Risk Factors for Admission Within a Hospital-Based COVID-19 Home Monitoring Program

BACKGROUND: Despite increasing vaccination rates, coronavirus disease 2019 (COVID-19) continues to overwhelm heath systems worldwide. Few studies follow outpatients diagnosed with COVID-19 to understand risks for subsequent admissions. We sought to identify hospital admission risk factors in individuals with COVID-19 to guide outpatient follow-up and prioritization for novel therapeutics. METHODS: We prospectively designed data collection templates and remotely monitored patients after a COVID-19 diagnosis, then retrospectively analyzed data to identify risk factors for 30-day admission for those initially managed outpatient and for 30-day re-admissions for those monitored after an initial COVID-19 admission. We included all patients followed by our COVID-19 follow-up monitoring program from April 2020 to February 2021. RESULTS: Among 4070 individuals followed by the program, older age (adjusted odds ratio [aOR], 1.05; 95% CI, 1.03–1.06), multiple comorbidities (1–2: aOR, 5.88; 95% CI, 2.07–16.72; ≥3: aOR, 20.40; 95% CI, 7.23–57.54), presence of fever (aOR, 2.70; 95% CI, 1.65–4.42), respiratory symptoms (aOR, 2.46; 95% CI, 1.53–3.94), and gastrointestinal symptoms (aOR, 2.19; 95% CI, 1.53–3.94) at initial contact were associated with increased risk of COVID-19-related 30-day admission among those initially managed outpatient. Loss of taste/smell was associated with decreased admission risk (aOR, 0.46; 95% CI, 0.25–0.85). For postdischarge patients, older age was also associated with increased re-admission risk (aOR, 1.04; 95% CI, 1.01–1.06). CONCLUSIONS: This study reveals that in addition to older age and specific comorbidities, the number of high-risk conditions, fever, respiratory symptoms, and gastrointestinal symptoms at diagnosis all increased odds of COVID-19-related admission. These data could enhance patient prioritization for early treatment interventions and ongoing surveillance.