A safe protocol to identify low risk patients with COVID-19 pneumonia for outpatient management

Teigell Munoz, F. J.; Garcia-Guijarro, E.; Garcia-Domingo, P.; Perez-Nieto, G.; Roque Rojas, F.; Garcia-Pena, M.; Nieto Gallo, M. A.; Melero Bermejo, J. A.; de Guzman-Monje, M. T.; Granizo, J. J.

Background: The coronavirus disease 2019 (COVID-19) outbreak has made necessary to rationalize health-care resources, but there are no published data to this moment regarding ambulatory management of patients with COVID-19 pneumonia. Objective: Evaluate the results of a protocol for ambulatory management of patients with COVID-19 pneumonia according to the rate of readmissions, admission into the Intensive Care Unit (ICU) and deaths. Identify unfavorable prognostic factors that increase the risk of readmission, ICU admission and/or death. Methods: Prospective cohort study of patients with COVID-19 pneumonia discharged from the emergency ward of Infanta Cristina Hospital (Madrid, Spain), that met the criteria of the hospital protocol for outpatient management. We describe outcomes of those patients and compare those who needed readmission versus those we did not. We use logistic regression to explore factors associated with readmissions. Findings: 314 patients were included, of which 20 (6.4%) needed readmission, 3 (1%) developed severe respiratory failure, and none needed ICU admission nor died. 29.9% of patients had any one comorbidity. Hypertension, leukopenia, lymphocytopenia, increased lactate dehydrogenase (LDH), increased aminotransferases were associated to a higher risk of readmission. A clinical course of 10 days or longer, and an absolute eosinophil count over 200/L were associated with a lower risk. After multivariate analysis, only hypertension (OR 4.99, CI 1.54-16.02), temperature over 38{degrees}C in the emergency ward (OR 9.03, CI: 1.89-45.77), leukopenia (OR 4.92, CI 1.42-17.11) and increased LDH (OR 6.62, CI 2.82-19.26) remained significantly associated to readmission. Conclusion Outpatient management of patients with low-risk COVID-19 pneumonia is safe, if adequately selected. The protocol presented here has allowed avoiding 30% of the admissions for COVID-19 pneumonia in our hospital, with a very low readmission rate and non-existing mortality.