Re-admission and Death after initial Hospital Discharge among patients with COVID-19 in a large Multi-Hospital system

Journal of American Medical Association (JAMA) 15th Dec 2020: This study describes reasons for readmission, use of ICU interventions during readmission, and proportions of death after initial hospital discharge of COVID-19 patients from US Veterans Affairs (VA) hospitals March-June 2020.

India

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New Delhi, December 17, 2020 :

Although more patients are surviving severe corona virus disease 2019 CORONA-19

In this study, rate of readmission, cause for readmission, and rate of death till 60 days after hospital discharge was measured among patients with COVID-19 in 132 VA Hospitals

Salient Features :

• There were 2179 index hospitalizations for COVID-19 and 1775 (81.5%) survived to discharge.

• Within 60 days of discharge, 354 patients (19.9%) were readmitted and 162 (9.1%) died

• Older patients were more likely to require readmission with higher mortality.

• The most common diagnosis for readmission was Covid (30.2%)

• COVID-19 survivors had higher rates of readmission or death within the first 10 days after discharge than matched survivors of pneumonia (13.4% vs 9.7%; P = .01) and heart failure (13.9% vs 8.8%; P < .001) suggesting a period of heightened risk of clinical deterioration.

According to Dr G C Khilnani Chairman, PSRI Institute of Pulmonary, Critical care and Sleep Medicine, PSRI Hospital, “It is indeed very disturbing that as many as 30% patients getting discharged after treatment of Covid require re-admission and 9% die. This study further reveals that there is higher rate of readmission within 10 days of discharge and death rate.”

In as many as 30% the diagnoses after re-admission was COVID only. Dr G.C. Khilani said, “In my experience we have seen several patients getting readmitted with deterioration which is in the form of fever and desaturation associated with worsening of pneumonia on CT scan. There is increase in inflammatory markers, especially CRP and D dimer and in some the RTPCR is positive. There seems to be resurgence of Covid inflammation which must be recognized. We have also observed that in these cases the TLC is quite often raised with low lymphocyte count. However, the serum Procalcitonin is normal. These patients require supportive treatment along with anti-inflammatory agents ( corticosteroids). In my practice I have also administered second course of Remdesivir for 5 days (off label use). It is important not to discharge patients in a hurry (especially elderly with co-morbidities). After discharge they should be followed closely with symptoms and periodic measurement of biomarkers (CBC, CRP, D-dimer)”

Dr G C Khilnani is the Chairman, PSRI Institute of Pulmonary, Critical care and Sleep Medicine, PSRI Hospital, New Delhi. Formerly, Professor and Head Dept of Pulmonary Critical care and Sleep Medicine, AIIMS, New Delhi.

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