Berry, C. et al. (2021) Post-COVID-19 illness trajectory: a multisystem investigation [Pre-print]. Research Square, (doi: 10.21203/rs.3.rs-1053331/v1)
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Abstract
Background: The pathophysiology and trajectory of multiorgan involvement in post-COVID-19 syndrome is uncertain. Methods: A prospective, multicenter, longitudinal, cohort study involving post-COVID-19 patients enrolled in-hospital or early post-discharge (visit 1) and re-evaluated 28-60 days post-discharge (visit 2). Multisystem investigations included chest computed tomography with pulmonary and coronary angiography, cardiovascular and renal magnetic resonance imaging, digital electrocardiography, and multisystem biomarkers. The primary outcome was the adjudicated likelihood of myocarditis. Results: 161 patients (mean age 55 years, 43% female) and 27 controls with similar age, sex, ethnicity, and vascular risk factors were enrolled from 22 May 2020 to 2 July 2021 and had a primary outcome evaluation. Compared to controls, at 28-60 days post-discharge, patients with COVID-19 had persisting evidence of cardio-renal involvement, systemic inflammation, and hemostasis pathway activation. Myocarditis was adjudicated as being not likely (n=17; 10%), unlikely (n=56; 35%), probable (n=67; 42%) or very likely (n=21; 13%). Acute kidney injury (odds ratio, 95% confidence interval: 3.40 (1.13, 11.84); p=0.038) and low hemoglobin A1c (0.26 (0.07, 0.87); p=0.035) were multivariable associates of adjudicated myocarditis. During convalescence, compared to controls, COVID-19 was associated with worse health-related quality of life (EQ5D-5L) (p<0.001), illness perception (p<0.001), anxiety and depression (p<0.001), physical activity (p<0.001) and predicted maximal oxygen utilization (ml/kg/min) (p<0.001). These measures were associated with adjudicated myocarditis. Conclusions: The illness trajectory of COVID-19 includes persisting cardio-renal inflammation, lung damage and hemostasis activation. Adjudicated myocarditis occurred in one in eight hospitalized patients and was associated with impairments in health status, physical and psychological wellbeing during community convalescence. Public registration: ClinicalTrials.gov identifier is NCT04403607.
| Item Type: | Articles |
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| Additional Information: | This was an investigator-initiated clinical study that was funded by the Chief Scientist Office of the Scottish Government (COV/GLA/Portfolio project number 311300). The funder had no role in the design, conduct (non-voting TSC member), data analysis and interpretation, manuscript writing, or dissemination of the results. C.B, C.D., N.S., R.M.T. were supported by the British Heart Foundation (RE/18/6134217). The MRI study involved technologies provided by Siemens Healthcare and the National Institutes of Health. HeartFlow (HeartFlow, Redwood City, CA) provided FFRCT. The study was co-sponsored by NHS Greater Glasgow & Clyde Health Board and the University of Glasgow. |
| Keywords: | SARS-CoV-2, post-COVID-19 syndrome, myocardial inflammation, myocarditis. |
| Status: | Published |
| Refereed: | No |
| Glasgow Author(s) Enlighten ID: | Macfarlane, Professor Peter and Veldtman, Professor Gruschen and Church, Dr Colin and Corcoran, Dr David and Gibson, Dr Vivienne and Mangion, Dr Kenneth and Morrow, Dr Andrew and Nordin, Dr Sabrina and Blyth, Professor Kevin and Roditi, Dr Giles and Weeden, Dr Sarah and Sykes, Dr Robert and Kamdar, Anna and McConnachie, Professor Alex and Mark, Professor Patrick and Welsh, Professor Paul and McIntosh, Dr Alasdair 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 Lang, Professor Ninian and Sattar, Professor Naveed |
| Authors: | Berry, C., Morrow, A., Sykes, R., McIntosh, A., Kamdar, A., Bagot, C., Barrientos, P., Bayes, H., Blyth, K., Briscoe, M., Bulluck, H., Carrick, D., Church, C., Corcoran, D., Findlay, I., Gibson, V., Gillespie, L., Grieve, D., Ho, A., Lang, N., Lowe, D., Lennie, V., Macfarlane, P., Mayne, K., Mark, P., McConnachie, A., McGeoch, R., Mcginley, C., McKee, C., Nordin, S., Payne, A., Rankin, A., Ryan, N., Roditi, G., Stobo, D., Sattar, N., Allwood-Spiers, S., Touyz, R., Veldtman, G., Weeden, S., Watkins, S., Welsh, P., Wereski, R., and Mangion, K. |
| 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 > Centre for Virus Research College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing |
| Journal Name: | Research Square |
| Copyright Holders: | Copyright © 2021 The Authors |
| First Published: | First published in Research Square 08 Nov 2021 |
| Publisher Policy: | Reproduced under a Creative Commons license |
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