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Published on: April 19, 2019
Risk Factors for Admission Within a Hospital-Based COVID-19 Home Monitoring Program
Heather Sperring1, Melissa Hofman2, Heather E Hsu3
1Center for Infectious Diseases, Boston Medical Center, Boston, Massachusetts, USA.
Insights
Older age, multiple comorbidities, fever, and respiratory or gastrointestinal symptoms increase COVID-19 admission risk. Identifying these factors aids in prioritizing patients for early treatment and surveillance.
Area of Science:
- Infectious Diseases
- Public Health
- Clinical Medicine
Background:
- Coronavirus disease 2019 (COVID-19) continues to strain healthcare systems globally.
- Limited research exists on the risks of hospital admission for outpatients diagnosed with COVID-19.
- Understanding these risks is crucial for effective outpatient follow-up and therapeutic prioritization.
Purpose of the Study:
- To identify risk factors for 30-day hospital admission in COVID-19 outpatients.
- To identify risk factors for 30-day re-admission in patients initially hospitalized with COVID-19.
- To inform strategies for outpatient follow-up and early intervention.
Main Methods:
- Prospective data collection templates were designed for remote patient monitoring.
- Retrospective analysis of data from a COVID-19 follow-up monitoring program (April 2020 - February 2021).
- Included 4070 individuals diagnosed with COVID-19.
Main Results:
- Older age, multiple comorbidities, fever, respiratory, and gastrointestinal symptoms at initial contact increased 30-day admission risk for outpatients.
- Loss of taste/smell was associated with decreased admission risk.
- Older age also increased re-admission risk for post-discharge patients.
Conclusions:
- Factors beyond age and comorbidities, including fever and specific symptoms, elevate COVID-19 admission odds.
- These findings can improve patient stratification for early treatment and ongoing monitoring.
- Data supports enhanced surveillance and timely intervention for high-risk COVID-19 patients.
Background:
Despite increasing vaccination rates, coronavirus disease 2019 (COVID-19) continues to overwhelm heath systems worldwide. Few studies follow outpatients diagnosed with COVID-19 to understand risks for subsequent admissions. We sought to identify hospital admission risk factors in individuals with COVID-19 to guide outpatient follow-up and prioritization for novel therapeutics.
Methods:
We prospectively designed data collection templates and remotely monitored patients after a COVID-19 diagnosis, then retrospectively analyzed data to identify risk factors for 30-day admission for those initially managed outpatient and for 30-day re-admissions for those monitored after an initial COVID-19 admission. We included all patients followed by our COVID-19 follow-up monitoring program from April 2020 to February 2021.
Results:
Among 4070 individuals followed by the program, older age (adjusted odds ratio [aOR], 1.05; 95% CI, 1.03-1.06), multiple comorbidities (1-2: aOR, 5.88; 95% CI, 2.07-16.72; ≥3: aOR, 20.40; 95% CI, 7.23-57.54), presence of fever (aOR, 2.70; 95% CI, 1.65-4.42), respiratory symptoms (aOR, 2.46; 95% CI, 1.53-3.94), and gastrointestinal symptoms (aOR, 2.19; 95% CI, 1.53-3.94) at initial contact were associated with increased risk of COVID-19-related 30-day admission among those initially managed outpatient. Loss of taste/smell was associated with decreased admission risk (aOR, 0.46; 95% CI, 0.25-0.85). For postdischarge patients, older age was also associated with increased re-admission risk (aOR, 1.04; 95% CI, 1.01-1.06).
Conclusions:
This study reveals that in addition to older age and specific comorbidities, the number of high-risk conditions, fever, respiratory symptoms, and gastrointestinal symptoms at diagnosis all increased odds of COVID-19-related admission. These data could enhance patient prioritization for early treatment interventions and ongoing surveillance.
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