Also like the COVID-19 the pandemic continues to rage, mortality rates due to this disease have decreased in many parts of the world. Still, many patients who are recovering COVID-19 they tend to have some complications, even if they had mild illness.
The long COVID concept is rapidly gaining popularity because not only do patients tend to have prolonged or persistent symptoms even after getting two consecutive negative results. COVID-19 test results but also because re-hospitalizations and deaths due to post-COVID complications continue to occur.
A new study published in JAMA suggests that the higher risk for a COVID-19 The patient’s health is likely to be in the 10 day period after discharge from the hospital, so proper care and monitoring of patients’ health status is very important during this early stage of recovery.
Post-COVID morbidity and mortality peak
The study was led by researchers from the University of Michigan and the Veteran Affairs Ann Arbor Healthcare System. Noting that data on initial outcomes after hospitalization were limited, the researchers decided to measure the readmission rate, reasons for readmission, and death rate after hospital discharge among patients with COVID-19 .
To do this, they used a two-pronged approach:
First, they collected data on the hospitalization of veterans with COVID-19 from 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 admitted to hospital during the same duration due to non-COVID-related pneumonia and heart failure. Researchers focused on data regarding length of hospitalization, use of an intensive care unit (ICU), dependence 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 regarding 2,179 veteran hospitalizations for COVID-19 , of which 678 patients were treated in intensive care, 279 had access to mechanical ventilators, 307 received vasopressors and 1,775 survived the disease to finally be discharged. Among 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 readmission and death of survivors were COVID-19 reinfection, sepsis, pneumonia and heart failure. During readmission, 22.6% of these patients had to be treated in the ICU, 7.1% were mechanically ventilated and 7.9% 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% and 98.3% survived, respectively, and were discharged after treatment. After excluding the deceased patients, the health outcomes of 1,799 pneumonia and 3,505 patients with heart failure were compared with those who survived COVID-19 and were discharged.
By comparing these two cohorts of surviving patients, the researchers found this out COVID-19 survivors had lower rates of readmission or death at 60 days than patients with pneumonia or heart failure. However, COVID-19 survivors had the highest rates of readmission and / or death within the first 10 days after discharge compared to these same patients.
Urgent need for intensive care in the first 10 days after discharge
Although the prognosis for COVID-19 survivors after discharge for 60 days do not look so bad when compared to patients of other potentially fatal causes of hospitalization, results regarding readmission or death rates in the first 10 days suggest an increased risk of clinical deterioration during this period.
The researchers therefore conclude that although their study has some limitations (both cohorts were predominantly male and elderly, and therefore had greater risks of serious 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. They focus only on mortality during hospitalization and do not take into account this critical post-hospitalization period, they may underestimate the burden of COVID-19 and obtain distorted results at the expense of the entire world population fighting the pandemic.
For more information, read our post-COVID care article.
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