Persistent multiple organ damage identified in COVID-19

A multi-centre Scottish study shows persistent multi-systemic abnormalities in 159 COVID-19 patients 28 to 60 days after hospital discharge, including cardio-renal inflammation, decreased lung function, poorer quality of life and poor outcomes.

In the study published yesterday in naturopathy, a team led by researchers from the University of Glasgow collected serial blood biomarkers and patient-reported results and performed digital electrocardiography, chest computed tomography (CT) with lung and coronary angiography, and cardiorenal (heart-kidney) magnetic resonance imaging (MRI). . in the hospital and 28 to 60 days later. For longer-term results, the researchers accessed electronic patient records.

Patients were evaluated from May 22, 2020 to March 16, 2021. The 159 COVID-19 patients had an average age of 55 and 43% were female, 87% White, 9% Asian and 3% Arab, 1% were Black, 46% had a history of cardiovascular disease or treatment , 40% belonged to the top quintile of social deprivation, 23% were health care workers and almost all were unvaccinated.

Their results were compared to those of 29 matched control patients who underwent the same tests at a single visit from April 13 to July 2, 2021.

Twenty-two patients (15%) had normal chest radiological results during the COVID-19 hospitalization, 1.2% of patients had received a single dose of vaccine prior to hospitalization, 9% required supplemental oxygen, 20% received noninvasive respiratory support, and 9 % required invasive treatment Ventilation.

COVID-related myocarditis in up to 54%

Compared to controls, 28 to 60 days after hospital discharge, COVID-19 patients had persistent signs of heart and lung involvement, inflammation, and a blood-clotting environment, including imaging findings of coronary artery disease, reduced ventricular function, and myocardial fibrosis (leading to leads to deterioration of the heart muscle). Imaging of the kidneys showed no differences between the two groups.

Myocarditis (inflammation of the heart muscle) was considered very likely in 21 patients (13%), likely in 65 (41%), unlikely in 56 (35%) and absent in 17 (11%). Myocarditis was associated with typical COVID-19 radiological findings, ICU admission, and invasive ventilation, but not with demographic characteristics, cardiovascular history, or standard blood test results obtained during the first hospitalization.

Twenty-eight to 60 days after hospital discharge, COVID-19 was associated with poorer health-related quality of life (mean EQ-5D-5L score 0.77 versus 0.87), anxiety, and depression (Patient Health Questionnaire-9 total score, 3rd .59) vs. 1.28) and aerobic capacity (predicted maximal oxygen consumption, 20.0 vs. 29.5 milliliters per kilogram per minute).

“These abnormalities explain in part the persistent impairments in patient-reported health-related quality of life, physical functioning, and psychological well-being,” the researchers wrote. “Taken together, our findings implicate multisystem injury pathways as mediators of the post-COVID-19 syndrome.”

Possible increased healthcare requirements

Over a median of 450 days of follow-up, 24 COVID-19 patients (15%) and 2 controls (7%) died or were hospitalized again, and 108 patients (68%) and 7 controls (26%) received treatment outpatient care. More COVID-19 patients than controls were referred for long-term COVID investigation (36.5% vs. 3.7%).

“The disease course of patients following hospitalization with COVID-19 includes persistent multisystem abnormalities and health impairments that could result in significant demand for health services in the future,” the researchers wrote. “Prophylactic therapy for post-COVID-19 syndromes and longer-term studies of prognosis are warranted.”

In a related research briefing, the journal’s editors said the findings add to the underdeveloped knowledge base about long-COVID. “This work provides a deep clinical phenotyping of patients with post-acute symptoms after hospitalization with COVID-19 and demonstrates the persistence of multisystemic involvement and cardiac complications,” they wrote.

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