Reingresos por la COVID-19 durante los tres primeros periodos epidémicos en Orihuela, España: incidencia, factores de riesgo y letalidad / COVID-19 readmissions during the first three epidemic periods in Orihuela, Spain: incidence, risk factors and letality

Fundamentos: los reingresos por la covid-19 se asocian a un incremento de la mortalidad, saturación de los servicios sanitarios y elevados costes. Este estudio pretendió evaluar la incidencia y los factores de riesgo de reingreso en pacientes con covid-19 en un hospital comarcal español entre febrero de 2020 y marzo de 2021.métodos: se realizó un estudio sobre una cohorte que describía las características de los pacientes adultos reingresados en los treinta días siguientes al alta tras un ingreso por la covid-19. Se analizaron los factores de riesgo asociados a reingreso mediante un modelo de regresión de logística binaria.resultados: de los 967 pacientes dados de alta de un primer ingreso por la covid-19, 70 (7,2%) reingresaron en los treinta días siguientes. De ellos, el 34,3% presentó progresión de la neumonía, el 15,7% deterioro funcional y el 12,9% otras infecciones. La letalidad en el reingreso fue del 28,6%. No hubo diferencias estadísticamente significativas en la incidencia acumulada de reingreso entre los tres periodos (p=0,241). Los factores asociados de forma independiente con el reingreso fueron: diabetes mellitus (ora: 1,96; ic 95%:1,07-3,57; p=0,030); insuficiencia renal aguda (ora 2,69; ic del 95%: 1,43-5,07, p=0,002); no ser candidato a cuidados intensivos (ora 7,68, ic 95% 4,28-13,80, p<0,001); y no tener prescritos corticosteroides al alta (ora 2,15, ic 95% 1,04- 4,44; p=0,039).conclusiones: una proporción sustancial de los pacientes ingresados por la covid-19 reingresan, con una elevada letalidad. La diabetes mellitus, la insuficiencia renal aguda, no ser candidato a ingreso en uci y no tener prescritos corticoides al alta se asocian con un mayor riesgo de reingreso.(AU)

Background: readmission for covid-19 is associated with high mortality, saturation of health services, and high costs. This study aimed to assess the incidence and risk factors of readmissions in covid-19 patients in a regional hospital of spain from february 2020 to march 2021.methods: a retrospective cohort study describing the characteristics of adult patients readmitted within thirty days of discharge after being infected with sars-cov-2 was carried out. Readmission associated risk factors were analysed using a binary logistic regression model.results: of the 967 patients who survived their first covid-19 admission, 70 (7.2%) were readmitted within thirty days. Of these, 34.3% presented pneumonia progression, 15.7% functional deterioration, and 12.9% other infections. The mortality rate during read-mission was 28.6%. There were no statistically significant differences in the cumulative incidence of readmissions between the epide-mic periods (p=0.241). Factors independently associated with readmission were: diabetes mellitus (aor 1.96, 95%ci 1.07-3.57, p=0.030); acute kidney failure (aor 2.69, 95%ci 1.43-5.07, p=0.002); not being a candidate for intensive care (aor 7.68, 95% ci 4.28-13.80, p<0.001); and not being prescribed corticosteroids at discharge (aor 2.15, 95% ci 1.04-4.44; p=0.039).conclusions: a substantial proportion of patients admitted due to covid-19 are readmitted, and they carry a high letality. Dia-betes mellitus, acute kidney failure, not being a candidate for icu admission, and not being prescribed corticosteroids on discharge are independently associated with an increased risk of readmission.(AU)

[COVID-19 readmissions during the first three epidemic periods in Orihuela, Spain: incidence, risk factors and letality]. / Reingresos por la COVID-19 durante los tres primeros periodos epidémicos en Orihuela, España: incidencia, factores de riesgo y letalidad.

OBJECTIVE: Readmission for COVID-19 is associated with high mortality, saturation of health services, and high costs. This study aimed to assess the incidence and risk factors of readmissions in COVID-19 patients in a regional hospital of Spain from February 2020 to March 2021. METHODS: A retrospective cohort study describing the characteristics of adult patients readmitted within thirty days of discharge after being infected with SARS-CoV-2 was carried out. Readmission associated risk factors were analysed using a binary logistic regression model. RESULTS: Of the 967 patients who survived their first COVID-19 admission, 70 (7.2%) were readmitted within thirty days. Of these, 34.3% presented pneumonia progression, 15.7% functional deterioration, and 12.9% other infections. The mortality rate during readmission was 28.6%. There were no statistically significant differences in the cumulative incidence of readmissions between the epidemic periods (p=0.241). Factors independently associated with readmission were: diabetes mellitus (aOR 1.96, 95%CI 1.07-3.57, p=0.030); acute kidney failure (aOR 2.69, 95%CI 1.43-5.07, p=0.002); not being a candidate for intensive care (aOR 7.68, 95% CI 4.28-13.80, p<0.001); and not being prescribed corticosteroids at discharge (aOR 2.15, 95% CI 1.04-4.44; p=0.039). CONCLUSIONS: A substantial proportion of patients admitted due to COVID-19 are readmitted, and they carry a high letality. Diabetes mellitus, acute kidney failure, not being a candidate for ICU admission, and not being prescribed corticosteroids on discharge are independently associated with an increased risk of readmission.

OBJECTIVE: Los reingresos por la COVID-19 se asocian a un incremento de la mortalidad, saturación de los servicios sanitarios y elevados costes. Este estudio pretendió evaluar la incidencia y los factores de riesgo de reingreso en pacientes con COVID-19 en un hospital comarcal español entre febrero de 2020 y marzo de 2021. METHODS: Se realizó un estudio sobre una cohorte que describía las características de los pacientes adultos reingresados en los treinta días siguientes al alta tras un ingreso por la COVID-19. Se analizaron los factores de riesgo asociados a reingreso mediante un modelo de regresión de logística binaria. RESULTS: De los 967 pacientes dados de alta de un primer ingreso por la COVID-19, 70 (7,2%) reingresaron en los treinta días siguientes. De ellos, el 34,3% presentó progresión de la neumonía, el 15,7% deterioro funcional y el 12,9% otras infecciones. La letalidad en el reingreso fue del 28,6%. No hubo diferencias estadísticamente significativas en la incidencia acumulada de reingreso entre los tres periodos (p=0,241). Los factores asociados de forma independiente con el reingreso fueron: diabetes mellitus (ORa: 1,96; IC 95%:1,07-3,57; p=0,030); insuficiencia renal aguda (ORa 2,69; IC del 95%: 1,43-5,07, p=0,002); no ser candidato a cuidados intensivos (ORa 7,68, IC 95% 4,28-13,80, p<0,001); y no tener prescritos corticosteroides al alta (ORa 2,15, IC 95% 1,04- 4,44; p=0,039). CONCLUSIONS: Una proporción sustancial de los pacientes ingresados por la COVID-19 reingresan, con una elevada letalidad. La diabetes mellitus, la insuficiencia renal aguda, no ser candidato a ingreso en UCI y no tener prescritos corticoides al alta se asocian con un mayor riesgo de reingreso.

Ivermectin Effect on In-Hospital Mortality and Need for Respiratory Support in COVID-19 Pneumonia: Propensity Score-Matched Retrospective Study.

INTRODUCTION: There is negligible evidence on the efficacy of ivermectin for treating COVID-19 pneumonia. This study aimed to assess the efficacy of ivermectin for pre-emptively treating Strongyloides stercoralis hyperinfection syndrome in order to reduce mortality and the need for respiratory support in patients hospitalized for COVID-19. METHODS: This single-center, observational, retrospective study included patients admitted with COVID-19 pneumonia at Hospital Vega Baja from 23 February 2020 to 14 March 2021. Because strongyloidiasis is endemic to our area, medical criteria support empiric administration of a single, 200 µg/kg dose of ivermectin to prevent Strongyloides hyperinfection syndrome. The outcome was a composite of all-cause in-hospital mortality and the need for respiratory support. RESULTS: Of 1167 patients in the cohort, 96 received ivermectin. After propensity score matching, we included 192 patients. The composite outcome of in-hospital mortality or need for respiratory support occurred in 41.7% of the control group (40/96) and 34.4% (33/96) of the ivermectin group. Ivermectin was not associated with the outcome of interest (adjusted odds ratio [aOR] 0.77, 95% confidence interval [CI] 0.35, 1.69; p = 0.52). The factors independently associated with this endpoint were oxygen saturation (aOR 0.78, 95% CI 0.68, 0.89, p < 0.001) and C-reactive protein at admission (aOR: 1.09, 95% CI 1.03, 1.16, p < 0.001). CONCLUSIONS: In hospitalized patients with COVID-19 pneumonia, ivermectin at a single dose for pre-emptively treating Strongyloides stercoralis is not effective in reducing mortality or the need for respiratory support measures.