Article Text
Abstract
Objective To assess medium-term organ impairment in symptomatic individuals following recovery from acute SARS-CoV-2 infection.
Design Baseline findings from a prospective, observational cohort study.
Setting Community-based individuals from two UK centres between 1 April and 14 September 2020.
Participants Individuals ≥18 years with persistent symptoms following recovery from acute SARS-CoV-2 infection and age-matched healthy controls.
Intervention Assessment of symptoms by standardised questionnaires (EQ-5D-5L, Dyspnoea-12) and organ-specific metrics by biochemical assessment and quantitative MRI.
Main outcome measures Severe post-COVID-19 syndrome defined as ongoing respiratory symptoms and/or moderate functional impairment in activities of daily living; single-organ and multiorgan impairment (heart, lungs, kidneys, liver, pancreas, spleen) by consensus definitions at baseline investigation.
Results 201 individuals (mean age 45, range 21–71 years, 71% female, 88% white, 32% healthcare workers) completed the baseline assessment (median of 141 days following SARS-CoV-2 infection, IQR 110–162). The study population was at low risk of COVID-19 mortality (obesity 20%, hypertension 7%, type 2 diabetes 2%, heart disease 5%), with only 19% hospitalised with COVID-19. 42% of individuals had 10 or more symptoms and 60% had severe post-COVID-19 syndrome. Fatigue (98%), muscle aches (87%), breathlessness (88%) and headaches (83%) were most frequently reported. Mild organ impairment was present in the heart (26%), lungs (11%), kidneys (4%), liver (28%), pancreas (40%) and spleen (4%), with single-organ and multiorgan impairment in 70% and 29%, respectively. Hospitalisation was associated with older age (p=0.001), non-white ethnicity (p=0.016), increased liver volume (p<0.0001), pancreatic inflammation (p<0.01), and fat accumulation in the liver (p<0.05) and pancreas (p<0.01). Severe post-COVID-19 syndrome was associated with radiological evidence of cardiac damage (myocarditis) (p<0.05).
Conclusions In individuals at low risk of COVID-19 mortality with ongoing symptoms, 70% have impairment in one or more organs 4 months after initial COVID-19 symptoms, with implications for healthcare and public health, which have assumed low risk in young people with no comorbidities.
Trial registration number NCT04369807; Pre-results.
- COVID-19
- epidemiology
- health policy
- public health
Data availability statement
Data are available upon reasonable request from the corresponding author.
This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
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Data availability statement
Data are available upon reasonable request from the corresponding author.
Supplementary materials
Supplementary Data
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Footnotes
RB and AB are joint senior authors.
Twitter @amibanerjee1
Contributors Study design: AD, RB, JA, COVERSCAN team. Patient recruitment: RB, COVERSCAN team. Data collection: MW, COVERSCAN team. Data analysis: AD, AB, COVERSCAN team. Data interpretation: AB, AD, MW, RB. Initial manuscript drafting: AB, AD, RB. Critical review of early and final versions of the manuscript: all authors including JO and DJC. Specialist input: MW, AB (cardiology); RB, MH, DW, MC, DJC (general medicine); MH, MC, DW (long COVID-19); MB, RB (imaging); AD (statistics); AB (epidemiology/public health); MG (primary care); JA (healthcare management); LH, EA (patient and public involvement).
Funding This work was supported by the UK’s National Consortium of Intelligent Medical Imaging (Industry Strategy Challenge Fund), Innovate UK (Grant 104688) and the European Union’s Horizon 2020 research and innovation programme (agreement no 719445). The research was designed, conducted, analysed and interpreted by the authors independently of the funding sources.
Competing interests AD, RB and MB are employees of Perspectum.
Provenance and peer review Not commissioned; externally peer reviewed.
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