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.

中文翻译：

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对 SARS-CoV-2 的抗体反应与 COVID-19 患者的长期临床结果相关：一项纵向研究

背景

COVID-19 患者的宿主免疫反应和病毒复制与健康结果之间的关系仍有待确定。我们旨在描述 COVID-19 住院后的中长期临床、病毒学和血清学结果，并确定长期 COVID 的预测因子。

方法

在经 RT-PCR 确认的 COVID-19 患者中进行的前瞻性纵向研究。在住院期间以及出院后 1、2 和 6 个月时，采集了用于测量 SARS-CoV-2 RNA 和 S-IgG/N-IgG 抗体的系列血液和鼻咽样本 (NPS)。在适当的情况下进行基因组测序。患者在 2 个月和 6 个月就诊时填写了一份 COVID-19 症状问卷 (CSQ)，并对得分最高的患者进行了表征。

结果

在 146 名患者（60% 男性，中位年龄 64 岁）的随访中，20.6% 需要再次住院，5.5% 死亡。在 2 个月和 6 个月时，分别有 9.6% 和 7.8% 的患者报告了中度/重度持续症状。在 2 个月和 6 个月时，SARS-CoV-2 RT-PCR 的 NPS 阳性率分别为 11.8%（中位 Ct = 38）和 3%（中位 Ct = 36），但未发现再感染。抗体滴度逐渐下降，27 名（27.6%）N-IgG 患者和 6 名（6%）S-IgG 患者在 6 个月时出现血清逆转。最高 CSQ 评分 (OR [95%CI]) 的调整后 2 个月预测因子是 S-IgG 峰值较低 (0.80 [0.66–0.94]) 和 WHO 严重程度评分较高 (2.57 [1.20–5.86])；6 个月的预测因子是较低的 S-IgG 峰值 (0.89 [0.79–0.99]) 和女性 (2.41 [1.20–4.82])；没有发现与延长的病毒 RNA 脱落有关。

结论

Long-COVID 与抗 SARS-CoV-2 抗体反应较弱、疾病严重程度和女性性别有关。很大一部分因 COVID-19 住院的患者会出现晚期临床事件和中长期持续症状。