• Cheng-Wei Huang, Joon S Park, Hubert Song, Vang Kou Khang, Albert S Yu, Huong Q Nguyen, Janet S Lee, Christopher C Subject, and Ernest Shen.
• Department of Hospital Medicine, Kaiser Permanente Los Angeles Medical Center, 4867 W. Sunset Blvd 6th Floor, Los Angeles, CA, 90027, USA. Cheng-wei.huang@kp.org.
• J Gen Intern Med. 2022 Nov 1; 37 (15): 397339783973-3978.

BackgroundUnderstanding the implications of disease-specific factors beyond baseline patient characteristics for coronavirus disease 2019 (COVID-19) may allow for identification of indicators for safe hospital discharge.ObjectiveAssess whether disease-specific factors are associated with adverse events post-discharge using a data-driven approach.DesignRetrospective cohort study.SettingFifteen medical centers within Kaiser Permanente Southern California.ParticipantsAdult patients (n=3508) discharged alive following hospitalization for COVID-19 between 05/01/2020 and 09/30/2020.InterventionsNone.Main MeasuresAdverse events defined as all-cause readmission or mortality within 14 days of discharge. Least absolute shrinkage and selection operator (LASSO) was used for variable selection and logistic regression was performed to estimate odds ratio (OR) and 95% confidence interval (CI).Key ResultsFour variables including age, Elixhauser index, treatment with remdesivir, and symptom duration at discharge were selected by LASSO. Treatment with remdesivir was inversely associated with adverse events (OR: 0.46 [95%CI: 0.36-0.61]), while symptom duration ≤ 10 days was associated with adverse events (OR: 2.27 [95%CI: 1.79-2.87]) in addition to age (OR: 1.02 [95%CI: 1.01-1.03]) and Elixhauser index (OR: 1.15 [95%CI: 1.11-1.20]). A significant interaction between remdesivir and symptom duration was further observed (p=0.01). The association of remdesivir was stronger among those with symptom duration ≤10 days vs >10 days at discharge (OR: 0.30 [95%CI: 0.19-0.47] vs 0.62 [95%CI: 0.44-0.87]), while the association of symptom duration ≤ 10 days at discharge was weaker among those treated with remdesivir vs those not treated (OR: 1.31 [95%CI: 0.79-2.17] vs 2.71 [95%CI 2.05-3.59]).ConclusionsDisease-specific factors including treatment with remdesivir, symptom duration, and their interplay may help guide clinical decision making at time of discharge.© 2022. The Author(s), under exclusive licence to Society of General Internal Medicine.

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