ABSTRACT
INTRODUCTION: During the COVID-19 pandemic, the burden on the healthcare system makes it critical to examine readmission patterns. In this study, we evaluated the readmission rates and risk factors associated with COVID-19 from the large SCCM Discovery VIRUS: COVID-19 Registry. METHOD(S): This was a retrospective, cohort study including hospitalized adult patients from 181 hospitals in 24 countries within the VIRUS: COVID-19 Registry. Demographic, clinical, and outcome data were extracted and divided into two groups: Patients with readmission with COVID-19 in 30 days from discharge and those who were not. A univariate analysis is done using chi-square and t-test as appropriate. Multivariable logistic regression was used to measure risk factor associations with 30-day readmission. RESULT(S): Among 20,283 patients, 1,195 (5.9%) were readmitted within 30 days from discharge. The median (IQR) age of readmitted patients was 66 (55-78) years and 45.2% were female, 60.2% were white, and 78.9% non-Hispanic. Higher odds of readmission were observed in patients aged >60 vs 18-40 years (OR 2.76;95% CI, 2.23-3.41), moderate COVID-19 disease (WHO Ordinal scale 4-5) vs Severe COVID-19 (WHO Ordinal scale 6-9) (OR 1.23;95% CI, 1.10-1.39), no ICU admission at index hospitalization (OR 1.70;95% CI, 1.32-1.80), and Hospital length of stay <=14 vs >14 days (OR 1.53;95% CI, 1.32-1.80) vs those not readmitted (p= < 0.001). Comorbidities including coronary artery disease (OR 2.14;95% CI 1.84-2.48), hypertension (OR 1.58;95% CI 1.40-1.78), congestive Heart Failure (OR 2.54;95% CI 2.16-2.98), chronic pulmonary disease (OR 2.26;95% CI 1.94-2.63), diabetes (OR 1.32;95% CI 1.17-1.49) or chronic kidney disease (CKD) (OR 2.41;95% CI 1.2.09-2.78) were associated with higher odds of readmission. In multivariate logistic regression adjusted for age group, hospital length of stay <=14 days and, highest WHO COVID-19 ordinal scale and index ICU admission coronary artery disease, congestive heart failure, chronic pulmonary disease, chronic kidney disease, hospital length of stay <=14 days and age >60 years remained independent risk factors for readmission within 30 days. CONCLUSION(S): Among hospitalized patients with COVID-19, those readmitted had a higher burden of comorbidities compared to those non-readmitted.
ABSTRACT
SESSION TITLE: ECMO and ARDS in COVID-19 Infections SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/17/2022 12:15 pm - 1:15 pm PURPOSE: To compare characteristics and outcomes of COVID-19 patients with respiratory failure meeting ECMO eligibility criteria who received ECMO vs. conventional therapy (CT) alone. METHODS: Retrospective analysis of COVID-19 patients (admitted April 2020 -December 2021) meeting ECMO eligibility criteria (PaO2/FiO2 <50 for more than 3 hours, PaO2/FiO2 < 80 for more than 6 hours, or pH < 7.25 with a pCO2 of at least 60 mm Hg for more than 6 hours within the first 7 days of mechanical ventilation (MV)) was performed. All patients received optimal therapies according to current guidelines. Due to the criteria evolution over the course of the pandemic, two intensivists confirmed eligibility by independent chart review. Differences between CT and ECMO groups were analyzed using Chi-square, Fisher’s exact, and Wilcoxon rank-sum tests as appropriate. RESULTS: 62 patients met ECMO eligibility criteria, and 20 of them received CT alone. Reasons for not receiving ECMO included high BMI, comorbid conditions, improving gas exchange, or treatment team preference. CT patients had higher BMI (39.0 vs. 32.5, p=0.01), higher incidence of acute kidney injury (70% vs. 42.9%, p=0.05), and lower prevalence of current smoking (10% vs. 33%) compared to ECMO patients. In-hospital mortality for CT was 60% vs. 47.6% for ECMO (p= 0.36). Overall, CT patients had a significantly shorter duration of MV, ICU and hospital length of stay (LOS) than ECMO patients (18.0 vs. 41.0, 19.0 vs. 44.5, and 18.0 vs. 49 days respectively, p< 0.001). CT survivors had a shorter duration of MV, and shorter ICU and hospital LOS than ECMO survivors (23.5 vs. 44.5, 25.0 vs. 52.0, 31.5 vs. 56.0 days respectively, p <0.05). Among CT patients, survivors were younger (38.5 vs. 55, p=0.01), had higher P/F ratio (66.0 vs. 53.5, p=0.05), and lower pCO2 (71.5 vs. 86.0, p= 0.02) during the first week of MV than non-survivors. Respiratory acidosis was the principal ECMO eligibility criteria in 50% of CT survivors and 8.3% of non-survivors. CONCLUSIONS: The difference in mortality between ECMO-eligible patients treated with ECMO vs. CT alone didn’t reach statistical significance, possibly due to small sample size. ECMO was associated with a longer duration of MV, and ICU and hospital LOS. In CT patients, younger age and less severe oxygenation and ventilation abnormalities were associated with survival. Observed survival differences in relation to respiratory acidosis vs. hypoxemia as the main ECMO indication require confirmation. CLINICAL IMPLICATIONS: A significant number of patients meeting ECMO eligibility criteria survived with CT alone. ECMO is resource-intensive and is not universally available, especially at the peaks of the pandemic. We demonstrate characteristics of survivors receiving CT alone which may help further refine ECMO indications in COVID-19 patients. DISCLOSURES: No relevant relationships by Roman Melamed No relevant relationships by Ramiro Saavedra Romero No relevant relationships by Lynn Sipsey No relevant relationships by Ashley Stenzel No relevant relationships by David Tierney