6-month mortality and readmissions of hospitalized COVID-19 patients: A nationwide cohort study of 8,679 patients in Germany

PLoS One. 2021 Aug 5;16(8):e0255427. doi: 10.1371/journal.pone.0255427. eCollection 2021.


Background: COVID-19 frequently necessitates in-patient treatment and in-patient mortality is high. Less is known about the long-term outcomes in terms of mortality and readmissions following in-patient treatment.

Aim: The aim of this paper is to provide a detailed account of hospitalized COVID-19 patients up to 180 days after their initial hospital admission.

Methods: An observational study with claims data from the German Local Health Care Funds of adult patients hospitalized in Germany between February 1 and April 30, 2020, with PCR-confirmed COVID-19 and a related principal diagnosis, for whom 6-month all-cause mortality and readmission rates for 180 days after admission or until death were available. A multivariable logistic regression model identified independent risk factors for 180-day all-cause mortality in this cohort.

Results: Of the 8,679 patients with a median age of 72 years, 2,161 (24.9%) died during the index hospitalization. The 30-day all-cause mortality rate was 23.9% (2,073/8,679), the 90-day rate was 27.9% (2,425/8,679), and the 180-day rate, 29.6% (2,566/8,679). The latter was 52.3% (1,472/2,817) for patients aged ≥80 years 23.6% (1,621/6,865) if not ventilated during index hospitalization, but 53.0% in case of those ventilated invasively (853/1,608). Risk factors for the 180-day all-cause mortality included coagulopathy, BMI ≥ 40, and age, while the female sex was a protective factor beyond a fewer prevalence of comorbidities. Of the 6,235 patients discharged alive, 1,668 were readmitted a total of 2,551 times within 180 days, resulting in an overall readmission rate of 26.8%.

Conclusions: The 180-day follow-up data of hospitalized COVID-19 patients in a nationwide cohort representing almost one-third of the German population show significant long-term, all-cause mortality and readmission rates, especially among patients with coagulopathy, whereas women have a profoundly better and long-lasting clinical outcome compared to men.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • COVID-19 / epidemiology*
  • COVID-19 / mortality*
  • Cohort Studies
  • Comorbidity
  • Female
  • Germany / epidemiology
  • Hospital Mortality / trends
  • Hospitalization / trends
  • Humans
  • Kaplan-Meier Estimate
  • Logistic Models
  • Male
  • Middle Aged
  • Patient Discharge / trends
  • Patient Readmission / statistics & numerical data
  • Patient Readmission / trends*
  • Retrospective Studies
  • Risk Factors
  • SARS-CoV-2 / pathogenicity
  • Time Factors

Grant support

Institutional support and physical resources were provided by the University Witten/ Herdecke and Kliniken der Stadt Köln, the Federal Association of the Local Health Care Funds and the Technical University of Berlin. The latter also received a grant from the Berlin University Alliance (112_PreEP_Corona). Article processing fees were funded by the authors. No funding source had a role in the design or conduct of the study; data collection, management, analysis, or interpretation; or the preparation, review, or approval of the manuscript.