6-Month Follow Up of Hospitalised COVID-19 Patients: A Nationwide Cohort Study of 8679 Patients in Germany

Abstract

Background: COVID-19 frequently necessitates inpatient treatment and inpatient mortality is high. Less is known about long-term outcomes in terms of mortality and readmissions. We provide a detailed account of hospitalised COVID-19 patients until 180 days after their initial hospital admission. Methods: An observational study with claims data from the German Local Health Care Funds of adult patients hospitalised in Germany between Feb 1 and April 30, 2020 with PCR-confirmed COVID-19 and a related principal diagnosis, for whom follow-up data for 180 days after admission or until death was available. A multivariable logistic regression model identified independent risk factors for 180-day mortality. Findings: Of 8679 patients with a median age of 72 years, 2161 (24·9%) died during the index hospitalisation. 30-day mortality was 23·9% (2073/8679), 90-day 27·9% (2425/8679), and 180-day 29·6% (2566/8679). The latter was 52·3% (1472/2817) for patients aged ≥80 years, 23·6% (1621/6865) if not ventilated during index hospitalisation but 53·0% in those ventilated invasively (853/1608). Risk factors for 180-day mortality included coagulopathy, BMI ≥ 40 and age, while female sex was a protective factor beyond fewer prevalence of comorbidities. Of 6235 patients discharged alive, 1668 patients were readmitted a total of 2551 times within 180 days, resulting in an overall readmission rate of 26·8%. Interpretation: 180 day-follow up data of hospitalised COVID-19 patients in a nationwide cohort representing almost one-third of the German population show considerable long-term mortality and readmission rates, especially among patients with coagulopathy, whereas women have a profound and long-lasting better clinical outcome compared to men. Funding: Funding Institutional support and physical resources were provided by the University Witten/Herdecke and Kliniken der Stadt Köln, the Federal Association of the Local Health Care Funds and the Technical University of Berlin. The latter also received a grant from the Berlin University Alliance (112_PreEP_Corona). Declaration of Interest: Dr. Busse 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, Dr. Schuppert reports grants from Bayer AG, outside the submitted work. Dr. Karagiannidis 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. Christian Günster, Melissa Spoden, Steffen Weber-Carstens, Gerhard Schillinger, Tanja Rombey and Dr. Hofmann have nothing to disclose. Ethical Approval: The study was approved by the Ethics Committee of the Witten/Herdecke University (research ethics board number 92/2020).<br>