Almost third of UK Covid hospital patients readmitted within four months

[Bruce Stephens]

Almost third of UK Covid hospital patients readmitted within four months

BMJ analysis of 48,000 records also finds one in eight patients die within four months of discharge

www.theguardian.com

Actual study (which is linked) is here: https://www.bmj.com/content/372/bmj.n693

Results Over a mean follow-up of 140 days, nearly a third of individuals who were discharged from hospital after acute covid-19 were readmitted (14 060 of 47 780) and more than 1 in 10 (5875) died after discharge, with these events occurring at rates four and eight times greater, respectively, than in the matched control group. Rates of respiratory disease (P<0.001), diabetes (P<0.001), and cardiovascular disease (P<0.001) were also significantly raised in patients with covid-19, with 770 (95% confidence interval 758 to 783), 127 (122 to 132), and 126 (121 to 131) diagnoses per 1000 person years, respectively. Rate ratios were greater for individuals aged less than 70 than for those aged 70 or older, and in ethnic minority groups compared with the white population, with the largest differences seen for respiratory disease (10.5 (95% confidence interval 9.7 to 11.4) for age less than 70 years v 4.6 (4.3 to 4.8) for age ≥70, and 11.4 (9.8 to 13.3) for non-white v 5.2 (5.0 to 5.5) for white individuals).

 

[Amity Island]

"We selected controls from the general population rather than matching to non-covid hospital admissions to determine the increased risk after hospital admission for covid-19 versus no hospital admission for covid-19 (that is, compared with the expected risk for people with similar personal and clinical characteristics in the general population)."

Does this mean they have done a comparative "study" by not comparing those hospitalised "with" and "without" covid, but against those who weren't in hospital?

It doesn't make clear why these patients were admitted to hosptial. It gives a "primary" (in hospital) diagnosis of "covid19" but not the "admitting" diagnosis of the patients.

How can draw an accurate conclusion without knowing why these patients were admitted?

I have no issue with @Bruce Stephens post, just the relentless doom and gloom favoured reports and news etc. They always find the worst outcomes to print and publish, even if it means comparing two completely different situations to make the situation seems worse than it actually is (which is already bad enough).

 

[Bruce Stephens]

Does this mean they have done a comparative "study" by not comparing those hospitalised "with" and "without" covid, but against those who weren't in hospital?

No, the controls are people who may or may not have been in hospital. (Given the period I'm guessing most would not have been in hospital, partly because most people aren't in hospital generally, and especially over the past year hospital stays have been unusual except related to covid.)

I guess it would also be interesting to compare outcomes of people in hospital with COVID against those admitted for other respiratory viruses (or for other reasons altogether) but you're right that that's not what they were trying to do.

It doesn't make clear why these patients were admitted to hosptial. It gives a "primary" (in hospital) diagnosis of "covid19" but not the "admitting" diagnosis of the patients.

Not sure that's particularly significant, is it? If a patient were in hospital because of cancer treatment and also happened to have COVID then the primary diagnosis would be cancer wouldn't it?

 

[Amity Island]

Not sure that's particularly significant, is it? If a patient were in hospital because of cancer treatment and also happened to have COVID then the primary diagnosis would be cancer wouldn't it?

Hi Bruce,

I would say it is important in terms of the impression being made in the article. To me it appears to infer that 48,000 people were admitted to hospital due to covid, which sounds quite a lot. But, if those 48,000 people went in for some other reason, this should be made very clear, to make the article clear, honest, open and transparent. Why leave that (rather important and relevant) information out, why make no mention of this in the article?

 

[Docb]

Having had a quick look at the paper it would appear to me that the authors are not some bunch of clinical and statistical incompetents and it should be pointed out that it was not published in some scurrilous rag. As such it seems to me one should take great care in criticizing their methodology and serious consideration should be given to their conclusions.

There has been much anecdotal evidence that a reaction to a COVID infection needing hospital admission may lead to long lasting problems. What this study does is to put a much needed measure on both the risk and severity of those problems and as such will be valuable in forward planning for the health services needed to treat those affected. It is clear that they are not going to be insubstantial.

Sad thing, if there is one, is that Hancock, Johnson & Co will have already forgotten about this group of people - too busy generating PR wins from their "world class" vaccine development.

 

[Amity Island]

Something that still bugs me to this day is the HCID decision...given how many deaths have been attributed to covid 19, how might this of all "played out" if the governement had retained sarscov2 as a High Consequence Infectious Disease and acted on it from the very first knowledge of it's dangers?

It seemed an odd decision at the time, to one day have sarscov2 as a HCID and the following day say it's not, then be told it could cause 500,000 deaths, followed by the decision to take the whole country into endless restrictions and lockdowns, crash the economy etc etc

What i'm basically asking is, could this have all been avoided if it had been dealt with as a HCID with spread of the virus contained by other means?

 

[Inka]

Hi Bruce,

I would say it is important in terms of the impression being made in the article. To me it appears to infer that 48,000 people were admitted to hospital due to covid, which sounds quite a lot. But, if those 48,000 people went in for some other reason, this should be made very clear, to make the article clear, honest, open and transparent. Why leave that (rather important and relevant) information out, why make no mention of this in the article?

The study was looking at the increased risk of organ problems in people who previously had Covid compared to people who hadn’t had Covid. The reason for their admission is secondary but part of that. We know Covid can cause long-term problems eg kidney issues, heart issues, etc etc so matching Covid and non-Covid people then looking at hospital admissions can indicate whether/how much Covid increases the risk of subsequent organ problems.

I don’t find the article misleading. I assume the patients were matched with non-Covid controls that were very similar to them. So the increase in organ problems is indicative of Covid being involved.

 

[Amity Island]

The study was looking at the increased risk of organ problems in people who previously had Covid compared to people who hadn’t had Covid. The reason for their admission is secondary but part of that. We know Covid can cause long-term problems eg kidney issues, heart issues, etc etc so matching Covid and non-Covid people then looking at hospital admissions can indicate whether/how much Covid increases the risk of subsequent organ problems.

I don’t find the article misleading. I assume the patients were matched with non-Covid controls that were very similar to them. So the increase in organ problems is indicative of Covid being involved.

Hi Inka,

I don't find the article misleading, but if someone said to me they had to go to hospital or had a hospital appointment, my first question would be why or what for? closely followed by how are they or I hope they get sorted etc?

I just find it odd that a study discussing 48,000 hospital admissions failed to mention why they were hospitalised.

 

[Amity Island]

Having a bout of illness makes you more likely to have another bout of illness.
Having a severe bout of illness makes you more likely to have another bout of severe illness. I assume we all accept this as a given.

Comparing mortality of Covid19 pneumonia inpatients to other types of pneumonia inpatients seems fair

Long-term prognosis in community-acquired pneumonia:​

Long-term prognosis in community-acquired pneumonia

Pneumonia is considered the leading infectious diseases cause of death and the seventh leading cause of death overall in the US. There is significant interest in understanding the relationship between community-acquired pneumonia (CAP) and mortality.Most ...

www.ncbi.nlm.nih.gov

Hi Benny,

It reads similar to covid19, in terms of risks and long term problems after initial admissions. It also points this out, which is very interesting in terms of all the restrictions that have been put on for covid but not for community acquired pneumonia.

"Therefore, it is unclear why CAP is not considered a public health threat and major funding is not devoted to this important healthcare problem around the world."

Hmmm....

 

[Bruce Stephens]

What i'm basically asking is, could this have all been avoided if it had been dealt with as a HCID with spread of the virus contained by other means?

Maybe. A few countries managed it, but they had particular factors in their favour (recent experience of epidemics, mostly).

Realistically our government hasn't been willing (or maybe able) to put in place sufficient support for people who feel sick to isolate effectively, and that's after a year of knowing that that would help. I suspect realistically there wasn't a chance: significant restrictions (which we call a lockdown, though it doesn't really compare to what other countries did) were inevitable by March.

It reads similar to covid19, in terms of risks and long term problems after initial admissions.

Very different in speed, though. Remember the news last February/March: hospitals in north Italy were being overwhelmed. By the time we noticed there were infections in the UK we thought it was doubling about every week (actually it was more like 2-3 days). That forces government action in ways that CAP, obesity, air pollution, inequality, just don't.

 

[Inka]

Hi Inka,

I don't find the article misleading, but if someone said to me they had to go to hospital or had a hospital appointment, my first question would be why or what for? closely followed by how are they or I hope they get sorted etc?

I just find it odd that a study discussing 48,000 hospital admissions failed to mention why they were hospitalised.

I get you. I think the actual study is clearer because you can see its purpose and the people-matching process and conclusions. I pasted the Extract below with my underlining:

Abstract​

Objective To quantify rates of organ specific dysfunction in individuals with covid-19 after discharge from hospital compared with a matched control group from the general population.
Design Retrospective cohort study.
Setting NHS hospitals in England.
Participants 47 780 individuals (mean age 65, 55% men) in hospital with covid-19 and discharged alive by 31 August 2020, exactly matched to controls from a pool of about 50 million people in England for personal and clinical characteristics from 10 years of electronic health records.
Main outcome measures Rates of hospital readmission (or any admission for controls), all cause mortality, and diagnoses of respiratory, cardiovascular, metabolic, kidney, and liver diseases until 30 September 2020. Variations in rate ratios by age, sex, and ethnicity.
Results mean follow-up of 140 days, nearly a third of individuals who were discharged from hospital after acute covid-19 were readmitted (14 060 of 47 780) and more than 1 in 10 (5875) died after discharge, with these events occurring at rates four and eight times greater, respectively, than in the matched control group. Rates of respiratory disease (P<0.001), diabetes (P<0.001), and cardiovascular disease (P<0.001) were also significantly raised in patients with covid-19, with 770 (95% confidence interval 758 to 783), 127 (122 to 132), and 126 (121 to 131) diagnoses per 1000 person years, respectively. Rate ratios were greater for individuals aged less than 70 than for those aged 70 or older, and in ethnic minority groups compared with the white population, with the largest differences seen for respiratory disease (10.5 (95% confidence interval 9.7 to 11.4) for age less than 70 years v 4.6 (4.3 to 4.8) for age ≥70, and 11.4 (9.8 to 13.3) for non-white v 5.2 (5.0 to 5.5) for white individuals).
Conclusions Individuals discharged from hospital after covid-19 had increased rates of multiorgan dysfunction compared with the expected risk in the general population. The increase in risk was not confined to the elderly and was not uniform across ethnicities. The diagnosis, treatment, and prevention of post-covid syndrome requires integrated rather than organ or disease specific approaches, and urgent research is needed to establish the risk factors.