# Clinical Characteristics and Outcome of Readmitted Adult Patients With Acute COVID-19 Infection Within 30 Days of Their Hospital Discharge

## TL;DR

This study examines why some adult patients with acute COVID-19 are readmitted to the hospital within 30 days and finds that persistent pneumonia and other complications are common causes.

## Contribution

The study provides a detailed analysis of 30-day readmission rates and causes for adult COVID-19 patients in Saudi Arabia.

## Key findings

- The 30-day readmission rate was 5.7%, with persistent pneumonia being the most common cause.
- Readmission was associated with increased ICU admissions and mechanical ventilation needs.
- Renal impairment and urinary tract infections were also significant causes of readmission.

## Abstract

Introduction: Readmission to the hospital after an acute COVID-19 infection varies in the literature in terms of rate, causes, and outcomes. The 30-day readmission rate ranges from 4% to as high as 11.3%. The causes of readmission after a COVID-19 admission are diverse and include persistent respiratory symptoms, hypoxia, secondary bacterial infection, and thromboembolic disease. This study aims to describe the causes of hospital readmission within 30 days of discharge following an acute COVID-19 infection.

Methods: This retrospective cohort study was conducted at a tertiary care center in Riyadh, Saudi Arabia, between March 2020 and February 2022 and included all adult patients who were readmitted to the hospital within 30 days after a primary hospital admission due to COVID-19 infection.

Results: A total of 3517 patients were hospitalized with acute COVID-19 infection during the study period, and 200 patients were rehospitalized within 30 days postdischarge, resulting in a readmission rate of 5.7%. The mean age of the readmitted patients was 66.35 ± 19.5 years, and 105 (52.5%) were male. Hypertension and diabetes mellitus were the most common comorbidities. Chronic respiratory disease was present in 44 patients (22%) prior to their acute COVID-19 infection. The mean time to readmission was 7.86 ± 5.8 days. Persistent COVID-19 pneumonia was the most common cause of readmission, diagnosed in 105 patients (52.5%), followed by renal impairment in 29 patients (14.5%). Urinary tract infections were the leading infectious cause of readmission, occurring in 23 patients (11.5%), while secondary bacterial pneumonia was rare. Shortness of breath and cough were the most common symptoms at the second presentation. Respiratory therapeutic interventions were required for 120 patients (60%), and 45 patients required intensive care unit (ICU) admission. Compared to the index admission, a higher proportion of patients required ICU admission and mechanical ventilation. After the index admission, most patients were still symptomatic at discharge (moderate to critical National Early Warning Scores (NEWS)).

Conclusion: The readmission rate after acute COVID-19 infection was 5.7%, aligning with rates reported internationally. The most frequent causes of readmission were persistent COVID-19 pneumonia, renal impairment, and urinary tract infections, while secondary bacterial pneumonia at readmission was rare. Readmission was associated with increased rates of ICU admission and the need for mechanical ventilation. The use of NEWS at discharge may serve as a useful criterion for determining readiness for discharge. Future follow-up of this cohort of patients will determine chronic long-term respiratory complications.