Tweet
Nat Med
. 2022 May 23.
doi: 10.1038/s41591-022-01837-9. Online ahead of print.
A multisystem, cardio-renal investigation of post-COVID-19 illness
Andrew J Morrow # 1 2 , Robert Sykes # 1 2 , Alasdair McIntosh 3 , Anna Kamdar 1 , Catherine Bagot 4 , Hannah K Bayes 5 , Kevin G Blyth 6 7 , Michael Briscoe 2 , Heerajnarain Bulluck 8 , David Carrick 9 , Colin Church 6 10 , David Corcoran 1 2 , Iain Findlay 11 , Vivienne B Gibson 4 , Lynsey Gillespie 12 , Douglas Grieve 13 , Pauline Hall Barrientos 14 , Antonia Ho 15 , Ninian N Lang 1 2 , Vera Lennie 16 , David J Lowe 17 , Peter W Macfarlane 18 , Patrick B Mark 1 19 , Kaitlin J Mayne 1 19 , Alex McConnachie 3 , Ross McGeoch 9 , Christopher McGinley 2 , Connor McKee 2 , Sabrina Nordin 2 , Alexander Payne 20 , Alastair J Rankin 1 , Keith E Robertson 10 , Giles Roditi 21 , Nicola Ryan 16 , Naveed Sattar 1 , Sarah Allwood-Spiers 5 , David Stobo 21 , Rhian M Touyz 1 , Gruschen Veldtman 22 , Stuart Watkins 10 , Sarah Weeden 3 , Robin A Weir 9 , Paul Welsh 1 , Ryan Wereski 17 23 , CISCO-19 Consortium; Kenneth Mangion 1 2 , Colin Berry 24 25 26
Collaborators, Affiliations
- PMID: 35606551
- DOI: 10.1038/s41591-022-01837-9
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.
Comment