Should Comorbidities Be Considered in the Decision to Discharge COVID-19 Patients From Hospital? A Case Series
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Abstract
An outbreak of COVID-19 started in December 2019 in the city of Wuhan and is now rapidly spreading across the world. We report two cases of confirmed COVID-19 with pre-existing comorbidities who were discharged from the hospital with a good clinical condition and in concordance with interim discharge protocols. However, they were readmitted and died on the discharge day. Here we discuss the importance of patient demographics in clinical management vs. the resolution of the pulmonary disease alone and raise a question about the impact of comorbidities on discharge protocols.
1. World Health Organization. Coronavirus disease 2019: World Health Organization; 2020 (Accessed at https://www.who.int/emergencies/diseases/novel-coronavirus-2019.)
2. Du RH, Liang LR, Yang CQ, Wang W, Cao TZ, Li M, et al. Predictors of Mortality for Patients with COVID-19 Pneumonia Caused by SARS-CoV-2: A Prospective Cohort Study. Eur Respir J 2020;55:2000524.
3. Valizadeh R, Moghaddam-Tabrizi F, Omidi T, Mahdi-Akhgar M, Bahadori R, Farrokh-Eslamlou H. Identification of Risk Factors Associated With Mortality Among Patients With COVID-19 Using Random Forest Model: A Historical Cohort Study. Acta Med Iran 2021;59:457-65.
4. Guan WJ, Liang WH, Zhao Y, Liang HR, Chen ZS, Li YM, et al. Comorbidity and its impact on 1590 patients with Covid-19 in China: A Nationwide Analysis. Eur Respir J 2020;55:2000547.
5. Guo T, Fan Y, Chen M, Wu X, Zhang L, He T, et al. Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19). JAMA Cardiol 2020;5:811-8.
6. Shi S, Qin M, Shen B, Cai Y, Liu T, Yang F, et al. Association of Cardiac Injury With Mortality in Hospitalized Patients With COVID-19 in Wuhan, China. JAMA Cardiol 2020,5:802-10.
7. Li B, Yang J, Zhao F, Zhi L, Wang X, Liu L, et al. Prevalence and impact of cardiovascular metabolic diseases on COVID-19 in China. Clin Res Cardiol 2020;109:531-8.
8. Guo W, Li M, Dong Y, Zhou H, Zhang Z, Tian C, et al. Diabetes is a risk factor for the progression and prognosis of COVID-19. Diabetes Metab Res Rev 2020:e3319 .
9. Cheng Y, Luo R, Wang K, Zhang M, Wang Z, Dong L, et al. Kidney disease is associated with in-hospital death of patients with COVID-19. Kidney Int 2020;97:829-38.
10. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA 2020;323:1061-9.
11. Dong N, Cai J, Zhou Y, Liu J, Li F. End-stage Heart Failure with COVID-19: Strong Evidence of Myocardial Injury by 2019-nCoV. JACC Heart Fail 2020;8:515-7.
12. Li T, Lu H, Zhang W. Clinical observation and management of COVID-19 patients. Emerg Microbes Infect 2020;9:687-90 .
13. Sardu CG, Morelli J, Morelli MB, Wang X, Marfella R, Santulli G. Is COVID-19 an Endothelial Disease? Clinical and Basic Evidence. Preprints 2020.
14. CDC. Discontinuation of Transmission-Based Precautions and Disposition of Patients with COVID-19 in Healthcare Settings (Interim Guidance), 2020.
15. ECDC. Discharge criteria for confirmed COVID-19 cases - When is it safe to discharge COVID-19 cases from the hospital or end home isolation? (Accessed at https://www.ecdc.europa.eu/sites/default/files/documents/COVID-19-Discharge-criteria.pdf2020.)
16. Tay JY, Lim PL, Marimuthu K, Sadarangani SP, Ling LM, Ang BSP, et al. De-isolating COVID-19 Suspect Cases: A Continuing Challenge. Clin Infect Dis 2020;71:883-4.
17. Kakodkar P, Kaka N, Baig MN. A Comprehensive Literature Review on the Clinical Presentation, and Management of the Pandemic Coronavirus Disease 2019 (COVID-19). Cureus 2020;12:e7560 .
18. CDC C. Diagnosis and treatment protocol for COVID-19 patients (trial version 7, revised) (Accessed at http://www.chinacdc.cn/en/COVID19/2020.)
2. Du RH, Liang LR, Yang CQ, Wang W, Cao TZ, Li M, et al. Predictors of Mortality for Patients with COVID-19 Pneumonia Caused by SARS-CoV-2: A Prospective Cohort Study. Eur Respir J 2020;55:2000524.
3. Valizadeh R, Moghaddam-Tabrizi F, Omidi T, Mahdi-Akhgar M, Bahadori R, Farrokh-Eslamlou H. Identification of Risk Factors Associated With Mortality Among Patients With COVID-19 Using Random Forest Model: A Historical Cohort Study. Acta Med Iran 2021;59:457-65.
4. Guan WJ, Liang WH, Zhao Y, Liang HR, Chen ZS, Li YM, et al. Comorbidity and its impact on 1590 patients with Covid-19 in China: A Nationwide Analysis. Eur Respir J 2020;55:2000547.
5. Guo T, Fan Y, Chen M, Wu X, Zhang L, He T, et al. Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19). JAMA Cardiol 2020;5:811-8.
6. Shi S, Qin M, Shen B, Cai Y, Liu T, Yang F, et al. Association of Cardiac Injury With Mortality in Hospitalized Patients With COVID-19 in Wuhan, China. JAMA Cardiol 2020,5:802-10.
7. Li B, Yang J, Zhao F, Zhi L, Wang X, Liu L, et al. Prevalence and impact of cardiovascular metabolic diseases on COVID-19 in China. Clin Res Cardiol 2020;109:531-8.
8. Guo W, Li M, Dong Y, Zhou H, Zhang Z, Tian C, et al. Diabetes is a risk factor for the progression and prognosis of COVID-19. Diabetes Metab Res Rev 2020:e3319 .
9. Cheng Y, Luo R, Wang K, Zhang M, Wang Z, Dong L, et al. Kidney disease is associated with in-hospital death of patients with COVID-19. Kidney Int 2020;97:829-38.
10. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA 2020;323:1061-9.
11. Dong N, Cai J, Zhou Y, Liu J, Li F. End-stage Heart Failure with COVID-19: Strong Evidence of Myocardial Injury by 2019-nCoV. JACC Heart Fail 2020;8:515-7.
12. Li T, Lu H, Zhang W. Clinical observation and management of COVID-19 patients. Emerg Microbes Infect 2020;9:687-90 .
13. Sardu CG, Morelli J, Morelli MB, Wang X, Marfella R, Santulli G. Is COVID-19 an Endothelial Disease? Clinical and Basic Evidence. Preprints 2020.
14. CDC. Discontinuation of Transmission-Based Precautions and Disposition of Patients with COVID-19 in Healthcare Settings (Interim Guidance), 2020.
15. ECDC. Discharge criteria for confirmed COVID-19 cases - When is it safe to discharge COVID-19 cases from the hospital or end home isolation? (Accessed at https://www.ecdc.europa.eu/sites/default/files/documents/COVID-19-Discharge-criteria.pdf2020.)
16. Tay JY, Lim PL, Marimuthu K, Sadarangani SP, Ling LM, Ang BSP, et al. De-isolating COVID-19 Suspect Cases: A Continuing Challenge. Clin Infect Dis 2020;71:883-4.
17. Kakodkar P, Kaka N, Baig MN. A Comprehensive Literature Review on the Clinical Presentation, and Management of the Pandemic Coronavirus Disease 2019 (COVID-19). Cureus 2020;12:e7560 .
18. CDC C. Diagnosis and treatment protocol for COVID-19 patients (trial version 7, revised) (Accessed at http://www.chinacdc.cn/en/COVID19/2020.)
| Files | ||
| Issue | Vol 59, No 11 (2021) | |
| Section | Case Report(s) | |
| DOI | https://doi.org/10.18502/acta.v59i11.7781 | |
| Keywords | ||
| Coronavirus disease 2019 (COVID-19) Comorbidity Discharge protocol Outcome assessment Health care | ||
| Rights and permissions | |
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Saberzadeh-Ardestani B, Sorouri M, Khosravi B, Sima AR, Malekzadeh R. Should Comorbidities Be Considered in the Decision to Discharge COVID-19 Patients From Hospital? A Case Series. Acta Med Iran. 2021;59(11):675-680.
