A multisystem, cardio-renal investigation of post-COVID-19 illness.

Abstract

The pathophysiology and trajectory of post-Coronavirus Disease 2019 (COVID-19) syndrome is uncertain. To clarify multisystem involvement, we undertook a prospective cohort study including patients who had been hospitalized with COVID-19 (ClinicalTrials.gov ID NCT04403607 ). Serial blood biomarkers, digital electrocardiography and patient-reported outcome measures were obtained in-hospital and at 28-60 days post-discharge when multisystem imaging using chest computed tomography with pulmonary and coronary angiography and cardio-renal magnetic resonance imaging was also obtained. Longer-term clinical outcomes were assessed using electronic health records. Compared to controls (n = 29), at 28-60 days post-discharge, people with COVID-19 (n = 159; mean age, 55 years; 43% female) had persisting evidence of cardio-renal involvement and hemostasis pathway activation. The adjudicated likelihood of myocarditis was 'very likely' in 21 (13%) patients, 'probable' in 65 (41%) patients, 'unlikely' in 56 (35%) patients and 'not present' in 17 (11%) patients. At 28-60 days post-discharge, COVID-19 was associated with worse health-related quality of life (EQ-5D-5L score 0.77 (0.23) versus 0.87 (0.20)), anxiety and depression (PHQ-4 total score 3.59 (3.71) versus 1.28 (2.67)) and aerobic exercise capacity reflected by predicted maximal oxygen utilization (20.0 (7.6) versus 29.5 (8.0) ml/kg/min) (all P < 0.01). During follow-up (mean, 450 days), 24 (15%) patients and two (7%) controls died or were rehospitalized, and 108 (68%) patients and seven (26%) controls received outpatient secondary care (P = 0.017). The illness trajectory of patients after hospitalization with COVID-19 includes persisting multisystem abnormalities and health impairments that could lead to substantial demand on healthcare services in the future.

• Authors: Andrew J Morrow, Robert Sykes, Alasdair McIntosh, Anna Kamdar, Catherine Bagot, Hannah K Bayes, Kevin G Blyth, Michael Briscoe, Heerajnarain Bulluck, David Carrick, Colin Church, David Corcoran, Iain Findlay, Vivienne B Gibson, Lynsey Gillespie, Douglas Grieve, Pauline Hall Barrientos, Antonia Ho, Ninian N Lang, Vera Lennie, David J Lowe, Peter W Macfarlane, Patrick B Mark, Kaitlin J Mayne, Alex McConnachie, Ross McGeoch, Christopher McGinley, Connor McKee, Sabrina Nordin, Alexander Payne, Alastair J Rankin, Keith E Robertson, Giles Roditi, Nicola Ryan, Naveed Sattar, Sarah Allwood-Spiers, David Stobo, Rhian M Touyz, Gruschen Veldtman, Stuart Watkins, Sarah Weeden, Robin A Weir, Paul Welsh, Ryan Wereski, CISCO-19 Consortium, Kenneth Mangion, Colin Berry
• Journal: Nature medicine (Nat Med) Vol. 28 Issue 6 Pg. 1303-1313 (06 2022) ISSN: 1546-170X [Electronic] United States
• PMID: 35606551 (Publication Type: Clinical Study, Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2022. The Author(s).

Topics

• Aftercare
• COVID-19 (complications)
• Female
• Humans
• Male
• Middle Aged
• Patient Discharge
• Prospective Studies
• Quality of Life
• SARS-CoV-2