6-month mortality and readmissions of hospitalized COVID-19 patients: A nationwide cohort study of 8,679 patients in Germany

  1. Christian Günster
  2. Reinhard Busse
  3. Melissa Spoden
  4. Tanja Rombey
  5. Gerhard Schillinger
  6. Wolfgang Hoffmann
  7. Steffen Weber-Carstens
  8. Andreas Schuppert
  9. Christian Karagiannidis

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Abstract

COVID-19 frequently necessitates in-patient treatment and in-patient mortality is high. Less is known about the long-term outcomes in terms of mortality and readmissions following in-patient treatment.

Aim

The aim of this paper is to provide a detailed account of hospitalized COVID-19 patients up to 180 days after their initial hospital admission.

Methods

An observational study with claims data from the German Local Health Care Funds of adult patients hospitalized in Germany between February 1 and April 30, 2020, with PCR-confirmed COVID-19 and a related principal diagnosis, for whom 6-month all-cause mortality and readmission rates for 180 days after admission or until death were available. A multivariable logistic regression model identified independent risk factors for 180-day all-cause mortality in this cohort.

Results

Of the 8,679 patients with a median age of 72 years, 2,161 (24.9%) died during the index hospitalization. The 30-day all-cause mortality rate was 23.9% (2,073/8,679), the 90-day rate was 27.9% (2,425/8,679), and the 180-day rate, 29.6% (2,566/8,679). The latter was 52.3% (1,472/2,817) for patients aged ≥80 years 23.6% (1,621/6,865) if not ventilated during index hospitalization, but 53.0% in case of those ventilated invasively (853/1,608). Risk factors for the 180-day all-cause mortality included coagulopathy, BMI ≥ 40, and age, while the female sex was a protective factor beyond a fewer prevalence of comorbidities. Of the 6,235 patients discharged alive, 1,668 were readmitted a total of 2,551 times within 180 days, resulting in an overall readmission rate of 26.8%.

Conclusions

The 180-day follow-up data of hospitalized COVID-19 patients in a nationwide cohort representing almost one-third of the German population show significant long-term, all-cause mortality and readmission rates, especially among patients with coagulopathy, whereas women have a profoundly better and long-lasting clinical outcome compared to men.

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  1. Version published to 10.1371/journal.pone.0255427
  2. ScreenIT

    SciScore for 10.1101/2021.04.24.21256029: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsIRB: The study was approved by the Ethics Committee of the Witten/Herdecke University (research ethics board number 92/2020).
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    All analyses were performed using STATA 16.0 (StataCorp, College Station, Texas).
    STATA
    suggested: (Stata, RRID:SCR_012763)
    StataCorp
    suggested: (Stata, RRID:SCR_012763)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    One limitation of our study is the data source, which only includes patients from the one group of German sickness funds. However, it is the largest group which accounts for 1/3 of the total population, providing a large sample representative for the German population, even if the very old are somewhat overrepresented (20). Hospital data is of high quality because disease codes (ICD) and procedure codes (OPS) are relevant for the amount of remuneration and therefore verified by hospitals and sickness funds. Second, patient-specific data are limited to inpatient diagnoses, procedures and initial characteristics, so some pre-existing conditions might be unknown. Third, we stratified by mechanical ventilation, but not by ICU treatment (as it is not coded separately), which sometimes includes high-flow oxygen therapy without mechanical ventilation. Fourth, detailed data such as laboratory values and information on patient preferences or clinical decision making that may impact the initiation of invasive treatments are not available. Fifth, given its observational nature, this study cannot determine causality between risk factors and long-term mortality. In this nationwide cohort of patients hospitalized for COVID-19 considerable long-term mortality and readmission rates were observed. Patients with coagulopathy had the largest increase in 180-day mortality, followed by congestive heart failure, neurological diseases and acute renal failure. However, female sex is the profound pro...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

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  3. Version published to 10.1101/2021.04.24.21256029v1 on medRxiv