Sperring Heather, Hofman Melissa, Hsu Heather E, Xiao Yian, Keohane Elizabeth A, Lodi Sara, Marathe Jai, Epstein Rachel L
Center for Infectious Diseases, Boston Medical Center, Boston, Massachusetts, USA.
Boston Medical Center Clinical Data Warehouse, Boston, Massachusetts, USA.
Open Forum Infect Dis. 2022 Jun 30;9(7):ofac320. doi: 10.1093/ofid/ofac320. eCollection 2022 Jul.
Despite increasing vaccination rates, coronavirus disease 2019 (COVID-19) continues to overwhelm heath systems worldwide. Few studies follow outpatients diagnosed with COVID-19 to understand risks for subsequent admissions. We sought to identify hospital admission risk factors in individuals with COVID-19 to guide outpatient follow-up and prioritization for novel therapeutics.
We prospectively designed data collection templates and remotely monitored patients after a COVID-19 diagnosis, then retrospectively analyzed data to identify risk factors for 30-day admission for those initially managed outpatient and for 30-day re-admissions for those monitored after an initial COVID-19 admission. We included all patients followed by our COVID-19 follow-up monitoring program from April 2020 to February 2021.
Among 4070 individuals followed by the program, older age (adjusted odds ratio [aOR], 1.05; 95% CI, 1.03-1.06), multiple comorbidities (1-2: aOR, 5.88; 95% CI, 2.07-16.72; ≥3: aOR, 20.40; 95% CI, 7.23-57.54), presence of fever (aOR, 2.70; 95% CI, 1.65-4.42), respiratory symptoms (aOR, 2.46; 95% CI, 1.53-3.94), and gastrointestinal symptoms (aOR, 2.19; 95% CI, 1.53-3.94) at initial contact were associated with increased risk of COVID-19-related 30-day admission among those initially managed outpatient. Loss of taste/smell was associated with decreased admission risk (aOR, 0.46; 95% CI, 0.25-0.85). For postdischarge patients, older age was also associated with increased re-admission risk (aOR, 1.04; 95% CI, 1.01-1.06).
This study reveals that in addition to older age and specific comorbidities, the number of high-risk conditions, fever, respiratory symptoms, and gastrointestinal symptoms at diagnosis all increased odds of COVID-19-related admission. These data could enhance patient prioritization for early treatment interventions and ongoing surveillance.
尽管疫苗接种率不断提高，但2019冠状病毒病（COVID-19）仍在使全球卫生系统不堪重负。很少有研究对确诊为COVID-19的门诊患者进行跟踪，以了解后续住院的风险。我们试图确定COVID-19患者的住院风险因素，以指导门诊随访和新型治疗方法的优先排序。
我们前瞻性地设计了数据收集模板，并在COVID-19诊断后对患者进行远程监测，然后回顾性分析数据，以确定最初接受门诊治疗的患者30天内住院的风险因素，以及最初COVID-19住院后接受监测的患者30天内再次住院的风险因素。我们纳入了2020年4月至2021年2月期间由我们的COVID-19随访监测项目跟踪的所有患者。
在该项目跟踪的4070名个体中，年龄较大（调整优势比[aOR]，1.05；95%置信区间[CI]，1.03-1.06）、多种合并症（1-2种：aOR，5.88；95%CI，2.07-16.72；≥3种：aOR，20.40；95%CI，7.23-57.54）、初次接触时出现发热（aOR，2.70；95%CI，1.65-4.42）、呼吸道症状（aOR，2.46；95%CI，1.53-3.94）和胃肠道症状（aOR，2.19；95%CI，1.53-3.94）与最初接受门诊治疗的患者发生COVID-19相关30天内住院的风险增加有关。味觉/嗅觉丧失与住院风险降低有关（aOR，0.46；95%CI，0.25-0.85）。对于出院后的患者，年龄较大也与再次住院风险增加有关（aOR，1.04；95%CI，1.01-1.06）。
本研究表明，除了年龄较大和特定合并症外，诊断时的高危状况数量、发热、呼吸道症状和胃肠道症状均增加了COVID-19相关住院的几率。这些数据可以提高早期治疗干预和持续监测的患者优先级。
