Increased post-hospital mortality of polypathological patients during COVID-19 pandemic

Abstract

Background: The impact of COVID-19 pandemic on post-hospital mortality of polypathological patients is unknown. Methods: We compared two cohorts of polypathological patients: patients discharged during the first quarter of the years 2017-2019 (pre-pandemic cohort), and patients discharged in the first quarter of 2020 (pandemic cohort). Demographic characteristics, prognostic PROFUND score, use of hospital services after discharge, and vital status at 1, 3, 6, and 12 months were compared. The influence of the pandemic on 3, 6, and 12-month mortality was analyzed with a multivariant model, including gender, age, and prognostic PROFUND score. Results: The pre-pandemic (512 patients) and pandemic (132 patients) cohorts were similar in age (mean 78.8 vs. 79.1-year-old, respectively) and PROFUND prognostic index > 10 (31.9% vs. 37.4%, respectively). There were more men in the prepandemic cohort (59% vs. 49.6%, respectively, p = 0.06). The accumulated 6-month mortality was higher in the pandemic cohort (39.4% vs. 28.7%; p = 0.02), but not at 1, 3, and 12 months. A significant higher risk of accumulated mortality at 6 months in the pandemic cohort remained in multivariant analysis (Odds ratios: 1.63; IC95%: 1.07-2.48). Significant reduction in specialized healthcare utilization during the 12-month period after discharge was found in the pandemic cohort: 42% less emergency visits (p = 0.001), 30% less external office visits (p = 0.023), and 58% less hospitalizations (p = 0.001). Conclusions: Risk of 6-month accumulated mortality of polypathological patients discharged around the onset of the COVID-19 pandemic was 63% higher than historic controls. These differences disappeared 12 months after discharge.

Keywords

• Polypathological patient. Multimorbidity. Prognosis. Mortality. Internal Medicine. COVID-19.