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Outcomes of Hospitalized COVID-19 Patients by Risk Factors: Results from a United States Hospital Claims Database

ABSTRACT: Background/Objective The primary objective was to quantify the role of the number of Centers of Disease Control and Prevention (CDC) risk factors on in-hospital mortality. The secondary objective was to assess the associated hospital length of stay (LOS), intensive care unit (ICU) bed utilization, and ICU LOS with the number of CDC risk factors. Methods A retrospective cohort study consisting of all hospitalizations with a confirmed COVID-19 diagnosis discharged between March 15, 2020 and April 30, 2020 was conducted. Data was obtained from 276 acute care hospitals across the United States. Cohorts were identified based upon the number of the CDC COVID-19 risk factors. Multivariable regression modeling was performed to assess outcomes and utilization. The odds ratio (OR) and incidence rate ratio (IRR) were reported. Results Compared with patients with no CDC risk factors, patients with risk factors were significantly more likely to die during the hospitalization: One risk factor (OR 2.08, 95% CI, 1.60–2.70; P < 0.001), two risk factors (OR 2.63, 95% CI, 2.00–3.47; P < 0.001), and three or more risk factors (OR 3.49, 95% CI, 2.53–4.80; P < 0.001). The presence of CDC risk factors was associated with increased ICU utilization, longer ICU LOS, and longer hospital LOS compared to those with no risk factors. Patients with hypertension (OR 0.77, 95% CI, 0.70–0.86; P < 0.001) and those administered statins were less likely to die (OR 0.54, 95% CI, 0.49–0.60; P < 0.001). Conclusions Quantifying the role of CDC risk factors upon admission may improve risk stratification and identification of patients who may require closer monitoring and more intensive treatment.

SUBMITTER: Mallow P

PROVIDER: S-EPMC7539762 | biostudies-literature | 2020 Jan

REPOSITORIES: biostudies-literature

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Project description:PurposeTo identify if non-infectious uveitis (NIU) is associated with a greater risk of coronavirus disease 2019 (COVID-19) infection, hospitalization, and death.DesignA retrospective cohort study from January 20, 2020 to December 31, 2020 using a national claims-based database.ParticipantsEnrollees who had continuous enrollment with both medical and pharmacy coverage for three years prior to January 20, 2020. Patients with an NIU diagnosis within three years of the start of the study were included in the NIU cohort. Those with infectious uveitis codes or new NIU diagnoses during the risk period were excluded.MethodsCox proportional hazards models were used to identify unadjusted hazard ratios as well as adjusted hazard ratios for all covariates for each outcome measure. Adjusted models accounted for patient demographics, health status, and immunosuppressive medication use during the risk period.Main outcome measuresRates of COVID-19 infection, COVID-19-related hospitalization, and COVID-19-related in-hospital death identified with International Classification of Disease 10th revision codes.ResultsThis study included 5,806,227 patients of which 29,869 (0.5%) had a diagnosis of NIU. On unadjusted analysis, patients with NIU had a higher rate of COVID-19 infection (5.7% vs. 4.2%, p<0.001), COVID-19-related hospitalization (1.2% vs. 0.6%, p<0.001) and COVID-19-related death (0.3% vs. 0.1%, p<0.001). However, in adjusted models, NIU was not associated with a greater risk of COVID-19 infection (hazard ratio [HR] = 1.05; 95% confidence interval [CI]: 1.00 - 1.10; p = 0.04), hospitalization (HR = 0.98; 95% CI: 0.88 - 1.09; p = 0.67) or death (HR = 0.90, 95% CI: 0.72 - 1.13, p = 0.37). Use of systemic corticosteroids was significantly associated with higher risk of COVID-19 infection, hospitalization, and death.ConclusionsPatients with NIU were significantly more likely to be infected with COVID-19 and experience severe disease outcomes. However, this association was due to the demographics, comorbidities, and medications of patients with NIU, rather than to NIU alone. Patients utilizing systemic corticosteroids were significantly more likely to be infected with COVID-19 and were at greater risk of hospitalization and in-hospital death. Additional investigation is necessary to identify the impact of corticosteroid exposure on COVID-19-related outcomes.

Project description:BackgroundCeftriaxone is a convenient option for methicillin-sensitive Staphylococcus aureus (MSSA) outpatient parenteral antimicrobial therapy (OPAT), but population-based studies for its effectiveness are lacking.MethodsIn this retrospective cohort, a large insurance claims database was queried from 2010 to 2018 for adults with MSSA bloodstream infection (BSI). Patients discharged on OPAT on cefazolin or oxacillin/nafcillin were compared with ceftriaxone with respect to 90-day hospital readmission with the same infection category and 90-day all-cause readmission using logistic regression models.ResultsOf 1895 patients with MSSA BSI, 1435 (75.7%) patients received cefazolin, oxacillin, or nafcillin and 460 (24.3%) ceftriaxone. Readmission due to the same infection category occurred in 366 (19.3%), and all-cause readmission occurred in 535 (28.3%) within 90 days. Risk factors significantly associated with readmission with the same infection category were the oldest sampled age group (61-64 years: adjusted odds ratio [aOR], 1.47 [95% confidence interval {CI}, 1.01-2.14]), intensive care unit stay during index admission (aOR, 2.33 [95% CI, 1.81-3.01]), prosthetic joint infection (aOR, 1.96 [95% CI, 1.18-2.23]), central line-associated BSI (aOR, 1.72 [95% CI, 1.33-2.94]), and endocarditis (aOR, 1.63 [95% CI, 1.18-2.23]). Ceftriaxone was not associated with increased risk of readmission with the same infection category (aOR, 0.89 [95% CI, .67-1.18]), or 90-day all-cause readmission (aOR, 0.86 [95% CI, .66-1.10]) when compared with oxacillin/nafcillin/cefazolin.ConclusionsIn this cohort of MSSA BSI patients discharged on OPAT, there were no differences in outcomes of readmission with the same infection and 90-day all-cause readmission in patients treated with ceftriaxone compared to oxacillin/nafcillin or cefazolin. Patients with complicated BSIs such as endocarditis and epidural abscess were more likely to be prescribed cefazolin or oxacillin/nafcillin.

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Outcomes of Hospitalized COVID-19 Patients by Risk Factors: Results from a United States Hospital Claims Database

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