MORBIDITY AND MORTALITY OUTCOMES FOR PATIENTS WITH MODERATE-TO-SEVERE COVID-19 DISEASES: A POST-HOSPITALIZATION FOLLOW-UP STUDY

Abstract

Intro: The burden of post-COVID-related morbidity and mortality is significant yet undermined. We studied the morbidity and mortality outcomes of COVID-19 patients with moderate-to-severe diseases by 90-day post-hospitalization. Methods: This retrospective cohort study included 510 COVID-19 patients admitted to Kepala Batas Hospital with moderate to severe diseases, requiring oxygen therapy during hospitalization (Malaysia COVID severity category ≥5; WHO scale ≥5), between January and August 2021. We conducted telephone surveillance for 90 days post-discharge from the hospital, assessing for post- COVID complications and mortality. Relevant clinical data were extracted from medical records. Multiple logistic regression was employed to examine factors associated with post-COVID mortality after index hospitalization. Findings: Among 510 patients, 51%(n=260) were male with a mean age of 52.1 (14.65) years. A third had hypertension (39.8%) and diabetes (31.4%). Only 15.5% were partially vaccinated and 4.9% had complete vaccination before hospitalization. Nearly 65% were supplemented with nasal prong or face mask oxygenation (<10L/ min), 25.7% received high flow oxygenation and 10% were mechanically ventilated. Approximately 23.3% (n=119) of patients were admitted to the intensive care unit. By 90-day post-hospitalization, 46% (n=203) reported residual symptoms: lethargy (14.5%), dyspnoea (12.2%), hair loss (7.5%), memory loss (6.3%), depression (3.9%), anxiety (2.7%) and 1.6% required home oxygen supplementation. Forty-four patients (8.5%) were re- hospitalized at least once, with 40.9% due to post-COVID complications. About 87% of patients attended their post-COVID clinic appointment. Nearly 13.5% (n=69) of patients died within 90 days after being discharged from the hospital. Adjusted for gender, comorbids and ventilatory status, age ≥60 years (aOR 7.96; 95%CI 3.75-16.92; p<0.001), diabetes (aOR 2.30; 95%CI 1.12-4.72; p=0.024) and high oxygen requirement (aOR 3.41; 95%CI 1.56-7.46; p=0.002), were associated with increased 90-day post-COVID mortality. Conclusion: Post-COVID morbidity and mortality are significant among survivors hospitalized for moderate- to-sever disease. Comprehensive care must be addressed to improve the outcomes of post-COVID patients.