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Home Oxygen After Hospitalization for COVID-19: Results From the Multi-Center OXFORD Study
Michael B Freedman1, Yoo Jin Kim2, Ramandeep Kaur2
1Drs Freedman and Kaul are affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois; and Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois. Drs Kim, Labedz, and Taylor and Ms Ziauddin are affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois. Drs Kaur and Vines and Mr Rintz are affiliated with Division of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University, Chicago, Illinois. Dr Jain is affiliated with Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; and Division of Hospital Medicine, Department of Medicine, Northwestern University, Chicago, Illinois. Dr Adegunsoye is affiliated with Section of Pulmonary Critical and Critical Care, Department of Medicine, University of Chicago, Chicago, Illinois. Dr Chung and Ms DeLisa are affiliated with Office of Population Health Sciences, University of Illinois Hospital and Health Sciences System, Chicago, Illinois. Ms Gardner is affiliated with Research Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois. Drs Gordon and Khouzam are affiliated with Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; and Academic Internal Medicine and Geriatrics, Department of Medicine, University of Illinois Chicago, Chicago, Illinois. Drs Greenberg and Mokhlesi are affiliated with Division Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Rush University, Chicago, Illinois. Dr Rubinstein is affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois; Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; and Research Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois. Drs Gerald and Krishnan are affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois; and Office of Population Health Sciences, University of Illinois Hospital and Health Sciences System, Chicago, Illinois. mfreed2@uic.edu.
Background:
In the first months of the pandemic, prior to the introduction of proven-effective treatments, 15-37% of patients hospitalized with COVID-19 were discharged on home oxygen. After proven-effective treatments for acute COVID-19 were established by evidence-based guidelines, little remains known about home oxygen requirements following hospitalization for COVID-19.
Methods:
This was a retrospective, multi-center cohort study of subjects hospitalized for COVID-19 between October 2020-September 2021 at 3 academic health centers. Information was abstracted from electronic health records at the index hospitalization and for 60 d after discharge. The World Health Organization COVID-19 Clinical Progression Scale score was used to identify patients with severe COVID-19.
Results:
Of 517 subjects (mean age 58 y, 47% female, 42% Black, 36% Hispanic, 22% with severe COVID-19), 81% were treated with systemic corticosteroids, 61% with remdesivir, and 2.5% with tocilizumab. About one quarter of subjects were discharged on home oxygen (26% [95% CI 22-29]). Older age (adjusted odds ratio [aOR] 1.02 per 5 y [95% CI 1.02-1.02]), higher body mass index (aOR 1.02 per kg/m2 [1.00-1.04]), diabetes (yes vs no, aOR 1.73 [1.46-2.02]), severe COVID-19 (vs moderate, aOR 3.19 [2.19-4.64]), and treatment with systemic corticosteroids (yes vs no, aOR 30.63 [4.51-208.17]) were associated with an increased odds of discharge on home oxygen. Comorbid hypertension (yes vs no, aOR 0.71 [0.66-0.77) was associated with a decreased odds of home oxygen. Within 60 d of hospital discharge, 50% had documentation of pulse oximetry; in this group, home oxygen was discontinued in 46%.
Conclusions:
About one in 4 subjects were prescribed home oxygen after hospitalization for COVID-19, even after guidelines established proven-effective treatments for acute illness. Evidence-based strategies to reduce the requirement for home oxygen in patients hospitalized for COVID-19 are needed.
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