The association between baseline viral load and long-term risk in patients with COVID-19 in Hong Kong: a
Jasper Tromp1,2, Michael Wong3, Wouter Ouwerkerk4,5
1Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore. jasper_tromp@nus.edu.sg.
Insights
Higher viral load in COVID-19 patients, even with mild disease, significantly increases the risk of death, hospitalization, and cardiovascular complications post-discharge. This highlights the importance of monitoring viral load for predicting long-term health outcomes.
Area of Science:
- Infectious Diseases
- Public Health
- Epidemiology
Background:
- COVID-19 is known to cause long-term multiorgan dysfunction.
- Limited research exists on long-term COVID-19 risks in Asian populations and the role of viral load.
- Understanding post-discharge complications is crucial for managing the pandemic's aftermath.
Purpose of the Study:
- To investigate post-discharge hospitalization rates in COVID-19 patients in Hong Kong.
- To examine the association between baseline viral load and long-term risks.
- To identify specific complications and medication needs linked to viral load.
Main Methods:
- Population-based cohort study of all COVID-19 patients admitted to Hong Kong public facilities (Jan-Aug 2020).
- Utilized electronic health records for tracking outcomes like death and hospitalization.
- Analyzed viral load (RT-PCR Ct values) and its correlation with adverse events.
Main Results:
- Of 4054 patients, 11.9% were re-hospitalized, and 0.5% died during follow-up.
- Higher viral load (lower Ct values) strongly predicted death, hospitalization, and cardiovascular disease hospitalization.
- Increased viral load was linked to higher initiation rates of ACE-inhibitors and non-opioid analgesics.
Conclusions:
- Even in a mild COVID-19 cohort, significant post-acute complications occur.
- Baseline viral load is a critical predictor of long-term complications.
- Findings emphasize the need for continued monitoring and risk stratification based on viral load.
Abstract:
COVID-19 can increase the long-term risk of multiorgan dysfunction. Few studies investigated the long-term risk in Asian populations or investigated the association between viral load and long-term risk. We aimed to investigate the post-discharge rates of hospitalization and association with baseline viral load in all patients with COVID-19 in Hong Kong. This was a population-based cohort study included all patients with a positive RT-PCR test for SARS-CoV-2 in Hong Kong between January 1st 2020 and August 30th 2020, routinely admitted to public health care facilities for isolation and treatment. Viral Ct values were available in 3433 (85%) of patients. Outcomes of interest included death, cause-specific hospitalizations, and initiation of medication from the Hospital Authority's territory-wide electronic health records from the Clinical Data Analysis and Reporting System. In total, 4054 people in Hong Kong tested positive for COVID-19 and were admitted to a public health care facility, of whom 167 (4.1%) were admitted to ICU. During a median follow-up time of 251 (interquartile range 240-279) days, 408 (11.9%) were hospitalized for any reason and 16 (0.5%) patients died. After discharge, patients were most often readmitted for respiratory reasons, followed by gastro-intestinal reasons. A higher viral load (lower RT-PCR Ct values) was associated with a higher likelihood of death (Hazard ratio [HR] 5.86, 95% Confidence interval [CI] 2.57-13.33), hospitalization (HR 1.22, 95%CI 1.08-1.39) or hospitalization for cardiovascular disease (HR 12.78, 95%CI 3.67-44.48). Patients with higher viral loads more likely started ACE-inhibitors (HR 1.37, 95%CI 1.12-1.68) and non-opioid analgesics (HR 1.01, 95%CI 1.01-1.23). In a relatively mild COVID-19 population from Hong Kong, the post-acute risk of complications was substantial. Our results highlight that higher viral load predict post-acute complications in patients with relatively mild disease.
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