Results
Survival rate was 79% (401/508) among patients hospitalized for
COVID-19 during the study period. Overall, median age of COVID-19
survivors was 64 years; majority (73%) were admitted from home with
25% from a skilled nursing facility (SNF). The overall median TTS was 4
days (IQR: 2-10) for survivors, with 43% (n=174) within 3 days, 34%
(n=135) between 4-10 days, and 23% (n=92) after a prolonged period
exceeding 10 days. More females achieved prompt vs. prolonged time to
recovery (51% vs. 37%) (Table 1 ).
At time of admission, significantly less patients in the short TTS group
experienced fevers (47% vs. 58% vs. 63%, p = 0.0214), required
supplemental oxygen (55% vs. 73% vs. 77%, p <
0.0001), while none had septic shock (vs. 4% vs. 16%,
p<0.0001), required direct ICU admission (vs. 7% vs. 25%,p < 0.0001) or mechanical ventilation (vs. 2% vs.
16%, p < 0.0001) compared to the intermediate and
prolonged groups, respectively (Table 1 ). Therapy directed
against COVID-19 was less frequently prescribed to patients with short
compared to intermediate and prolonged TTS: hydroxychloroquine ±
azithromycin (13% vs. 32% vs. 37%, p < 0.0001),
remdesivir (14% vs.29% vs. 48%, p < 0.0001),
tocilizumab (0.6% vs. 0.7% vs. 12%, p < 0.0001),
corticosteroids (34% vs. 31% vs. 58%, p < 0.0001),
and convalescent plasma (10% vs. 24% vs. 40%, p <
0.0001).
Patients with prompt recovery were less likely to have secondary
bacterial infections at time of admission (presumed 13% vs. 24% vs.
39%, p = 0.0001; culture-positive 11% vs. vs. 21% vs. 28%,p = 0.0013), especially in the respiratory site (0% [0/19]
vs. 10% [3/29] vs. 46% [12/26], p = 0.0002) compared to
intermediate and prolonged TTS groups, respectively. Nonetheless, 83%
of the patients in the short TTS group who did not have secondary
bacterial infections were prescribed broad-spectrum antibacterial
therapy for a median duration of 4 days. A notable proportion of the
prolonged TTS cohort were co-infected with multidrug-resistant pathogens
such as Pseudomonas aeruginosa (15%) and carbapenem-resistant
organisms (4%) compared to none in the short TTS group; patients who
resided in a SNF prior to admission accounted for 56% (5/9) of those
with Pseudomonas aeruginosa and all three cases involving
carbapenem-resistant organisms. Interestingly, co-infection with
ESBL-producing isolates (mostly urine) occurred in 4% of patients
overall, irrespective of TTS. Compared to the intermediate and prolonged
TTS cohorts, less patients with a short TTS developed AKI (10% vs. 17%
vs. 34%, p < 0.0001) and none developed ARDS (vs. 1%
vs. 17%, p < 0.0001) (Table 1 ). Ultimately,
those who recovered fastest experienced a shorter hospital stay (median
5 vs. 9 vs. 22 days, p < 0.0001) (Table 1 ).
By multivariable logistic regression analysis, independent predictors
for prompt recovery from COVID-19 were female sex, absence of fever,
longer time from symptom onset to hospitalization, no direct ICU
admission, not requiring supplemental oxygen upon presentation and
absence of presumed or documented co/secondary bacterial infections
(Table 2 ).