Clinical Associations with Hospital Escalation Among COVID-19 Patients Receiving Remdesivir in a Hospital-at-Home Service: A Real-World Cohort Study

<b>Background/Objectives</b>: Hospital-at-home (HaH) programs expanded hospital capacity during the COVID-19 pandemic, but data on which HaH patients receiving intravenous (IV) remdesivir may require hospital escalation is limited. We therefore aimed to explore clinical characteristics associated with escalation to inpatient care. <b>Methods</b>: Single-center, retrospective cohort of adults with confirmed COVID-19 who received IV remdesivir via a HaH service was employed (September 2020-September 2024). Primary outcome was hospital escalation. Associations between baseline variables and escalation were assessed with bivariate statistics. <b>Results</b>: Seventy-eight HaH episodes were analyzed. Hospital escalation occurred in 4 cases (5.1%); 30-day readmission after HaH discharge occurred in 4 additional cases (5.1%). Immunosuppression and persistent COVID-19 were significantly associated with escalation (<i>p</i> = 0.03 and <i>p</i> < 0.001, respectively). Patients who escalated underwent more frequent blood testing and had longer HaH stays. Classical comorbidities (age, hypertension, diabetes, obesity, pulmonary disease) were not associated with escalation. No remdesivir discontinuations due to adverse events were recorded. <b>Conclusions</b>: In this real-world HaH cohort, IV remdesivir was well tolerated with low escalation and readmission rates. Immunosuppression and persistent COVID-19 showed significant associations with escalation, suggesting the need for refined selection and closer monitoring in these subgroups. Findings are exploratory and hypothesis-generating given the small number of events.