Article Text

Original research
Multiorgan impairment in low-risk individuals with post-COVID-19 syndrome: a prospective, community-based study
  1. Andrea Dennis1,
  2. Malgorzata Wamil2,3,
  3. Johann Alberts4,
  4. Jude Oben5,6,
  5. Daniel J Cuthbertson7,
  6. Dan Wootton8,9,
  7. Michael Crooks10,11,
  8. Mark Gabbay12,
  9. Michael Brady1,13,
  10. Lyth Hishmeh14,
  11. Emily Attree15,
  12. Melissa Heightman16,
  13. Rajarshi Banerjee1,
  14. Amitava Banerjee16,17,18
  15. On behalf of COVERSCAN study investigators
  1. 1Perspectum, Oxford, UK
  2. 2Department of Cardiology, Great Western Hospital Foundation NHS Trust, Swindon, UK
  3. 3Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
  4. 4Alliance Medical, Warwick, UK
  5. 5Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK
  6. 6Institute for Liver and Digestive Health, University College London, London, UK
  7. 7Institute of Cardiovascular and Metabolic Medicine, University of Liverpool, Liverpool, UK
  8. 8Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
  9. 9Department of Respiratory Research, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
  10. 10Department of Respiratory Medicine, Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
  11. 11Institute of Clinical and Applied Health Research, University of Hull, Hull, UK
  12. 12Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
  13. 13Department of Oncology, University of Oxford, Oxford, UK
  14. 14Long COVID SOS, Oxford, UK
  15. 15UKDoctors#Longcovid, London, UK
  16. 16Department of Medicine, University College London Hospitals NHS Foundation Trust, London, UK
  17. 17Institute of Health Informatics, University College London, London, UK
  18. 18Department of Cardiology, Barts Health NHS Trust, London, UK
  1. Correspondence to Dr Amitava Banerjee; ami.banerjee{at}


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:

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Data availability statement

Data are available upon reasonable request from the corresponding author.

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  • 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.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.