Journal Article

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

Payne, Alexander, Ryan, Nicola, Mangion, Kenneth, Grieve, Douglas, Rankin, Alastair J., Bayes, Hannah K., Bagot, Catherine, Ho, Antonia, Allwood-Spiers, Sarah, Welsh, Paul, Lang, Ninian N., Hall Barrientos, Pauline, Lowe, David J., Blyth, Kevin G., Church, Colin, McIntosh, Alasdair, Sykes, Robert, Stobo, David, McGeoch, Ross, Carrick, David, Findlay, Iain, Mark, Patrick B., Bulluck, Heerajnarain, Briscoe, Michael, Sattar, Naveed, Veldtman, Gruschen, McKee, Connor, Gibson, Vivienne B., McConnachie, Alex, Wereski, Ryan, Berry, Colin, Gillespie, Lynsey, McGinley, Christopher, Kamdar, Anna, Mayne, Kaitlin J., Robertson, Keith E., Weeden, Sarah, Roditi, Giles, Weir, Robin A., Morrow, Andrew J., Lennie, Vera, Corcoran, David, Watkins, Stuart, Touyz, Rhian M., Nordin, Sabrina, Macfarlane, Peter W.

2022

Overview

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. Deep clinical phenotyping at 28–60 days post-discharge of patients who had been hospitalized with COVID-19 and subsequent long-term follow-up with electronic health records reveal evidence of persistent cardio-renal involvement.

• Publisher: Nature Publishing Group US,Nature Publishing Group
• Subject: 631/443/1338/567 / 692/308/53/2421 / Abnormalities / Aerobic capacity / Aftercare / Angiography / Biomarkers / Biomedical and Life Sciences / Biomedicine / Cancer Research / Computed tomography / Coronaviruses / COVID-19 / COVID-19 - complications / EKG / Electrocardiography / Electronic health records / Electronic medical records / Female / Health care / Health services / Heart diseases / Hemostasis / Hemostatics / Humans / Illnesses / Infectious Diseases / Kidneys / Magnetic resonance imaging / Male / Medical imaging / Metabolic Diseases / Middle Aged / Molecular Medicine / Myocarditis / Neurosciences / Patient Discharge / Patients / Phenotyping / Prospective Studies / Quality of Life / SARS-CoV-2 / Viral diseases