Discharge disposition and clinical outcomes of patients hospitalized with COVID-19.

OBJECTIVES: By better understanding the long-term effects of COVID-19 and assessing rehabilitation placement among the patients in our study, we hope to determine the predictors of rehabilitation needs in individuals suffering from the long-term sequelae of COVID-19. METHODS: A retrospective chart review was performed of adult patients with a positive COVID-19 polymerase chain reaction test among multiple hospitals in a regional health system. The main outcomes measured were discharge disposition, total length of hospital stay, and overall all-cause mortality and readmission rates within 30 and 90 days of discharge. RESULTS: Of the 2502 patients included in the study, we found that 65.2% were discharged to home, while the remaining patients were discharged to home healthcare (33.6%), skilled nursing facilities (31.7%), or long-term acute rehabilitation centers (11.6%). The overall all-cause mortality rate at 30 and 90 days were 2.7% and 4.4%, respectively. The overall all-cause 30-day and 90-day readmission rates were 7.0% and 7.6%, respectively. CONCLUSION: Younger age and shorter hospitalization stays were the most important predictors of home discharge. Discharge to home was also significantly associated with lower all-cause mortality rates at 30 and 90 days after discharge.

Discharge Disposition and Clinical Outcomes of Patients Hospitalized with COVID-19

Objective By better understanding the long-term effects of COVID-19 and assessing rehabilitation placement among the patients in our study, we hope to determine the predictors of rehabilitation needs in individuals suffering from the long-term sequelae of COVID-19. Methods A retrospective chart review was performed of adult patients with positive COVID-19 PCR test among multiple hospitals in a regional health system. Main outcomes measured were discharge disposition, total length of hospital stay, and overall all-cause mortality and readmission rates within 30- and 90-days of discharge. Results Of the 2,502 patients included in the study, we found that 65.2% were discharged to home, while the remaining patients were discharged to home healthcare (33.6%), skilled nursing facilities (31.7%), or long-term acute rehabilitation centers (11.6%). The overall all-cause mortality rate at 30- and 90-days were 2.7% and 4.4%, respectively. The overall all-cause 30- and 90-day readmission rates were 7.0% and 7.6%, respectively. Conclusion Younger age and shorter hospitalization stay were the most important predictors of home discharge. Discharge to home was also significantly associated with lower all-cause mortality rates at 30- and 90-days post-discharge.

COVID-19 Mortality and Therapeutics in Nebraska and Southwest Iowa during Early Pandemic.

Different pharmacotherapeutics have been introduced, and then stopped or continued, for the treatment of SARS-CoV-2. We evaluated the risks associated with mortality from SARS-CoV-2 infection. METHODS: Data was concurrently or retrospectively captured on COVID-19 hospitalized patients from 6 regional hospitals within the health system. Demographic details, the source of SARS-CoV-2 infection, concomitant disease status, as well as the therapeutic agents used for treating SARS-CoV-2 (e.g., antimicrobials, dexamethasone, convalescent plasma, tocilizumab, and remdesivir) were recorded. Discrete and continuous variables were analyzed using SPSS (ver. 27). Logistic regression identified variables significantly correlated with mortality. RESULTS: 471 patients (admitted from 1 March 2020 through 15 July 2020) were reviewed. Mean (±SD) age and body weight (kg) were 62.5 ± 17.7 years and 86.3 ± 27.1 kg, respectively. Patients were Caucasian (50%), Hispanic (34%), African-American (10%), or Asian (5%). Females accounted for 52% of patients. Therapeutic modalities used for COVID-19 illness included remdesivir (16%), dexamethasone (35%), convalescent plasma (17.8%), and tocilizumab (5.8%). The majority of patients returned home (62%) or were transferred to a skilled nursing facility (23%). The overall mortality from SARS-CoV-2 was 14%. Logistic regression identified variables significantly correlated with mortality. Intubation, receipt of dexamethasone, African-American or Asian ethnicity, and being a patient from a nursing home were significantly associated with mortality (x2 = 86.36 (13) p < 0.0005). CONCLUSIONS: SARS-CoV-2 infected hospitalized patients had significant mortality risk if they were intubated, received dexamethasone, were of African-American or Asian ethnicity, or occupied a nursing home bed prior to hospital admission.

DISCHARGE DISPOSITION OF COVID-19 PATIENTS ADMITTED TO THE INTENSIVE CARE UNIT

A significant number of ICU patients and non-ICU patients (over 25%) required SNF placement. Patients admitted to the ICU with COVID-19 early during the pandemic had significantly higher APACHE II scores and body weight compared to non-ICU patients. [Extracted from the article] Copyright of Critical Care Medicine is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Bamlanivimab use in mild-to-moderate COVID-19 disease: A matched cohort design.

STUDY OBJECTIVE: Our objective was to determine if bamlanivimab (LY-CoV555; BAM), a monoclonal antibody for mild-to-moderate Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-Co-V-2, prevented emergency department (ED) visits, hospitalizations for SARS-CoV-2, or death within 60 days of a positive SARS-CoV-2 viral test. DESIGN: Patient propensity matching was performed for BAM administration to get two discrete groups of patients; those who received BAM (N = 117) and those who did not (N = 117). SETTING: Outpatients (N = 2107) eligible to receive BAM from November 1 to December 31, 2020, were identified. PATIENTS: A total of 144 of 2107 patients with mild-to-moderate SARS-CoV-2 received BAM INTERVENTION: Eligible patients had mild-to-moderate SARS-CoV-2 disease, a positive SARS-CoV-2 test, and risk factor(s) for progression to severe SARS-CoV-2 infection. All patients were reviewed for subsequent ED visits, subsequent hospitalization, and death. MEASUREMENTS AND MAIN RESULTS: Patients (N = 234) were matched, 117 in each group. Median (interquartile range) age was 72 (65-80) years. Forty-seven percent of patients were male. Twenty-one patients who received BAM were subsequently seen in the ED compared to 34 untreated patients (18.0% vs. 29.1%; p = 0.045). Fourteen BAM-treated patients were subsequently hospitalized post-BAM infusion compared to 27 untreated patients (12.0% vs. 23.1%; p = 0.025). Finally, there were no mortalities in the BAM group, however, eleven patients in the untreated group died (0.0% vs. 9.4%; p < 0.001). The number needed to treat (NNT) is 11 patients to prevent one mortality event. CONCLUSIONS: BAM infusion for mild-to-moderate SARS-CoV-2 infection in outpatients significantly prevented subsequent ED visits, hospitalizations, and death from SARS-CoV-2.

Multisystem inflammatory syndrome in adults: A rare sequela of SARS-CoV-2 infection.

Multisystem inflammatory syndrome in adults (MIS-A) came to attention back in June 2020, when the United States Center for Disease Control and Prevention (CDC) received initial reports regarding patients who had presented delayed and multisystem involvement of the disease, with clinical course resembling multisystem inflammatory syndrome in children (MIS-C). This study introduces a case of MIS-A, where the patient presented 3 weeks after initial COVID-19 exposure. His clinical course was consistent with the working definition of MIS-A as specified by the CDC. Aggressive supportive care in the intensive care unit, utilization of advanced heart failure devices, and immunomodulatory therapeutics (high-dose steroids, anakinra, intravenous immunoglobulin) led to clinical recovery. Management of MIS-A is a topic of ongoing research and needs more studies to elaborate on treatment modalities and clinical predictors.