OBJECTIVE: Identify predictors of clinical deterioration in a virtual hospital (VH) setting for COVID-19 .
DESIGN: Real-world prospective observational study .
SETTING: VH remote assessment service in West Hertfordshire NHS Trust, UK .
PARTICIPANTS: Patients with suspected COVID-19 illness enrolled directly from the community (postaccident and emergency (A & E) or medical intake assessment) or postinpatient admission . MAIN OUTCOME MEASURE: Death or (re-) admission to inpatient hospital care during VH follow-up and for 2 weeks post-VH discharge .
RESULTS: 900 patients with a clinical diagnosis of COVID-19 (455 referred from A & E or medical intake and 445 postinpatient) were included in the analysis . 76 (8.4 %) of these experienced clinical deterioration (15 deaths in admitted patients , 3 deaths in patients not admitted and 58 additional inpatient admissions). Predictors of clinical deterioration were increase in age (OR 1.04 (95% CI 1.02 to 1.06) per year of age), history of cancer (OR 2.87 (95% CI 1.41 to 5.82) ), history of mental health problems (OR 1.76 (95% CI 1.02 to 3.04) ), severely impaired renal function (OR for eGFR <30=9.09 (95% CI 2.01 to 41.09) ) and having a positive SARS-CoV-2 PCR result (OR 2.0 (95% CI 1.11 to 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 confirm our findings and identify the reasons for increased risk of clinical deterioration associated with cancer and mental health problems.
MeSH: Adult, Aged, COVID-19, diagnosis, pathology, Clinical Deterioration, Cohort Studies, Female, Hospitals, Humans, Male, Middle Aged, Remote Consultation, Risk Factors
Index: COVID-19, epidemiology, general medicine (see internal medicine), infectious diseases