After COVID-19 Discharge, Return to Hospital Is Common

May 27, 2021 | 2 min. to read

A new Northwestern Medicine study, published in GeroScience May 21, analyzed 509 patients hospitalized for COVID-19 and found that many subsequently returned for emergency department care, observation stays or hospital readmission. Recurrence of COVID-19 symptoms was the leading reason patients sought hospital-level care within 30 days of discharge.
 
Patients with a history of neurologic disorders before COVID-19 were at elevated risk to return to the hospital, according to the study by the NM Neuro COVID-19 research group. However, the study also found that steroid treatment during a patient’s initial hospitalization for COVID-19 may reduce symptom recurrence that necessitates subsequent hospital-level care.

“We were surprised to find that a history of neurologic disorders was the only comorbidity that predicted an increased risk for recurrent medical complications that required hospital-level care, both at 30 days and four months,” says Eric Liotta, MD, a neurocritical care specialist at NM and co-author of the study. “Neither age, need for mechanical ventilation during COVID-19, nor length of the COVID-19 hospitalization predicted having a hospital reencounter. This finding highlights the unique role of the nervous system in COVID-19 and COVID-19 recovery, a role which has been suggested by other major research groups.”
 
The 509 patients included in the study were first hospitalized for COVID-19 within the Northwestern Medicine health system between March 5 to April 6, 2020. Of the 509 patients:

• 466 patients (91.6%) were discharged from the hospital:
  • Within 30 days, 12.4% of those patients needed hospital-level care
  • Within four months, 21.5% of those patients needed hospital-level care
• Recurrence of COVID-19 symptoms, including shortness of breath, fatigue, fever and respiratory distress, was the leading reason for hospital-level care. Other leading reasons included:
  • Bacterial pneumonia
  • Other pulmonary complications
  • Infections besides pneumonia
  • Bleeding
• Older patients and those with diabetes, chronic obstructive pulmonary disease or organ transplantation had more frequent reencounters
• More than 40% of patients with reencounters had a history of neurological disorders before COVID-19, including epilepsy, stroke, dementia, migraines, spinal stenosis and peripheral neuropathy

 
The study also found that steroid therapy during the initial hospitalization reduced the need for patients to return to the hospital within 30 days of discharge. Furthermore, patients who continued to test positive for COVID-19 on nasal swabs returned more frequently to the hospital over four months, which supports the idea of a post-viral syndrome in COVID-19.

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“Needing to return to the hospital after having been hospitalized for COVID-19 is common,” says Ayush Batra, MD, a neurocritical care specialist at NM and co-author of the study. “Our future work will seek to identify the full range of symptoms experienced by patients following hospitalization for COVID-19, the duration of those symptoms and their impact on function and quality of life. Additionally, we will assess if specific interventions, such as steroids during COVID-19 hospitalization, demonstrate evidence of mitigating symptoms and improving recovery from COVID-19.”
 
The NM Neuro COVID-19 research group has also published studies on the neurologic manifestations in patients hospitalized with COVID-19 and the impact on non-hospitalized COVID-19 long-haulers.

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