IDEAS home Printed from https://ideas.repec.org/a/nat/natcom/v16y2025i1d10.1038_s41467-025-61737-7.html
   My bibliography  Save this article

SARS-CoV-2 rebound and post-acute mortality and hospitalization among patients admitted with COVID-19: cohort study

Author

Listed:
  • Ka Chun Chong

    (The Chinese University of Hong Kong)

  • Yuchen Wei

    (The Chinese University of Hong Kong)

  • Katherine Min Jia

    (Harvard T.H. Chan School of Public Health)

  • Christopher Boyer

    (Harvard T.H. Chan School of Public Health)

  • Guozhang Lin

    (The Chinese University of Hong Kong)

  • Huwen Wang

    (The Chinese University of Hong Kong)

  • Conglu Li

    (The Chinese University of Hong Kong)

  • Chi Tim Hung

    (The Chinese University of Hong Kong)

  • Xiaoting Jiang

    (The Chinese University of Hong Kong)

  • Carrie Ho Kwan Yam

    (The Chinese University of Hong Kong)

  • Tsz Yu Chow

    (The Chinese University of Hong Kong)

  • Yawen Wang

    (The University of Hong Kong)

  • Shi Zhao

    (The Chinese University of Hong Kong
    Tianjin Medical University)

  • Kehang Li

    (The Chinese University of Hong Kong)

  • Aimin Yang

    (The Chinese University of Hong Kong)

  • Chris Ka Pun Mok

    (Chinese University of Hong Kong)

  • David SC Hui

    (Chinese University of Hong Kong)

  • Eng Kiong Yeoh

    (The Chinese University of Hong Kong)

  • Zihao Guo

    (The Chinese University of Hong Kong)

Abstract

Recent investigations have demonstrated a relationship between the persistence of SARS-CoV-2 and post-COVID-19 conditions. Building upon a potential connection between SARS-CoV-2 persistence and early virologic rebound, we examine the association of early virologic rebound with post-acute mortality and hospitalization due to post-acute sequelae among hospitalized patients with COVID-19 in Hong Kong. Our study includes 13,859, 3959, and 4502 patients in the all-patient, nirmatrelvir/ritonavir, and molnupiravir group, respectively. Results show that patients who experienced virologic rebound exhibited a significantly higher risk of post-acute mortality (hazard ratio [HR], 1.52; 95% confidence interval [CI], 1.36–1.70) with a risk difference [RD] of 7.19%, compared with patients without virologic rebound. A similar increase in the risk of post-acute mortality is also observed in nirmatrelvir/ritonavir-treated patients (HR, 1.78; 95% CI, 1.41–2.25; RD, 12.55%) and molnupiravir-treated patients (HR, 1.47; 95% CI, 1.18–1.82; RD, 4.90%). The virologic rebound may thus serve as an early marker for post-COVID-19 condition, enabling healthcare officials to monitor and provide timely intervention for long COVID.

Suggested Citation

  • Ka Chun Chong & Yuchen Wei & Katherine Min Jia & Christopher Boyer & Guozhang Lin & Huwen Wang & Conglu Li & Chi Tim Hung & Xiaoting Jiang & Carrie Ho Kwan Yam & Tsz Yu Chow & Yawen Wang & Shi Zhao & , 2025. "SARS-CoV-2 rebound and post-acute mortality and hospitalization among patients admitted with COVID-19: cohort study," Nature Communications, Nature, vol. 16(1), pages 1-10, December.
    • Handle: RePEc:nat:natcom:v:16:y:2025:i:1:d:10.1038_s41467-025-61737-7
    DOI: 10.1038/s41467-025-61737-7
    as

    Download full text from publisher

    File URL: https://www.nature.com/articles/s41467-025-61737-7
    File Function: Abstract
    Download Restriction: no
    File URL: https://libkey.io/10.1038/s41467-025-61737-7?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Sydney R. Stein & Sabrina C. Ramelli & Alison Grazioli & Joon-Yong Chung & Manmeet Singh & Claude Kwe Yinda & Clayton W. Winkler & Junfeng Sun & James M. Dickey & Kris Ylaya & Sung Hee Ko & Andrew P. , 2022. "SARS-CoV-2 infection and persistence in the human body and brain at autopsy," Nature, Nature, vol. 612(7941), pages 758-763, December.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Alexsia Richards & Andrew S. Khalil & Max Friesen & Troy W. Whitfield & Xinlei Gao & Tenzin Lungjangwa & Roger D. Kamm & Zhengpeng Wan & Lee Gehrke & David Mooney & Rudolf Jaenisch, 2024. "SARS-CoV-2 infection of human pluripotent stem cell-derived vascular cells reveals smooth muscle cells as key mediators of vascular pathology during infection," Nature Communications, Nature, vol. 15(1), pages 1-17, December.
    2. Sung Hee Ko & Pierce Radecki & Frida Belinky & Jinal N. Bhiman & Susan Meiring & Jackie Kleynhans & Daniel Amoako & Vanessa Guerra Canedo & Margaret Lucas & Dikeledi Kekana & Neil Martinson & Limakats, 2024. "Rapid intra-host diversification and evolution of SARS-CoV-2 in advanced HIV infection," Nature Communications, Nature, vol. 15(1), pages 1-14, December.
    3. Scott Lu & Michael J. Peluso & David V. Glidden & Michelle C. Davidson & Kara Lugtu & Jesus Pineda-Ramirez & Michel Tassetto & Miguel Garcia-Knight & Amethyst Zhang & Sarah A. Goldberg & Jessica Y. Ch, 2024. "Early biological markers of post-acute sequelae of SARS-CoV-2 infection," Nature Communications, Nature, vol. 15(1), pages 1-9, December.
    4. Ali-Reza Mohammadi-Nejad & Martin Craig & Eleanor F. Cox & Xin Chen & R. Gisli Jenkins & Susan Francis & Stamatios N. Sotiropoulos & Dorothee P. Auer, 2025. "Accelerated brain ageing during the COVID-19 pandemic," Nature Communications, Nature, vol. 16(1), pages 1-13, December.
    5. Kirsten Broderick & Mohamed Taha Moutaoufik & Tatiana Saccon & Ramy Malty & Shahreen Amin & Sadhna Phanse & Thomson Patrick Joseph & Mara Zilocchi & Ali Hosseinnia & Zoe Istace & Maryam Hajikarimlou &, 2025. "Human protein interaction networks of ancestral and variant SARS-CoV-2 in organ-specific cells and bodily fluids," Nature Communications, Nature, vol. 16(1), pages 1-20, December.
    6. S. Jaumdally & M. Tomasicchio & A. Pooran & A. Esmail & A. Kotze & S. Meier & L. Wilson & S. Oelofse & C. Merwe & A. Roomaney & M. Davids & T. Suliman & R. Joseph & T. Perumal & A. Scott & M. Shaw & W, 2024. "Frequency, kinetics and determinants of viable SARS-CoV-2 in bioaerosols from ambulatory COVID-19 patients infected with the Beta, Delta or Omicron variants," Nature Communications, Nature, vol. 15(1), pages 1-13, December.
    7. Al Ozonoff & Naresh Doni Jayavelu & Shanshan Liu & Esther Melamed & Carly E. Milliren & Jingjing Qi & Linda N. Geng & Grace A. McComsey & Charles B. Cairns & Lindsey R. Baden & Joanna Schaenman & Albe, 2024. "Features of acute COVID-19 associated with post-acute sequelae of SARS-CoV-2 phenotypes: results from the IMPACC study," Nature Communications, Nature, vol. 15(1), pages 1-17, December.
    8. Noel G. Panagiotides & Fritz Zimprich & Klaus Machold & Oliver Schlager & Markus Müller & Sebastian Ertl & Henriette Löffler-Stastka & Renate Koppensteiner & Patricia P. Wadowski, 2023. "A Case of Autoimmune Small Fiber Neuropathy as Possible Post COVID Sequelae," IJERPH, MDPI, vol. 20(6), pages 1-12, March.
    9. Anthony Coleon & Florence Larrous & Lauriane Kergoat & Magali Tichit & David Hardy & Thomas Obadia & Etienne Kornobis & Hervé Bourhy & Guilherme Dias de Melo, 2025. "Hamsters with long COVID present distinct transcriptomic profiles associated with neurodegenerative processes in brainstem," Nature Communications, Nature, vol. 16(1), pages 1-17, December.
    10. Clovis S. Palmer & Chrysostomos Perdios & Mohamed Abdel-Mohsen & Joseph Mudd & Prasun K. Datta & Nicholas J. Maness & Gabrielle Lehmicke & Nadia Golden & Linh Hellmers & Carol Coyne & Kristyn Moore Gr, 2024. "Non-human primate model of long-COVID identifies immune associates of hyperglycemia," Nature Communications, Nature, vol. 15(1), pages 1-18, December.
    11. Alexandra Detrille & Steve Huvelle & Marit J. Gils & Tatiana Geara & Quentin Pascal & Jonne Snitselaar & Laetitia Bossevot & Mariangela Cavarelli & Nathalie Dereuddre-Bosquet & Francis Relouzat & Vane, 2025. "Whole-body visualization of SARS-CoV-2 biodistribution in vivo by immunoPET imaging in non-human primates," Nature Communications, Nature, vol. 16(1), pages 1-16, December.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:nat:natcom:v:16:y:2025:i:1:d:10.1038_s41467-025-61737-7. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Sonal Shukla or Springer Nature Abstracting and Indexing (email available below). General contact details of provider: http://www.nature.com .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.