Review Identifies Factors Linked With COVID-19 Discharge to Postacute Care Facilities

Older age, more comorbidities, and having higher baseline inflammatory markers were all associated with discharge to post-acute care (PAC) facilities and in-hospital death or hospice care discharges following hospitalization for COVID-19, new study results published in PLoS One show.

Higher D-Dimer levels were also linked with these outcomes, while a breakthrough infection—or an infection in a patient vaccinated against SARS-CoV-2—reduced the likelihood of being discharged to PAC and in-hospital death or hospice care.

“Discharge to PAC is associated with higher mortality based on state death certificate–based mortality rates,” the study authors noted.

The study also found discharges to PAC were mitigated for those infected with the Alpha variant. Furthermore, Black and Asian patients and those of Hispanic ethnicity were more likely to be discharged to their homes vs PAC.

To better understand which factors, both at baseline and within the hospital, are associated with the need for and type of post-acute discharge following hospitalization for COVID-19, the researchers assessed electronic health records of 6248 patients admitted between March 7, 2020, and May 4, 2022. To the authors’ knowledge, this is the first study of its kind to look at specific discharge dispositions of patients with COVID-19 following hospitalization.

The dataset represented a single academic health care system of 12 US Midwest hospitals and 60 primary care clinics in Minnesota. PAC facilities included inpatient rehabilitation facilities, skilled nursing facilities, and long-term acute care hospitals. All patients tested positive for COVID-19, while researchers used a cohort of individuals admitted with a primary diagnosis of influenza from January 6, 2011, to November 14, 2020, as a control group.

Of the 6248 patients hospitalized with COVID-19, 4611 (73.8%) were discharged home, 985 (15.8%) to PAC, and 652 (10.4 %) died in hospital. Those discharged to PAC had a higher median age than those who went home and had a longer mean length of stay (LOS).

Data revealed:

• The relative risks (RR) for in-hospital death were lower with a higher platelet count (RR, 0.998; 95% CI, 0.99-0.99) and albumin levels (RR, 0.342; 95% CI, 0.26-0.45), and higher with increased C-reactive protein (RR, 1.006; 95% CI, 1.004-1.007) and D-Dimer (RR, 1.070; 95% CI, 1.039-1.101)
• Increased albumin had lower risk to PAC discharge (RR, 0.630; 95% CI, 0.497-0.798)
• An increase in D-Dimer (RR, 1.033; 95% CI, 1.002-1.064) and C-reactive protein (RR, 1.002; 95% CI, 1.001-1.004) was associated with higher risk of PAC discharge

Vaccination was protective against prolonged length of hospital stay, intensive care unit (ICU) stay, number of days in the ICU, and death during hospitalization.

In addition, “of the baseline COVID-19 symptoms obtained from natural language processing, only dyspnea was found to impact disposition by reducing the association of PAC utilization,” the researchers found. More research is needed to better understand why race was independently associated with discharge home, they said.

Results also suggest monitoring levels of the inflammatory markers studied could help predict outcomes in hospitalized patients.

Investigators were unable to account for unique factors inherent to local practices that could determine discharge to PAC, marking a limitation to the study.

Overall, “we observed that having a later variant and admission vaccination was associated with more favorable outcomes as indicated by discharge disposition,” the researchers concluded. “Further, older age, a greater burden of comorbidities, and longer hospital LOS, ICU LOS, and ICU admission are associated with discharge to PAC and dying in the hospital or discharge to hospice.”

Reference

Ikramuddin F, Melnik T, Ingraham NE, et al. Predictors of discharge disposition and mortality following hospitalization with SARS-CoV-2 infection. PLoS One. Published online April 13, 2023. doi:10.1371/journal.pone.0283326