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Observational Study
. 2021 Aug 5;16(8):e0255427.
doi: 10.1371/journal.pone.0255427. eCollection 2021.

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

Christian Günster  1 , Reinhard Busse  2 , Melissa Spoden  1 , Tanja Rombey  2 , Gerhard Schillinger  1 , Wolfgang Hoffmann  3 , Steffen Weber-Carstens  4 , Andreas Schuppert  5 , Christian Karagiannidis  6
Affiliations
Observational Study

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

Christian Günster et al. PLoS One. .

Abstract

Background: 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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Conflict of interest statement

RB reports grants from Berlin University Alliance, during the conduct of the study; grants from Federal Ministry of Research and Education, grants from Federal Ministry of Health, grants from Innovation Fonds of the Federal Joint Committee, grants from World Health Organization, outside the submitted work, AS reports grants from Bayer AG, outside the submitted work. CK reports personal fees from Maquet, personal fees from Xenios, personal fees from Bayer, non-financial support from Speaker of the German register of ICUs, grants from German Ministry of Research and Education, during the conduct of the study. CG, MS, TR, GS, WH, and SWC have nothing to disclose.

Figures

Fig 1
Fig 1. Patient flow diagram.
Fig 2
Fig 2. Kaplan-Meier survival curves of all hospitalized COVID-19 patients followed for 180 days after hospital admission.
Fig 3
Fig 3. Kaplan-Meier survival curves of all hospitalized COVID-19 patients on mechanical ventilation followed for 180 days after hospital admission.
Fig 4
Fig 4. Multivariable logistic regression analysis for 180-day all-cause mortality after hospital admission.
CI confidence interval, OR odds ratio, BMI body mass index. Only significant risk factors are included in the model. Each covariate has been adjusted for all other covariates displayed.
See this image and copyright information in PMC

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