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Long COVID impacts heart, lung and kidney – Scottish study

The condition called long COVID, say some experts, could result in a generation affected by disability.

Damage to the lungs and kidneys is common in people who were hospitalised with COVID, with one in eight found to have heart inflammation, while previous studies also showed that fewer than a third of patients with ongoing COVID symptoms after being hospitalised with the disease felt fully recovered a year later.

Now, reports The Guardian, researchers tracking the progress of patients treated in hospital for COVID say they have found evidence the disease can take its toll on a range of organs and, they say, the severity of ongoing symptoms appears linked to the severity of the COVID infection itself.

“Even fit, healthy individuals can suffer severe COVID-19 illness,” said Prof Colin Berry of the University of Glasgow, which led the CISCO-19 (Cardiac imaging in Sars coronavirus disease-19) study.

“Our study provides objective evidence of abnormalities at one to two months post-COVID and these findings tie in with persisting symptoms at that time and the likelihood of ongoing health needs one year later,” he added.

Writing in the journal Nature Medicine, the researchers describe how they tracked the outcomes of 159 people hospitalised with COVID between May 2020 and March 2021.

The team carried out a range of scans and blood tests at 28-60 days after the patients were discharged, with patients also given questionnaires to complete. The results were compared with those from a control group of 29 people with a similar age, sex, ethnicity, and cardiovascular risk factors, who had not had COVID.

The authors write that, compared with controls, those who had been hospitalised with COVID showed several abnormalities, including in results from imaging of the heart, lungs and kidneys.

About 13%, or one in eight, of those hospitalised for COVID were deemed by experts to be very likely to have myocarditis, or heart inflammation, compared with just one control participant. This led to a “lower health-related quality of life, greater illness perception, higher levels of anxiety and depression (and) lower levels of physical activity”, said Dr Andrew Morrow, also from the University of Glasgow.

The likelihood of myocarditis was higher among healthcare workers and those with acute kidney injury, as well as those with more severe disease requiring invasive ventilation.

The results also reveal those who had been hospitalised with COVID were more likely to need outpatient secondary care or be referred for symptoms consistent with long COVID, with death and re-hospitalisations also much higher in this group.

Dr Betty Raman, a cardiologist and long COVID expert at the University of Oxford who was not involved in the work, said the study provided important insights into the prevalence of clinically adjudicated myocarditis and its association with prolonged symptoms in those hospitalised with COVID early in the pandemic.

However, she noted that presence of persistent heart inflammation was not assessed during later follow-up, few participants had received a COVID jab, and the COVID variants involved were unlikely to be the Omicron lineages prevalent today.

“Current-day estimates of myocarditis after more novel Sars-CoV-2 variants in the post-vaccine era may differ from this study, given the lower risk of hospitalisation and severe disease attributable to differences in variants and vaccine effects,” she said.

Study details

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

Andrew J. Morrow, Robert Sykes, Colin Berry et al.

Published in Nature Medicine on 23 May 2022

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 hospitalised 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 utilisation (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 rehospitalised, and 108 (68%) patients and seven (26%) controls received outpatient secondary care (P = 0.017).
The illness trajectory of patients after hospitalisation with COVID-19 includes persisting multisystem abnormalities and health impairments that could lead to substantial demand on healthcare services in the future.

 

The Guardian article – Covid can cause ongoing damage to heart, lungs and kidneys, study finds (Open access)

 

Nature Medicine article – A multisystem, cardio-renal investigation of post-COVID-19 illness (Open access)

 

See more from MedicalBrief archives:

 

Preliminary results from two UK studies suggest significant heart inflammation from COVID

 

Why COVID-19 pneumonia lasts longer, causes more damage than typical pneumonia

 

COVID-19 causes neurological injuries in 1 in 7 patients — NYU study

 

Long COVID breathlessness: Novel scans uncover hidden lung damage

 

 

 

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