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

Morrow, A. J. et al. (2022) A multisystem, cardio-renal investigation of post-COVID-19 illness. Nature Medicine, 28(6), pp. 1303-1313. (doi: 10.1038/s41591-022-01837-9) (PMID:35606551) (PMCID:PMC9205780)

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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.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Macfarlane, Professor Peter and Veldtman, Professor Gruschen and Robertson, Dr Keith and McGinley, Dr Christopher and Carrick, Dr David and Church, Dr Colin and Bulluck, Dr Heerajnarain and Corcoran, Dr David and Mangion, Dr Kenneth and Morrow, Dr Andrew and Findlay, Dr Iain and Blyth, Professor Kevin and Roditi, Dr Giles and Weeden, Dr Sarah and Sykes, Dr Robert and Bayes, Dr Hannah and McConnachie, Professor Alex and Mark, Professor Patrick and Welsh, Dr Paul and McIntosh, Dr Alasdair and Gillespie, Dr Lynsey and Ho, Dr Antonia and Rankin, Dr Alastair and Watkins, Dr Stuart and Lowe, Dr David and Bagot, Dr Catherine and Touyz, Professor Rhian and Berry, Professor Colin and Mayne, Dr Kaitlin and Allwood-Spiers, Sarah and Hall Barrientos, Dr Pauline and Lang, Dr Ninian and Wereski, Dr Ryan and Sattar, Professor Naveed and Payne, Dr Alexander
Authors: Morrow, A. J., Sykes, R., McIntosh, A., Kamdar, A., Bagot, C., Bayes, H. K., Blyth, K. G., Briscoe, M., Bulluck, H., Carrick, D., Church, C., Corcoran, D., Findlay, I., Gibson, V. B., Gillespie, L., Grieve, D., Hall Barrientos, P., Ho, A., Lang, N. N., Lennie, V., Lowe, D. J., Macfarlane, P. W., Mark, P. B., Mayne, K. J., McConnachie, A., McGeoch, R., McGinley, C., McKee, C., Nordin, S., Payne, A., Rankin, A. J., Robertson, K. E., Roditi, G., Ryan, N., Sattar, N., Allwood-Spiers, S., Stobo, D., Touyz, R. M., Veldtman, G., Watkins, S., Weeden, S., Weir, R. A., Welsh, P., Wereski, R., Mangion, K., and Berry, C.
College/School:College of Medical Veterinary and Life Sciences > School of Cancer Sciences
College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre
College of Medical Veterinary and Life Sciences > School of Infection & Immunity
College of Medical Veterinary and Life Sciences > School of Infection & Immunity > Centre for Virus Research
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:Nature Medicine
Publisher:Nature Research
ISSN:1078-8956
ISSN (Online):1546-170X
Published Online:23 May 2022
Copyright Holders:Copyright © 2022 The Authors
First Published:First published in Nature Medicine 28(6): 1303-1313
Publisher Policy:Reproduced under a Creative Commons License
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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
311300CSO covid 19 portfolioIain McInnesOffice of the Chief Scientific Adviser (CSO)COV/GLA/PortfolioIII - Immunology
303944BHF Centre of ExcellenceColin BerryBritish Heart Foundation (BHF)RE/18/6/34217CAMS - Cardiovascular Science