Post-acute sequelae of hospitalised COVID-19 re-infection compared with hospitalised first-time infection: a population-based retrospective cohort study in Hong Kong
Introduction COVID-19 infection is associated with post-acute adverse outcomes affecting multiple organ systems. Although preliminary studies have suggested that COVID-19 re-infection may have a cumulative effect on long-term outcome, differential effects of COVID-19 re-infection severe enough to be...
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BMJ Publishing Group
2025-01-01
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| author | Yin Zhang Francisco T T Lai Shirley Chiu Wai Chan Chak Sing Lau Xue Li Eric Yuk Fai Wan Lung Yi Mak Celine S L Chui Ivan F N Hung Esther Wai Yin Chan Vincent Ka Chun Yan Deliang Yang Carlos Wong Ian Chi-Kei Wong |
| author_facet | Yin Zhang Francisco T T Lai Shirley Chiu Wai Chan Chak Sing Lau Xue Li Eric Yuk Fai Wan Lung Yi Mak Celine S L Chui Ivan F N Hung Esther Wai Yin Chan Vincent Ka Chun Yan Deliang Yang Carlos Wong Ian Chi-Kei Wong |
| author_sort | Yin Zhang |
| collection | DOAJ |
| description | Introduction COVID-19 infection is associated with post-acute adverse outcomes affecting multiple organ systems. Although preliminary studies have suggested that COVID-19 re-infection may have a cumulative effect on long-term outcome, differential effects of COVID-19 re-infection severe enough to be hospitalised on post-acute sequelae compared with hospitalised first-time infection have not been explored.Methods Retrospective cohort study using territory-wide electronic medical records databases in Hong Kong. Adults hospitalised with COVID-19 between 1 January and 30 November 2022, who survived the first 28 days after infection and was discharged, were categorised into re-infection and first-time infection groups. Individuals with reinfection were compared with those with first-time infection for all-cause mortality, all-cause hospital readmission, attendance to the emergency department and complications during the post-acute period using propensity-score-weighted Cox regression. Subgroup analyses were conducted by age (<65 and ≥65 years), sex, Charlson Comorbidity Index (0–4, ≥5), COVID-19 vaccination (0–1, 2+doses) and hospitalisation status of previous infection.Results 2244 patients with hospitalised COVID-19 re-infection and 58 894 patients with hospitalised first-time COVID-19 infection were included. After a median follow-up of 170 days, re-infection was associated with a significantly higher risk of post-acute all-cause mortality compared with first-time infection (adjusted HR (95% CI): 1.366 (1.166 to 1.600); incidence rate (95% CI): 7.3 (7.1 to 7.5) vs 4.6 (4.4 to 4.7) per 10 000 person-days), all-cause hospital readmission (1.297 (1.200 to 1.403); 50.5 (49.8 to 51.1) vs 28.1 (27.8 to 28.5)), and attendance to emergency departments (1.307 (1.199 to 1.425); 35.4 (34.8 to 35.9) vs 21.9 (21.6 to 22.2)). Findings were consistent across subgroups of age, sex, health status and vaccination status. A greater magnitude of increased risk was observed especially among those hospitalised during a previous infection.Conclusion Among patients with COVID-19 infection requiring hospitalisation, COVID-19 re-infection was associated with increased post-acute mortality and morbidity compared with first-time infection. Further studies are warranted to delineate the effects on complications. |
| format | Article |
| id | doaj-art-d0d692ac7f034abe96be5f86a85ae419 |
| institution | Kabale University |
| issn | 2753-4294 |
| language | English |
| publishDate | 2025-01-01 |
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| spelling | doaj-art-d0d692ac7f034abe96be5f86a85ae4192025-01-21T09:30:09ZengBMJ Publishing GroupBMJ Public Health2753-42942025-01-013110.1136/bmjph-2023-000833Post-acute sequelae of hospitalised COVID-19 re-infection compared with hospitalised first-time infection: a population-based retrospective cohort study in Hong KongYin Zhang0Francisco T T Lai1Shirley Chiu Wai Chan2Chak Sing Lau3Xue Li4Eric Yuk Fai Wan5Lung Yi Mak6Celine S L Chui7Ivan F N Hung8Esther Wai Yin Chan9Vincent Ka Chun Yan10Deliang Yang11Carlos Wong12Ian Chi-Kei Wong13China Academy of Chinese Medical Sciences, Beijing, China1 The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong KongDepartment Rheumatology and Clinical Immunology, The University of Hong Kong, Pokfulam, Hong KongDepartment of Medicine, The University of Hong Kong, Hong Kong, Hong Kong Special Administrative Region, Hong Kong1 Department of Head and Neck Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, ChinaLaboratory of Data Discovery for Health, Hong Kong, Hong Kong Special Administrative Region, Hong KongDepartment of Medicine, The University of Hong Kong, Hong Kong, Hong KongSchool of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong KongDepartment of Medicine, The University of Hong Kong, Hong KongCentre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong KongCentre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong KongDepartment of Medicine, The University of Hong Kong, Hong Kong, Hong Kong Special Administrative Region, Hong KongLaboratory of Data Discovery for Health, Hong Kong, Hong Kong Special Administrative Region, Hong KongDepartment of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong, Hong Kong Special Administrative Region, Hong KongIntroduction COVID-19 infection is associated with post-acute adverse outcomes affecting multiple organ systems. Although preliminary studies have suggested that COVID-19 re-infection may have a cumulative effect on long-term outcome, differential effects of COVID-19 re-infection severe enough to be hospitalised on post-acute sequelae compared with hospitalised first-time infection have not been explored.Methods Retrospective cohort study using territory-wide electronic medical records databases in Hong Kong. Adults hospitalised with COVID-19 between 1 January and 30 November 2022, who survived the first 28 days after infection and was discharged, were categorised into re-infection and first-time infection groups. Individuals with reinfection were compared with those with first-time infection for all-cause mortality, all-cause hospital readmission, attendance to the emergency department and complications during the post-acute period using propensity-score-weighted Cox regression. Subgroup analyses were conducted by age (<65 and ≥65 years), sex, Charlson Comorbidity Index (0–4, ≥5), COVID-19 vaccination (0–1, 2+doses) and hospitalisation status of previous infection.Results 2244 patients with hospitalised COVID-19 re-infection and 58 894 patients with hospitalised first-time COVID-19 infection were included. After a median follow-up of 170 days, re-infection was associated with a significantly higher risk of post-acute all-cause mortality compared with first-time infection (adjusted HR (95% CI): 1.366 (1.166 to 1.600); incidence rate (95% CI): 7.3 (7.1 to 7.5) vs 4.6 (4.4 to 4.7) per 10 000 person-days), all-cause hospital readmission (1.297 (1.200 to 1.403); 50.5 (49.8 to 51.1) vs 28.1 (27.8 to 28.5)), and attendance to emergency departments (1.307 (1.199 to 1.425); 35.4 (34.8 to 35.9) vs 21.9 (21.6 to 22.2)). Findings were consistent across subgroups of age, sex, health status and vaccination status. A greater magnitude of increased risk was observed especially among those hospitalised during a previous infection.Conclusion Among patients with COVID-19 infection requiring hospitalisation, COVID-19 re-infection was associated with increased post-acute mortality and morbidity compared with first-time infection. Further studies are warranted to delineate the effects on complications.https://bmjpublichealth.bmj.com/content/3/1/e000833.full |
| spellingShingle | Yin Zhang Francisco T T Lai Shirley Chiu Wai Chan Chak Sing Lau Xue Li Eric Yuk Fai Wan Lung Yi Mak Celine S L Chui Ivan F N Hung Esther Wai Yin Chan Vincent Ka Chun Yan Deliang Yang Carlos Wong Ian Chi-Kei Wong Post-acute sequelae of hospitalised COVID-19 re-infection compared with hospitalised first-time infection: a population-based retrospective cohort study in Hong Kong BMJ Public Health |
| title | Post-acute sequelae of hospitalised COVID-19 re-infection compared with hospitalised first-time infection: a population-based retrospective cohort study in Hong Kong |
| title_full | Post-acute sequelae of hospitalised COVID-19 re-infection compared with hospitalised first-time infection: a population-based retrospective cohort study in Hong Kong |
| title_fullStr | Post-acute sequelae of hospitalised COVID-19 re-infection compared with hospitalised first-time infection: a population-based retrospective cohort study in Hong Kong |
| title_full_unstemmed | Post-acute sequelae of hospitalised COVID-19 re-infection compared with hospitalised first-time infection: a population-based retrospective cohort study in Hong Kong |
| title_short | Post-acute sequelae of hospitalised COVID-19 re-infection compared with hospitalised first-time infection: a population-based retrospective cohort study in Hong Kong |
| title_sort | post acute sequelae of hospitalised covid 19 re infection compared with hospitalised first time infection a population based retrospective cohort study in hong kong |
| url | https://bmjpublichealth.bmj.com/content/3/1/e000833.full |
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