Abstract：
BACKGROUND: Patients hospitalized with COVID-19 can clinically deteriorate after a period of initial stability, making optimal timing of discharge a clinical and operational challenge.
OBJECTIVE: To determine risks for post-discharge readmission and death among patients hospitalized with COVID-19.
METHODS: Multicenter retrospective observational cohort study, 2020-2021, with 30-day follow-up.
METHODS: Adults admitted for care of COVID-19 respiratory disease between March 2, 2020, and February 11, 2021, to one of 180 US hospitals affiliated with the HCA Healthcare system.
METHODS: Readmission to or death at an HCA hospital within 30 days of discharge was assessed. The area under the receiver operating characteristic curve (AUC) was calculated using an internal validation set (33% of the HCA cohort), and external validation was performed using similar data from six academic centers associated with a hospital medicine research network (HOMERuN).
RESULTS: The final HCA cohort included 62,195 patients (mean age 61.9 years, 51.9% male), of whom 4704 (7.6%) were readmitted or died within 30 days of discharge. Independent risk factors for death or readmission included fever within 72 h of discharge; tachypnea, tachycardia, or lack of improvement in oxygen requirement in the last 24 h; lymphopenia or thrombocytopenia at the time of discharge; being ≤ 7 days since first positive test for SARS-CoV-2; HOSPITAL readmission risk score ≥ 5; and several comorbidities. Inpatient treatment with remdesivir or anticoagulation were associated with lower odds. The model\'s AUC for the internal validation set was 0.73 (95% CI 0.71-0.74) and 0.66 (95% CI 0.64 to 0.67) for the external validation set.
CONCLUSIONS: This large retrospective study identified several factors associated with post-discharge readmission or death in models which performed with good discrimination. Patients 7 or fewer days since test positivity and who demonstrate potentially reversible risk factors may benefit from delaying discharge until those risk factors resolve.
OBJECTIVE: To determine risks for post-discharge readmission and death among patients hospitalized with COVID-19.
METHODS: Multicenter retrospective observational cohort study, 2020-2021, with 30-day follow-up.
METHODS: Adults admitted for care of COVID-19 respiratory disease between March 2, 2020, and February 11, 2021, to one of 180 US hospitals affiliated with the HCA Healthcare system.
METHODS: Readmission to or death at an HCA hospital within 30 days of discharge was assessed. The area under the receiver operating characteristic curve (AUC) was calculated using an internal validation set (33% of the HCA cohort), and external validation was performed using similar data from six academic centers associated with a hospital medicine research network (HOMERuN).
RESULTS: The final HCA cohort included 62,195 patients (mean age 61.9 years, 51.9% male), of whom 4704 (7.6%) were readmitted or died within 30 days of discharge. Independent risk factors for death or readmission included fever within 72 h of discharge; tachypnea, tachycardia, or lack of improvement in oxygen requirement in the last 24 h; lymphopenia or thrombocytopenia at the time of discharge; being ≤ 7 days since first positive test for SARS-CoV-2; HOSPITAL readmission risk score ≥ 5; and several comorbidities. Inpatient treatment with remdesivir or anticoagulation were associated with lower odds. The model\'s AUC for the internal validation set was 0.73 (95% CI 0.71-0.74) and 0.66 (95% CI 0.64 to 0.67) for the external validation set.
CONCLUSIONS: This large retrospective study identified several factors associated with post-discharge readmission or death in models which performed with good discrimination. Patients 7 or fewer days since test positivity and who demonstrate potentially reversible risk factors may benefit from delaying discharge until those risk factors resolve.
摘要：
背景：COVID-19住院患者在经过一段时间的初始稳定后，临床上可能会恶化，使最佳出院时机成为临床和手术挑战。
目的：确定COVID-19住院患者出院后再入院和死亡的风险。
方法：多中心回顾性观察队列研究，2020-2021年，随访30天。
方法：2020年3月2日至2021年2月11日期间，在美国180家附属于HCA医疗保健系统的医院之一入院治疗COVID-19呼吸系统疾病的成年人。
方法：评估HCA医院出院后30天内再入院或死亡。使用内部验证集（HCA队列的33%）计算受试者工作特征曲线下面积（AUC），并且使用来自与医院医学研究网络(HOMERUN)相关的6个学术中心的类似数据进行外部验证.
结果：最终的HCA队列包括62,195名患者（平均年龄61.9岁，51.9%男性），其中4704人(7.6%)再次入院或在出院后30天内死亡。死亡或再次入院的独立危险因素包括出院后72小时内发热；呼吸急促，心动过速,或在最后24小时内对氧的需求没有改善；出院时淋巴细胞减少或血小板减少；自SARS-CoV-2首次阳性测试以来≤7天；医院再入院风险评分≥5；以及几种合并症。住院患者接受瑞米西韦或抗凝治疗的几率较低。内部验证集的模型AUC为0.73(95%CI0.71-0.74),外部验证集的模型AUC为0.66(95%CI0.64-0.67)。
结论：这项大型回顾性研究确定了与出院后再入院或死亡相关的几个因素，这些模型具有良好的区分度。测试阳性后7天或更短的患者以及显示潜在可逆危险因素的患者可能会从延迟出院中受益，直到这些危险因素解决。
目的：确定COVID-19住院患者出院后再入院和死亡的风险。
方法：多中心回顾性观察队列研究，2020-2021年，随访30天。
方法：2020年3月2日至2021年2月11日期间，在美国180家附属于HCA医疗保健系统的医院之一入院治疗COVID-19呼吸系统疾病的成年人。
方法：评估HCA医院出院后30天内再入院或死亡。使用内部验证集（HCA队列的33%）计算受试者工作特征曲线下面积（AUC），并且使用来自与医院医学研究网络(HOMERUN)相关的6个学术中心的类似数据进行外部验证.
结果：最终的HCA队列包括62,195名患者（平均年龄61.9岁，51.9%男性），其中4704人(7.6%)再次入院或在出院后30天内死亡。死亡或再次入院的独立危险因素包括出院后72小时内发热；呼吸急促，心动过速,或在最后24小时内对氧的需求没有改善；出院时淋巴细胞减少或血小板减少；自SARS-CoV-2首次阳性测试以来≤7天；医院再入院风险评分≥5；以及几种合并症。住院患者接受瑞米西韦或抗凝治疗的几率较低。内部验证集的模型AUC为0.73(95%CI0.71-0.74),外部验证集的模型AUC为0.66(95%CI0.64-0.67)。
结论：这项大型回顾性研究确定了与出院后再入院或死亡相关的几个因素，这些模型具有良好的区分度。测试阳性后7天或更短的患者以及显示潜在可逆危险因素的患者可能会从延迟出院中受益，直到这些危险因素解决。
