Predictors of adverse outcome in patients with suspected COVID-19 managed in a ‘virtual hospital’ setting: a cohort study

  1. Nick A Francis
  2. Beth Stuart
  3. Matthew Knight
  4. Rama Vancheeswaran
  5. Charles Oliver
  6. Merlin Willcox
  7. Andrew Barlow
  8. Michael Moore
1 evaluations Published on
Read the full article Related papers
This article on Sciety

Abstract

Objective

Identify predictors of adverse outcome in a Virtual Hospital (VH) setting for COVID 19.

Design

Real-world prospective observational study.

Setting

Virtual hospital remote assessment service in West Hertfordshire NHS Trust, UK.

Participants

Patients with suspected COVID-19 illness enrolled directly from the community (post-accident and emergency (A&E) or medical intake assessment) or post-inpatient admission.

Main outcome measure

Death or (re-)admission to inpatient hospital care over 28 days.

Results

900 patients with a clinical diagnosis of COVID-19 (455 referred from A&E or medical intake and 445 post-inpatient) were included in the analysis. 76 (8.4%) of these experienced an adverse outcome (15 deaths in admitted patients, 3 deaths in patients not admitted, and 58 additional inpatient admissions). Predictors of adverse outcome were increase in age (OR 1.04 [95%CI: 1.02, 1.06] per year of age), history of cancer (OR 2.87 [95%CI: 1.41, 5.82]), history of mental health problems (OR 1.76 [95%CI: 1.02, 3.04]), severely impaired renal function (OR for eGFR <30 = 9.09 [95%CI: 2.01, 41.09]) and having a positive SARS-CoV-2 PCR result (OR 2.0 [95% CI: 1.11, 3.60]).

Conclusions

These predictors may help direct intensity of monitoring for patients with suspected or confirmed COVID-19 who are being remotely monitored by primary or secondary care services. Further research is needed to identify the reasons for increased risk of adverse outcome associated with cancer and mental health problems.

ARTICLE SUMMARY

Strengths and limitations of this study

  • The study uses anonymised data from all patients registered for the virtual hospital between 17/03/20 and 17/05/20, and therefore selection bias is not an issue.

  • At the time of this study, this was the only service providing remote follow-up for patients with suspected COVID-19 in the area, and therefore our findings are likely to be relevant to primary care patients receiving remote follow-up.

  • We were able to collect reliable data on a wide range of clinical and demographic features, and reliably follow all patients for the primary outcome for at least two weeks following their discharge from the VH.

  • We were not able to extract detailed symptom or clinical examination data, and there were significant amounts of missing data for some variables.

  • Our study is likely underpowered to detect all predictors, especially in the analysis of our two sub-groups

Related articles

Related articles are currently not available for this article.