tetano
Editor, Senior Moderator
BMJ Open
. 2026 Apr 10;16(4):e113446.
doi: 10.1136/bmjopen-2025-113446.
Health outcomes and reinfection among COVID-19 survivors 4 years after hospital discharge in Wuhan, China: a cohort study
Yang Dai[SUP] 1 [/SUP], Huanyu Luo[SUP] 2 [/SUP], Xiaofeng Liu[SUP] 3 [/SUP], Bao Man Hu[SUP] 2 [/SUP], Man Wang[SUP] 2 [/SUP], Li Xia Cheng[SUP] 4 5 [/SUP], Yi Luo[SUP] 2 [/SUP], Xiang-Yu Ma[SUP] 6 [/SUP], Guoqiang Cao[SUP] 2 7 [/SUP], Qingxiang Mao[SUP] 1 [/SUP], Li Li[SUP] 8 7 [/SUP]
Affiliations
Objectives: To evaluate health outcomes and identify risk factors for reinfection and persistent symptoms among COVID-19 survivors 4 years after hospital discharge.
Design: Longitudinal cohort study.
Setting: Two hospitals in Wuhan, China.
Participants: 1076 COVID-19 survivors discharged from hospital.
Outcome measures: Self-reported symptom questionnaire, Chronic Obstructive Pulmonary Disease Assessment Test, Hospital Anxiety and Depression Scale and Checklist Individual Strength (CIS) fatigue subscale. Long covid was defined according to WHO criteria.
Results: Median age was 58 years and 50.2% were male. Reinfection during December 2022-April 2023 occurred in 36.1%; 21 developed pneumonia and 14 required hospitalisation. At least 12 months after reinfection, 12.1% reported sequelae compared with 46.9% after the initial infection. At 4 years, 16.7% reported long covid symptoms, commonly fatigue, chest tightness, cough and dyspnoea. In multivariable analysis, risk factors for abnormal fatigue (CIS ≥27) included age (OR 1.020, 95% CI 1.007 to 1.034; p=0.003), reinfection (OR 2.393, 95% CI 1.708 to 3.352; p<0.001), severe disease (OR 1.553, 95% CI 1.088 to 2.218; p=0.015) and tumour (OR 3.420, 95% CI 1.177 to 9.936; p=0.024).
Conclusions: At 4 years post discharge, symptom burden was lower than at earlier follow-up time points for most survivors. Reinfection and older age were associated with persistent symptoms.
Keywords: COVID-19; Fatigue; Post-Acute COVID-19 Syndrome; Risk Factors.
. 2026 Apr 10;16(4):e113446.
doi: 10.1136/bmjopen-2025-113446.
Health outcomes and reinfection among COVID-19 survivors 4 years after hospital discharge in Wuhan, China: a cohort study
Yang Dai[SUP] 1 [/SUP], Huanyu Luo[SUP] 2 [/SUP], Xiaofeng Liu[SUP] 3 [/SUP], Bao Man Hu[SUP] 2 [/SUP], Man Wang[SUP] 2 [/SUP], Li Xia Cheng[SUP] 4 5 [/SUP], Yi Luo[SUP] 2 [/SUP], Xiang-Yu Ma[SUP] 6 [/SUP], Guoqiang Cao[SUP] 2 7 [/SUP], Qingxiang Mao[SUP] 1 [/SUP], Li Li[SUP] 8 7 [/SUP]
Affiliations
- PMID: 41962975
- DOI: 10.1136/bmjopen-2025-113446
Objectives: To evaluate health outcomes and identify risk factors for reinfection and persistent symptoms among COVID-19 survivors 4 years after hospital discharge.
Design: Longitudinal cohort study.
Setting: Two hospitals in Wuhan, China.
Participants: 1076 COVID-19 survivors discharged from hospital.
Outcome measures: Self-reported symptom questionnaire, Chronic Obstructive Pulmonary Disease Assessment Test, Hospital Anxiety and Depression Scale and Checklist Individual Strength (CIS) fatigue subscale. Long covid was defined according to WHO criteria.
Results: Median age was 58 years and 50.2% were male. Reinfection during December 2022-April 2023 occurred in 36.1%; 21 developed pneumonia and 14 required hospitalisation. At least 12 months after reinfection, 12.1% reported sequelae compared with 46.9% after the initial infection. At 4 years, 16.7% reported long covid symptoms, commonly fatigue, chest tightness, cough and dyspnoea. In multivariable analysis, risk factors for abnormal fatigue (CIS ≥27) included age (OR 1.020, 95% CI 1.007 to 1.034; p=0.003), reinfection (OR 2.393, 95% CI 1.708 to 3.352; p<0.001), severe disease (OR 1.553, 95% CI 1.088 to 2.218; p=0.015) and tumour (OR 3.420, 95% CI 1.177 to 9.936; p=0.024).
Conclusions: At 4 years post discharge, symptom burden was lower than at earlier follow-up time points for most survivors. Reinfection and older age were associated with persistent symptoms.
Keywords: COVID-19; Fatigue; Post-Acute COVID-19 Syndrome; Risk Factors.