Factors associated with prompt recovery among hospitalised patients with coronavirus disease 2019

Abstract

Background: Patients who survived hospitalisation for COVID-19 experienced varying durations of illness but the factors associated with prompt recovery are unknown. This study identifies factors differentiating hospitalised patients who recovered promptly versus survived a prolonged course of illness because of COVID-19. Methods: This was a retrospective study from March-August 2020 of hospitalised adults with COVID-19 which were grouped based on time to recovery: short (≤3 days), intermediate (4-10 days) and prolonged (>10 days). Recovery was defined as resolution of fever, tachypnea, hypotension, extubation and return of mental status at baseline. Multivariate analysis was used to evaluate factors associated with prompt recovery. Results: Among 508 patients hospitalised for COVID-19, 401 (79%) survived. Of those, prompt recovery (within 3 days) was achieved in 43% (174/401), whereas 23% (92/401) recovered after a prolonged period of >10 days. Overall, median age was 64 years with 73% admitted from home and 25% from a skilled nursing facility. Predictors for prompt recovery upon admission included female sex (OR, 1.8; 95% CI, 1.1-2.7; P =.01), no fever (OR, 1.6; 95% CI, 1.1-2.6; P =.03), longer time from symptom onset to hospitalisation (OR, 1.1; 95% CI, 1.0-1.1; P =.001), no supplemental oxygen (OR, 1.9; 95% CI, 1.2-3.0; P =.004), no direct ICU admission (OR, 41.7; 95% CI, 2.4-740.4; P =.01) and absence of bacterial co-infections (OR, 2.5; 95% CI, 1.5-4.0, P =.0003). Conclusions: Our study provides relevant data that could help clinicians triage competing resources in health systems that are challenged by the ebb and flow of COVID-19 cases by identifying clinical features of COVID-19 patients who may require less intensive management including avoidance of unnecessary antibacterial therapy.