Abstract
Background: The relationship of host immune response and viral replication with health outcomes in patients with COVID-19 remains to be defined. We aimed to characterize the medium and long-term clinical, virological, and serological outcomes after hospitalization for COVID-19, and to identify predictors of long-COVID.
Methods: Prospective, longitudinal study conducted in COVID-19 patients confirmed by RT-PCR. Serial blood and nasopharyngeal samples (NPS) were obtained for measuring SARS-CoV-2 RNA and S-IgG/N-IgG antibodies during hospital stay, and at 1, 2, and 6 months post-discharge. Genome sequencing was performed where appropriate. Patients filled out a COVID-19 symptom questionnaire (CSQ) at 2-month and 6-month visits, and those with highest scores were characterized.
Results: Of 146 patients (60% male, median age 64 years) followed-up, 20.6% required hospital readmission and 5.5% died. At 2 months and 6 months, 9.6% and 7.8% patients, respectively, reported moderate/severe persistent symptoms. SARS-CoV-2 RT-PCR was positive in NPS in 11.8% (median Ct = 38) and 3% (median Ct = 36) patients at 2 months and 6 months, respectively, but no reinfections were demonstrated. Antibody titers gradually waned, with seroreversion occurring at 6 months in 27 (27.6%) patients for N-IgG and in 6 (6%) for S-IgG. Adjusted 2-month predictors of the highest CSQ scores (OR [95%CI]) were lower peak S-IgG (0.80 [0.66-0.94]) and higher WHO severity score (2.57 [1.20-5.86]); 6-month predictors were lower peak S-IgG (0.89 [0.79-0.99]) and female sex (2.41 [1.20-4.82]); no association was found with prolonged viral RNA shedding.
Conclusions: Long-COVID is associated with weak anti-SARS-CoV-2 antibody response, severity of illness, and female gender. Late clinical events and persistent symptoms in the medium and long term occur in a significant proportion of patients hospitalized for COVID-19.
Keywords: COVID-19; SARS-CoV-2; antibody response; long-COVID; viral shedding.
【저자키워드】 COVID-19, SARS-CoV-2, Antibody Response, viral shedding, long-COVID, 【초록키워드】 Hospitalization, antibody, severity, hospital, Sequencing, viral shedding, Sex, Symptom, outcome, RT-PCR, Symptoms, Reinfection, Health, Host immune response, anti-SARS-CoV-2 antibody, viral replication, Prospective, male, female, Patient, SARS-CoV-2 RNA, predictor, SARS-CoV-2 RT-PCR, serological, questionnaire, patients, Blood, association, readmission, COVID-19 patient, Hospital stay, COVID-19 symptom, Virological, Viral RNA shedding, medium, median age, female gender, positive, nasopharyngeal sample, NPs, event, defined, highest, identify, died, proportion, reported, required, conducted, was performed, median, characterized, occur, demonstrated, patients hospitalized, patients with COVID-19, waned, WHO severity score, 【제목키워드】 clinical, response, longitudinal,