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Factors associated with a SARS-CoV-2 recurrence after hospital discharge among patients with COVID-19: systematic review and meta-analysis 新型冠状病毒肺炎患者出院后 SARS-CoV-2 复阳的危险因素: 系统评价和 meta 分析

ABSTRACT: Background: The proportion of recurrences after discharge among patients with coronavirus disease 2019 (COVID-19) was reported to be between 9.1% and 31.0%. Little is known about this issue, however, so we performed a meta-analysis to summarize the demographical, clinical, and laboratorial characteristics of non-recurrence and recurrence groups. Methods: Comprehensive searches were conducted using eight electronic databases. Data regarding the demographic, clinical, and laboratorial characteristics of both recurrence and non-recurrence groups were extracted, and quantitative and qualitative analyses were conducted. Results: Ten studies involving 2071 COVID-19 cases were included in this analysis. The proportion of recurrence cases involving patients with COVID-19 was 17.65% (between 12.38% and 25.16%) while older patients were more likely to experience recurrence (weighted mean difference (WMD)=1.67, range between 0.08 and 3.26). The time from discharge to recurrence was 13.38 d (between 12.08 and 14.69 d). Patients were categorized as having moderate severity (odds ratio (OR)=2.69, range between 1.30 and 5.58), while those with clinical symptoms including cough (OR=5.52, range between 3.18 and 9.60), sputum production (OR=5.10, range between 2.60 and 9.97), headache (OR=3.57, range between 1.36 and 9.35), and dizziness (OR=3.17, range between 1.12 and 8.96) were more likely to be associated with recurrence. Patients presenting with bilateral pulmonary infiltration and decreased leucocyte, platelet, and CD4+ T counts were at risk of COVID-19 recurrence (OR=1.71, range between 1.07 and 2.75; WMD=−1.06, range between −1.55 and −0.57, WMD=−40.39, range between −80.20 and −0.48, and WMD=−55.26, range between −105.92 and −4.60, respectively). Conclusions: The main factors associated with the recurrence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) after hospital discharge were older age, moderate severity, bilateral pulmonary infiltration, laboratory findings including decreased leucocytes, platelets, and CD4+ T counts, and clinical symptoms including cough, sputum production, headache, and dizziness. These factors can be considered warning indicators for the recurrence of SARS-CoV-2 and might help the development of specific management strategies.

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The online version of this article (10.1631/jzus.B2000304) contains supplementary materials, which are available to authorized users

SUBMITTER: Yao M

PROVIDER: S-EPMC7759453 | biostudies-literature | 2020 Dec

REPOSITORIES: biostudies-literature

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Project description:Background and aimsHospital readmissions among COVID-19 patients have increased the load on the healthcare systems and added more pressure to hospital capacity. This affects the ability to accommodate newly diagnosed COVID-19 patients and other non-COVID-19 patients who require hospitalization. Therefore, this systematic review aims to understand the rates of and risk factors for hospital readmissions and all-cause mortality among COVID-19 patients who were hospitalized after being discharged following index hospitalization.MethodsOur systematic review protocol is registered with the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42021232324) and prepared in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) 2015 statement. We will search MEDLINE (Ovid), EMBASE (Ovid), MedRxiv, Web of Science (Science Citation Index), ProQuest Coronavirus research database, Cochrane Covid-19 study register, and WHO COVID-19: Global literature on coronavirus disease will be identified from December 31, 2019, to May 31, 2021. Two investigators will independently screen titles and abstracts and select studies reporting hospital readmissions among COVID-19 patients. Further, data extraction and risk of bias assessment will be carried out separately by these independent reviewers. We will extract data on demographics, readmissions, all-cause mortality, emergency department visits, comorbidities, and factors associated with hospitalization among COVID-19 patients. Random-effect meta-analysis will be performed if homogeneous groups of studies are found. The combined evidence will be further stratified according to important background characteristics if the data allow.DiscussionThis systematic review will summarize the available epidemiological evidence regarding rates of hospital readmissions, comorbidities, and related factors among COVID-19 patients who were readmitted after index hospitalization. A better understanding of the relationship between patient profiles and the rate of hospitalization will be helpful in the development of guidelines for patient management.

Project description:ObjectiveThe present study aimed to perform a systematic review and meta-analysis on the prevalence of one-year hospital readmissions and post-discharge all-cause mortality in recovered COVID-19 patients. Moreover, the country-level prevalence of the outcomes was investigated.MethodsAn extensive search was performed in Medline (PubMed), Embase, Scopus, and Web of Science databases until the end of August 3rd, 2021. A manual search was also performed in Google and Google Scholar search engines. Cohort and cross-sectional studies were included. Two independent reviewers screened the papers, collected data, and assessed the risk of bias and level of evidence. Any disagreement was resolved through discussion.Results91 articles were included. 48 studies examined hospital readmissions; nine studies assessed post-discharge all-cause mortality, and 34 studies examined both outcomes. Analyses showed that the prevalence of hospital readmissions during the first 30 days, 90 days, and one-year post-discharge were 8.97% (95% CI: 7.44, 10.50), 9.79% (95% CI: 8.37, 11.24), and 10.34% (95% CI: 8.92, 11.77), respectively. The prevalence of post-discharge all-cause mortality during the 30 days, 90 days and one-year post-discharge was 7.87% (95% CI: 2.78, 12.96), 7.63% (95% CI: 4.73, 10.53) and 7.51% (95% CI, 5.30, 9.72), respectively. 30-day hospital readmissions and post-discharge mortality were 8.97% and 7.87%, respectively. The highest prevalence of hospital readmissions was observed in Germany (15.5%), Greece (15.5%), UK (13.5%), Netherlands (11.7%), China (10.8%), USA (10.0%) and Sweden (9.9%). In addition, the highest prevalence of post-discharge all-cause mortality belonged to Italy (12.7%), the UK (11.8%), and Iran (9.2%). Sensitivity analysis showed that the prevalence of one-year hospital readmissions and post-discharge all-cause mortality in high-quality studies were 10.38% and 4.00%, respectively.Conclusion10.34% of recovered COVID-19 patients required hospital readmissions after discharge. Most cases of hospital readmissions and mortality appear to occur within 30 days after discharge. The one-year post-discharge all-cause mortality rate of COVID-19 patients is 7.87%, and the majority of patients' readmission and mortality happens within the first 30 days post-discharge. Therefore, a 30-day follow-up program and patient tracking system for discharged COVID-19 patients seems necessary.

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Factors associated with a SARS-CoV-2 recurrence after hospital discharge among patients with COVID-19: systematic review and meta-analysis 新型冠状病毒肺炎患者出院后 SARS-CoV-2 复阳的危险因素: 系统评价和 meta 分析

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