ABSTRACT
COVID-19 vaccination impact on hospital outcome metrics among patients hospitalized with COVID-19 is not well known. We evaluated if covid-19 vaccination was associated with better hospital outcomes such as in-hospital mortality, overall length of stay, and home discharge. This retrospective study analyzed data from the electronic health records of 29,732 patients admitted with COVID-19 with or without vaccination (21,525 unvaccinated and 8207 vaccinated) from January to December 2021. The association of COVID-19 vaccination status with overall length of hospitalization, in-hospital mortality rate, home discharge after hospitalization was investigated using a multivariate logistic regression and a generalized linear model. The mean age of all groups was 58.16 ± 17.39 years. The unvaccinated group was younger (54.95 ± 16.75) and had less comorbidities compared to the vaccinated group. Patients that had received COVID-19 vaccination exhibited decreased in-hospital mortality (OR 0.666, 95 % CI 0.580-0.764), decreased length of stay (-2.13 days, CI 2.73-1.55 days), and increased rate of home discharge (OR 1.168, CI 1.037-1.315). Older age and cerebrovascular accident diagnosis at admission demonstrated a negative effect on hospital outcomes with decreased home discharge (OR 0.950 per 1 year, CI 0.946-0.953 and OR 0.415, CI 0.202-0.854) and increased inhospital mortality (OR 1.04 per 1 year, CI 1.036-1.045 and OR 3.005, CI 1.961-4.604). This study shows the additional positive impact of COVID-19 vaccination has not just on in-hospital mortality but also in reducing overall length of stay and improved hospital outcome metrics including increasing likelihood of home discharge after hospitalization.
ABSTRACT
AIMS/HYPOTHESIS: This is an update of the results from the previous report of the CORONADO (Coronavirus SARS-CoV-2 and Diabetes Outcomes) study, which aims to describe the outcomes and prognostic factors in patients with diabetes hospitalised for coronavirus disease-2019 (COVID-19). METHODS: The CORONADO initiative is a French nationwide multicentre study of patients with diabetes hospitalised for COVID-19 with a 28-day follow-up. The patients were screened after hospital admission from 10 March to 10 April 2020. We mainly focused on hospital discharge and death within 28 days. RESULTS: We included 2796 participants: 63.7% men, mean age 69.7 ± 13.2 years, median BMI (25th-75th percentile) 28.4 (25.0-32.4) kg/m2. Microvascular and macrovascular diabetic complications were found in 44.2% and 38.6% of participants, respectively. Within 28 days, 1404 (50.2%; 95% CI 48.3%, 52.1%) were discharged from hospital with a median duration of hospital stay of 9 (5-14) days, while 577 participants died (20.6%; 95% CI 19.2%, 22.2%). In multivariable models, younger age, routine metformin therapy and longer symptom duration on admission were positively associated with discharge. History of microvascular complications, anticoagulant routine therapy, dyspnoea on admission, and higher aspartate aminotransferase, white cell count and C-reactive protein levels were associated with a reduced chance of discharge. Factors associated with death within 28 days mirrored those associated with discharge, and also included routine treatment by insulin and statin as deleterious factors. CONCLUSIONS/INTERPRETATION: In patients with diabetes hospitalised for COVID-19, we established prognostic factors for hospital discharge and death that could help clinicians in this pandemic period. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT04324736.