505 with heart failure were compared with those who survived. COVID-19 and were discharged.

Comparing these two cohorts of surviving patients, the researchers found that COVID-19 survivors had lower readmission or death rates of 60 days compared to patients with pneumonia or heart failure. However, COVID-19 survivors had the highest readmission and / or death rates in the first 10 days after discharge, compared to the same patients.

Urgent need for critical care in the first 10 days after discharge

Even if the prognosis for COVID-19 Survivors after discharge for 60 days do not look so bad compared to patients with other potentially fatal causes of admission, findings on readmission or death rates in the first 10 days suggest an increased risk of clinical deterioration during this period.

The researchers thus concluded that, although their study had some limitations (both cohorts were predominantly male and elderly and therefore had higher risks of severe outcomes), public health surveillance and clinical care for the 10-day post-discharge period for all COVID-19 patients is crucial.

If health systems and clinical trials for drugs, vaccines, etc. focus only on mortality during hospitalizations and do not take into account this critical post-hospitalization period, then they could underestimate the burden COVID-19 and achieving distorted results to the detriment of the entire global pandemic population.

For more information, read our article on post-COVID care.

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