Predictors of discharge disposition and mortality following hospitalization with SARS-CoV-2 infection.
<h4>Importance</h4>The SARS-CoV-2 pandemic has overwhelmed hospital capacity, prioritizing the need to understand factors associated with type of discharge disposition.<h4>Objective</h4>Characterization of disposition associated factors following SARS-CoV-2.<h4>Design&l...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2023-01-01
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| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0283326 |
| _version_ | 1797774458744733696 |
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| author | Farha Ikramuddin Tanya Melnik Nicholas E Ingraham Nguyen Nguyen Lianne Siegel Michael G Usher Christopher J Tignanelli Leslie Morse |
| author_facet | Farha Ikramuddin Tanya Melnik Nicholas E Ingraham Nguyen Nguyen Lianne Siegel Michael G Usher Christopher J Tignanelli Leslie Morse |
| author_sort | Farha Ikramuddin |
| collection | DOAJ |
| description | <h4>Importance</h4>The SARS-CoV-2 pandemic has overwhelmed hospital capacity, prioritizing the need to understand factors associated with type of discharge disposition.<h4>Objective</h4>Characterization of disposition associated factors following SARS-CoV-2.<h4>Design</h4>Retrospective study of SARS-CoV-2 positive patients from March 7th, 2020, to May 4th, 2022, requiring hospitalization.<h4>Setting</h4>Midwest academic health-system.<h4>Participants</h4>Patients above the age 18 years admitted with PCR + SARS-CoV-2.<h4>Intervention</h4>None.<h4>Main outcomes</h4>Discharge to home versus PAC (inpatient rehabilitation facility (IRF), skilled-nursing facility (SNF), long-term acute care (LTACH)), or died/hospice while hospitalized (DH).<h4>Results</h4>We identified 62,279 SARS-CoV-2 PCR+ patients; 6,248 required hospitalizations, of whom 4611(73.8%) were discharged home, 985 (15.8%) to PAC and 652 (10.4%) died in hospital (DH). Patients discharged to PAC had a higher median age (75.7 years, IQR: 65.6-85.1) compared to those discharged home (57.0 years, IQR: 38.2-69.9), and had longer mean length of stay (LOS) 14.7 days, SD: 14.0) compared to discharge home (5.8 days, SD: 5.9). Older age (RRR:1.04, 95% CI:1.041-1.055), and higher Elixhauser comorbidity index [EI] (RRR:1.19, 95% CI:1.168-1.218) were associated with higher rate of discharge to PAC versus home. Older age (RRR:1.069, 95% CI:1.060-1.077) and higher EI (RRR:1.09, 95% CI:1.071-1.126) were associated with more frequent DH versus home. Blacks, Asians, and Hispanics were less likely to be discharged to PAC (RRR, 0.64 CI 0.47-0.88), (RRR 0.48 CI 0.34-0.67) and (RRR 0.586 CI 0.352-0.975). Having alpha variant was associated with less frequent PAC discharge versus home (RRR 0.589 CI 0.444-780). The relative risks for DH were lower with a higher platelet count 0.998 (CI 0.99-0.99) and albumin levels 0.342 (CI 0.26-0.45), and higher with increased CRP (RRR 1.006 CI 1.004-1.007) and D-Dimer (RRR 1.070 CI 1.039-1.101). Increased albumin had lower risk to PAC discharge (RRR 0.630 CI 0.497-0.798. An increase in D-Dimer (RRR1.033 CI 1.002-1.064) and CRP (RRR1.002 CI1.001-1.004) was associated with higher risk of PAC discharge. A breakthrough (BT) infection was associated with lower likelihood of DH and PAC.<h4>Conclusion</h4>Older age, higher EI, CRP and D-Dimer are associated with PAC and DH discharges following hospitalization with COVID-19 infection. BT infection reduces the likelihood of being discharged to PAC and DH. |
| first_indexed | 2024-03-12T22:21:23Z |
| format | Article |
| id | doaj.art-0689f85e5af64b269f3568abb974a35b |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-03-12T22:21:23Z |
| publishDate | 2023-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-0689f85e5af64b269f3568abb974a35b2023-07-23T05:31:25ZengPublic Library of Science (PLoS)PLoS ONE1932-62032023-01-01184e028332610.1371/journal.pone.0283326Predictors of discharge disposition and mortality following hospitalization with SARS-CoV-2 infection.Farha IkramuddinTanya MelnikNicholas E IngrahamNguyen NguyenLianne SiegelMichael G UsherChristopher J TignanelliLeslie Morse<h4>Importance</h4>The SARS-CoV-2 pandemic has overwhelmed hospital capacity, prioritizing the need to understand factors associated with type of discharge disposition.<h4>Objective</h4>Characterization of disposition associated factors following SARS-CoV-2.<h4>Design</h4>Retrospective study of SARS-CoV-2 positive patients from March 7th, 2020, to May 4th, 2022, requiring hospitalization.<h4>Setting</h4>Midwest academic health-system.<h4>Participants</h4>Patients above the age 18 years admitted with PCR + SARS-CoV-2.<h4>Intervention</h4>None.<h4>Main outcomes</h4>Discharge to home versus PAC (inpatient rehabilitation facility (IRF), skilled-nursing facility (SNF), long-term acute care (LTACH)), or died/hospice while hospitalized (DH).<h4>Results</h4>We identified 62,279 SARS-CoV-2 PCR+ patients; 6,248 required hospitalizations, of whom 4611(73.8%) were discharged home, 985 (15.8%) to PAC and 652 (10.4%) died in hospital (DH). Patients discharged to PAC had a higher median age (75.7 years, IQR: 65.6-85.1) compared to those discharged home (57.0 years, IQR: 38.2-69.9), and had longer mean length of stay (LOS) 14.7 days, SD: 14.0) compared to discharge home (5.8 days, SD: 5.9). Older age (RRR:1.04, 95% CI:1.041-1.055), and higher Elixhauser comorbidity index [EI] (RRR:1.19, 95% CI:1.168-1.218) were associated with higher rate of discharge to PAC versus home. Older age (RRR:1.069, 95% CI:1.060-1.077) and higher EI (RRR:1.09, 95% CI:1.071-1.126) were associated with more frequent DH versus home. Blacks, Asians, and Hispanics were less likely to be discharged to PAC (RRR, 0.64 CI 0.47-0.88), (RRR 0.48 CI 0.34-0.67) and (RRR 0.586 CI 0.352-0.975). Having alpha variant was associated with less frequent PAC discharge versus home (RRR 0.589 CI 0.444-780). The relative risks for DH were lower with a higher platelet count 0.998 (CI 0.99-0.99) and albumin levels 0.342 (CI 0.26-0.45), and higher with increased CRP (RRR 1.006 CI 1.004-1.007) and D-Dimer (RRR 1.070 CI 1.039-1.101). Increased albumin had lower risk to PAC discharge (RRR 0.630 CI 0.497-0.798. An increase in D-Dimer (RRR1.033 CI 1.002-1.064) and CRP (RRR1.002 CI1.001-1.004) was associated with higher risk of PAC discharge. A breakthrough (BT) infection was associated with lower likelihood of DH and PAC.<h4>Conclusion</h4>Older age, higher EI, CRP and D-Dimer are associated with PAC and DH discharges following hospitalization with COVID-19 infection. BT infection reduces the likelihood of being discharged to PAC and DH.https://doi.org/10.1371/journal.pone.0283326 |
| spellingShingle | Farha Ikramuddin Tanya Melnik Nicholas E Ingraham Nguyen Nguyen Lianne Siegel Michael G Usher Christopher J Tignanelli Leslie Morse Predictors of discharge disposition and mortality following hospitalization with SARS-CoV-2 infection. PLoS ONE |
| title | Predictors of discharge disposition and mortality following hospitalization with SARS-CoV-2 infection. |
| title_full | Predictors of discharge disposition and mortality following hospitalization with SARS-CoV-2 infection. |
| title_fullStr | Predictors of discharge disposition and mortality following hospitalization with SARS-CoV-2 infection. |
| title_full_unstemmed | Predictors of discharge disposition and mortality following hospitalization with SARS-CoV-2 infection. |
| title_short | Predictors of discharge disposition and mortality following hospitalization with SARS-CoV-2 infection. |
| title_sort | predictors of discharge disposition and mortality following hospitalization with sars cov 2 infection |
| url | https://doi.org/10.1371/journal.pone.0283326 |
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