tetano
Editor, Senior Moderator
EClinicalMedicine
. 2021 Jan 7;31:100683.
doi: 10.1016/j.eclinm.2020.100683. eCollection 2021 Jan.
Medium-term effects of SARS-CoV-2 infection on multiple vital organs, exercise capacity, cognition, quality of life and mental health, post-hospital discharge
Betty Raman[SUP] 1 2 [/SUP], Mark Philip Cassar[SUP] 1 [/SUP], Elizabeth M Tunnicliffe[SUP] 1 [/SUP], Nicola Filippini[SUP] 3 [/SUP], Ludovica Griffanti[SUP] 3 4 [/SUP], Fidel Alfaro-Almagro[SUP] 4 [/SUP], Thomas Okell[SUP] 4 [/SUP], Fintan Sheerin[SUP] 5 [/SUP], Cheng Xie[SUP] 5 6 [/SUP], Masliza Mahmod[SUP] 1 [/SUP], Ferenc E M?zes[SUP] 7 [/SUP], Adam J Lewandowski[SUP] 1 [/SUP], Eric O Ohuma[SUP] 8 [/SUP], David Holdsworth[SUP] 9 [/SUP], Hanan Lamlum[SUP] 1 [/SUP], Myles J Woodman[SUP] 1 [/SUP], Catherine Krasopoulos[SUP] 1 [/SUP], Rebecca Mills[SUP] 1 [/SUP], Flora A Kennedy McConnell[SUP] 10 [/SUP], Chaoyue Wang[SUP] 4 [/SUP], Christoph Arthofer[SUP] 4 [/SUP], Frederik J Lange[SUP] 4 [/SUP], Jesper Andersson[SUP] 4 [/SUP], Mark Jenkinson[SUP] 4 [/SUP], Charalambos Antoniades[SUP] 1 2 [/SUP], Keith M Channon[SUP] 1 2 [/SUP], Mayooran Shanmuganathan[SUP] 1 [/SUP], Vanessa M Ferreira[SUP] 1 [/SUP], Stefan K Piechnik[SUP] 1 [/SUP], Paul Klenerman[SUP] 11 [/SUP], Christopher Brightling[SUP] 12 [/SUP], Nick P Talbot[SUP] 9 [/SUP], Nayia Petousi[SUP] 11 [/SUP], Najib M Rahman[SUP] 11 [/SUP], Ling-Pei Ho[SUP] 13 [/SUP], Kate Saunders[SUP] 14 [/SUP], John R Geddes[SUP] 14 [/SUP], Paul J Harrison[SUP] 14 [/SUP], Kyle Pattinson[SUP] 15 [/SUP], Matthew J Rowland[SUP] 15 [/SUP], Brian J Angus[SUP] 16 [/SUP], Fergus Gleeson[SUP] 17 [/SUP], Michael Pavlides[SUP] 1 18 [/SUP], Ivan Koychev[SUP] 15 [/SUP], Karla L Miller[SUP] 4 [/SUP], Clare Mackay[SUP] 3 15 [/SUP], Peter Jezzard[SUP] 4 [/SUP], Stephen M Smith[SUP] 4 [/SUP], Stefan Neubauer[SUP] 1 2 [/SUP]
Affiliations
Abstract
Background: The medium-term effects of Coronavirus disease (COVID-19) on organ health, exercise capacity, cognition, quality of life and mental health are poorly understood.
Methods: Fifty-eight COVID-19 patients post-hospital discharge and 30 age, sex, body mass index comorbidity-matched controls were enrolled for multiorgan (brain, lungs, heart, liver and kidneys) magnetic resonance imaging (MRI), spirometry, six-minute walk test, cardiopulmonary exercise test (CPET), quality of life, cognitive and mental health assessments.
Findings: At 2-3 months from disease-onset, 64% of patients experienced breathlessness and 55% reported fatigue. On MRI, abnormalities were seen in lungs (60%), heart (26%), liver (10%) and kidneys (29%). Patients exhibited changes in the thalamus, posterior thalamic radiations and sagittal stratum on brain MRI and demonstrated impaired cognitive performance, specifically in the executive and visuospatial domains. Exercise tolerance (maximal oxygen consumption and ventilatory efficiency on CPET) and six-minute walk distance were significantly reduced. The extent of extra-pulmonary MRI abnormalities and exercise intolerance correlated with serum markers of inflammation and acute illness severity. Patients had a higher burden of self-reported symptoms of depression and experienced significant impairment in all domains of quality of life compared to controls (p<0.0001 to 0.044).
Interpretation: A significant proportion of patients discharged from hospital reported symptoms of breathlessness, fatigue, depression and had limited exercise capacity. Persistent lung and extra-pulmonary organ MRI findings are common in patients and linked to inflammation and severity of acute illness.
Funding: NIHR Oxford and Oxford Health Biomedical Research Centres, British Heart Foundation Centre for Research Excellence, UKRI, Wellcome Trust, British Heart Foundation.
Keywords: COVID-19; Coronavirus; Follow up; Magnetic Resonance Imaging; Medium term; Mental health; Multiorgan effects; Post-hospital discharge; SARS-CoV-2 infection; Survivors.
. 2021 Jan 7;31:100683.
doi: 10.1016/j.eclinm.2020.100683. eCollection 2021 Jan.
Medium-term effects of SARS-CoV-2 infection on multiple vital organs, exercise capacity, cognition, quality of life and mental health, post-hospital discharge
Betty Raman[SUP] 1 2 [/SUP], Mark Philip Cassar[SUP] 1 [/SUP], Elizabeth M Tunnicliffe[SUP] 1 [/SUP], Nicola Filippini[SUP] 3 [/SUP], Ludovica Griffanti[SUP] 3 4 [/SUP], Fidel Alfaro-Almagro[SUP] 4 [/SUP], Thomas Okell[SUP] 4 [/SUP], Fintan Sheerin[SUP] 5 [/SUP], Cheng Xie[SUP] 5 6 [/SUP], Masliza Mahmod[SUP] 1 [/SUP], Ferenc E M?zes[SUP] 7 [/SUP], Adam J Lewandowski[SUP] 1 [/SUP], Eric O Ohuma[SUP] 8 [/SUP], David Holdsworth[SUP] 9 [/SUP], Hanan Lamlum[SUP] 1 [/SUP], Myles J Woodman[SUP] 1 [/SUP], Catherine Krasopoulos[SUP] 1 [/SUP], Rebecca Mills[SUP] 1 [/SUP], Flora A Kennedy McConnell[SUP] 10 [/SUP], Chaoyue Wang[SUP] 4 [/SUP], Christoph Arthofer[SUP] 4 [/SUP], Frederik J Lange[SUP] 4 [/SUP], Jesper Andersson[SUP] 4 [/SUP], Mark Jenkinson[SUP] 4 [/SUP], Charalambos Antoniades[SUP] 1 2 [/SUP], Keith M Channon[SUP] 1 2 [/SUP], Mayooran Shanmuganathan[SUP] 1 [/SUP], Vanessa M Ferreira[SUP] 1 [/SUP], Stefan K Piechnik[SUP] 1 [/SUP], Paul Klenerman[SUP] 11 [/SUP], Christopher Brightling[SUP] 12 [/SUP], Nick P Talbot[SUP] 9 [/SUP], Nayia Petousi[SUP] 11 [/SUP], Najib M Rahman[SUP] 11 [/SUP], Ling-Pei Ho[SUP] 13 [/SUP], Kate Saunders[SUP] 14 [/SUP], John R Geddes[SUP] 14 [/SUP], Paul J Harrison[SUP] 14 [/SUP], Kyle Pattinson[SUP] 15 [/SUP], Matthew J Rowland[SUP] 15 [/SUP], Brian J Angus[SUP] 16 [/SUP], Fergus Gleeson[SUP] 17 [/SUP], Michael Pavlides[SUP] 1 18 [/SUP], Ivan Koychev[SUP] 15 [/SUP], Karla L Miller[SUP] 4 [/SUP], Clare Mackay[SUP] 3 15 [/SUP], Peter Jezzard[SUP] 4 [/SUP], Stephen M Smith[SUP] 4 [/SUP], Stefan Neubauer[SUP] 1 2 [/SUP]
Affiliations
- PMID: 33490928
- PMCID: PMC7808914
- DOI: 10.1016/j.eclinm.2020.100683
Abstract
Background: The medium-term effects of Coronavirus disease (COVID-19) on organ health, exercise capacity, cognition, quality of life and mental health are poorly understood.
Methods: Fifty-eight COVID-19 patients post-hospital discharge and 30 age, sex, body mass index comorbidity-matched controls were enrolled for multiorgan (brain, lungs, heart, liver and kidneys) magnetic resonance imaging (MRI), spirometry, six-minute walk test, cardiopulmonary exercise test (CPET), quality of life, cognitive and mental health assessments.
Findings: At 2-3 months from disease-onset, 64% of patients experienced breathlessness and 55% reported fatigue. On MRI, abnormalities were seen in lungs (60%), heart (26%), liver (10%) and kidneys (29%). Patients exhibited changes in the thalamus, posterior thalamic radiations and sagittal stratum on brain MRI and demonstrated impaired cognitive performance, specifically in the executive and visuospatial domains. Exercise tolerance (maximal oxygen consumption and ventilatory efficiency on CPET) and six-minute walk distance were significantly reduced. The extent of extra-pulmonary MRI abnormalities and exercise intolerance correlated with serum markers of inflammation and acute illness severity. Patients had a higher burden of self-reported symptoms of depression and experienced significant impairment in all domains of quality of life compared to controls (p<0.0001 to 0.044).
Interpretation: A significant proportion of patients discharged from hospital reported symptoms of breathlessness, fatigue, depression and had limited exercise capacity. Persistent lung and extra-pulmonary organ MRI findings are common in patients and linked to inflammation and severity of acute illness.
Funding: NIHR Oxford and Oxford Health Biomedical Research Centres, British Heart Foundation Centre for Research Excellence, UKRI, Wellcome Trust, British Heart Foundation.
Keywords: COVID-19; Coronavirus; Follow up; Magnetic Resonance Imaging; Medium term; Mental health; Multiorgan effects; Post-hospital discharge; SARS-CoV-2 infection; Survivors.