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)

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 Kamdar, Anna and McConnachie, Professor Alex and Mark, Professor Patrick and Welsh, Professor Paul and McIntosh, Dr Alasdair and Gillespie, Dr Lynsey and Ho, Dr Antonia and Rankin, Dr Alastair and Lowe, Dr David and Watkins, Dr Stuart and Bagot, Dr Catherine and Touyz, Professor Rhian and Berry, Professor Colin and Mayne, Dr Kaitlin and Hall Barrientos, Dr Pauline and Allwood-Spiers, Sarah and Lang, Professor Ninian and Wereski, Dr Ryan and Payne, Dr Alexander and Sattar, Professor Naveed
• 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 Code	Award No	Project Name	Principal Investigator	Funder's Name	Funder Ref	Lead Dept
311300		CSO covid 19 portfolio	Iain McInnes	Office of the Chief Scientific Adviser (CSO)	COV/GLA/Portfolio	III - Immunology
303944		BHF Centre of Excellence	Colin Berry	British Heart Foundation (BHF)	RE/18/6/34217	CAMS - Cardiovascular Science