What are the risk factors of hospital length of stay in the novel coronavirus pneumonia (COVID-19) patients? A survival analysis in southwest China

  1. Zhuo Wang
  2. Yuanyuan Liu
  3. Luyi Wei
  4. John S. Ji
  5. Yang Liu
  6. Runyou Liu
  7. Yuxin Zha
  8. Xiaoyu Chang
  9. Lun Zhang
  10. Qian Liu
  11. Yu Zhang
  12. Jing Zeng
  13. Ting Dong
  14. Xinyin Xu
  15. Lijun Zhou
  16. Jun He
  17. Ying Deng
  18. Bo Zhong
  19. Xianping Wu

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Abstract

The global epidemic of novel coronavirus pneumonia (COVID-19) has resulted in substantial healthcare resource consumption. Since patients’ hospital length of stay (LoS) is at stake in the process, an investigation of COVID-19 patients’ LoS and its risk factors becomes urgent for a better understanding of regional capabilities to cope with COVID-19 outbreaks.

Methods

First, we obtained retrospective data of confirmed COVID-19 patients in Sichuan province via National Notifiable Diseases Reporting System (NNDRS) and field surveys, including their demographic, epidemiological, clinical characteristics and LoS. Then we estimated the relationship between LoS and the possibly determinant factors, including demographic characteristics of confirmed patients, individual treatment behavior, local medical resources and hospital grade. The Kaplan-Meier method and the Cox Proportional Hazards Model were applied for single factor and multi-factor survival analysis.

Results

From January 16, 2020 to March 4, 2020, 538 human cases of COVID-19 infection were laboratory-confirmed, and were hospitalized for treatment, including 271 (50%) patients aged ≥ 45, 285 (53%) males, and 450 patients (84%) with mild symptoms. The median LoS was 19 (interquartile range (IQR): 14–23, range: 3–41) days. Univariate analysis showed that age and clinical grade were strongly related to LoS (P<0.01). Adjusted multivariate analysis showed that the longer LoS was associated with those aged ≥ 45 (Hazard ratio (HR): 0.74, 95% confidence interval (CI): 0.60–0.91), admission to provincial hospital (HR: 0.73, 95% CI: 0.54–0.99), and severe illness (HR: 0.66, 95% CI: 0.48–0.90). By contrast, the shorter LoS was linked with residential areas with more than 5.5 healthcare workers per 1,000 population (HR: 1.32, 95% CI: 1.05–1.65). Neither gender factor nor time interval from illness onset to diagnosis showed significant impact on LoS.

Conclusions

Understanding COVID-19 patients’ hospital LoS and its risk factors is critical for governments’ efficient allocation of resources in respective regions. In areas with older and more vulnerable population and in want of primary medical resources, early reserving and strengthening of the construction of multi-level medical institutions are strongly suggested to cope with COVID-19 outbreaks.

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  1. Version published to 10.1371/journal.pone.0261216
  2. ScreenIT

    SciScore for 10.1101/2020.04.07.20057299: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    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:
    Strengths and limitations: As far as we know, this is the first study to report factors affecting the length of stay of COVID-19 from a province in China. We used the original data in Sichuan Province, a place with a size that is comparable to Germany, and more than that of most European countries such as Britain and Italy in population, and per capita gross domestic product is less than 50 thousand yuan, lower than that of most European countries 30. According to the research results, our study is a novel finding to make recommendations for policies, measures and strategies.31 We believe that the results of this study can serve as a practical reference for global control of COVID-19 under situations of a global pandemic and shortages of medical resources. There are some limitations of the study. First, there may be other factors that affect the length of stay that are not included in the analysis, such as whether the diagnosed patient has underlying diseases. Second, this study did not further divide the confirmed cases of COVID-19 into imported or local cases, in order to obtain more detailed inpatient characteristics.

    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.

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  3. Version published to 10.1101/2020.04.07.20057299v1 on medRxiv