Review identifies factors associated with COVID-19 discharge to post-acute care facility

Older age, increased comorbidities, and higher baseline inflammatory markers were all associated with discharge to a post-acute care (PAC) facility and posthospital mortality or hospice care discharge. COVID-19new research results published of PLoS One show.

Higher levels of D-dimer were also associated with these outcomes, but breakthrough infection, or infection in vaccinated patients with SARS-CoV-2, was associated with discharge to PAC and in-hospital death. or reduced likelihood of receiving hospice care.

“Discharge to PAC is associated with increased mortality based on state death certificate,” the study authors said.

The study also found that shedding into the PAC was moderated in people infected with the alpha variant. In addition, black and Asian patients, as well as Hispanic patients, were more likely to be discharged home than PACs.

To better understand which factors are associated with the need and type of acute hospital discharge after hospitalization with COVID-19, both at baseline and in hospital, investigators conducted a study on March 7, 2020. We evaluated the electronic medical records of 6248 patients who were hospitalized during . May 4, 2022. To the author’s knowledge, this is the first study of its kind examining the specific discharge tendencies of her COVID-19 patients after hospitalization.

This dataset represents a single academic healthcare system of 12 hospitals in the Midwestern United States and 60 primary care clinics in Minnesota. PAC facilities included inpatient rehabilitation facilities, skilled nursing facilities, and long-term acute care hospitals. All patients tested positive for her COVID-19, but the researchers compared a cohort of individuals who were hospitalized with a primary diagnosis of influenza from her January 6, 2011 to he November 14, 2020. was used as a control group.

Of the 6248 patients hospitalized with COVID-19, 4611 (73.8%) were discharged home, 985 (15.8%) were admitted to PAC, and 652 (10.4%) died in hospital. Those discharged to PAC had a higher median age and longer mean length of stay (LOS) than those discharged.

Revealed data:

• The relative risk (RR) of in-hospital mortality was lower with higher platelet counts (RR, 0.998; 95% CI, 0.99-0.99) and albumin levels (RR, 0.342; 95% CI, 0.26-0.45) and C-reactive protein (RR, 1.006; 95% CI, 1.004-1.007) and increased D-dimer (RR, 1.070; 95% CI, 1.039-1.101)
• Increased albumin reduced the risk of PAC excretion (RR, 0.630; 95% CI, 0.497-0.798)
• Increased D-dimer (RR, 1.033; 95% CI, 1.002-1.064) and C-reactive protein (RR, 1.002; 95% CI, 1.001-1.004) were associated with increased risk of PAC shedding

Vaccination was effective in prolonging hospital stay, intensive care unit (ICU) stay, length of stay in ICU, and preventing death during hospitalization.

Furthermore, “among the baseline COVID-19 symptoms obtained from natural language processing, only dyspnea was found to affect temperament by reducing the relevance of PAC utilization,” the researchers found. . Further research is needed to better understand why race was independently associated with home discharge, they said.

The results also suggest that monitoring the levels of the inflammatory markers studied can help predict outcome in hospitalized patients.

Investigators were unable to account for unique factors inherent in local practices that might determine discharge to PAC, demonstrating the limitations of the study.

Overall, “we observed that later variants and inpatient vaccination were associated with more favorable outcomes, as indicated by postdischarge trends,” the researchers concluded. , increased comorbidity burden, increased length of hospital stay, length of stay in ICU, and admission to ICU are associated with discharge to PAC, death in hospital or discharge to hospice.”

reference

Ikramuddin F, Melnik T, Ingraham NE, et al. Predictors of disposition and mortality after hospitalization with SARS-CoV-2 infection. PLoS One. Published online April 13, 2023. doi:10.1371/journal.pone.0283326