British researchers have found that nearly a third of patients admitted to hospital with Covid-19 had abnormalities in multiple organs five months after infection, damage to the lungs being almost 14 times higher among those discharged.
MRI scans of patients in the study showed more abnormal findings involving the lungs, brain and kidneys compared with a group of people who had not had the virus, said the team.
The Independent reports that abnormal findings involving the brain and kidneys were three and two times higher respectively.
The researchers suggest that in patients who did not have other conditions that might have caused abnormalities, the damage might have been caused by Covid infection.
The extent of abnormalities on MRI was often influenced by the severity of the Covid infection the patients had experienced and their age, as well as comorbidities (other conditions).
The findings are part of the C-MORE (Capturing the Multi-ORgan Effects of Covid-19) study, which is being led by Betty Raman, associate professor of cardiovascular medicine at the University of Oxford.
She said: “We found that nearly one in three patients had an excess burden of multi-organ abnormalities on MRI, relative to controls.
“At five months after hospital discharge for the virus, patients showed a high burden of abnormalities involving the lungs, brain and kidneys compared with our non-Covid-19 controls.
“Age, severity of acute Covid-19 infection, as well as comorbidities, were significant factors in determining who had organ injury at follow-up.
“In patients without organ-specific comorbidities, the damage may well be due to severe Covid-19 infections,” she added.
“The pattern of injury can also give us some clues. For example, the pattern of lung changes, which map on to ground glass changes on CT scans suggest this is related.
“Kidney injury in someone with a previously normal creatinine and no renal disease may well be Covid-19-associated.
“Yes, we think comorbidities (for example, diabetes, cardiac disease, etc.) lower the reserve of organs and potentially play a role in delayed recovery, but we see organ abnormalities even in those without comorbidities.”
She said people suffering with long Covid should feel hopeful that research was ongoing, and that there were some answers.
Published in The Lancet Respiratory Medicine, the follow-up study of 500 post-hospital admission patients is a key element of the national PHOSP-Covid platform, led by the University of Leicester, which is investigating the long-term effects of the virus on people who had been admitted to hospital.
The paper presents the results of an interim analysis of 259 post-hospital admission coronavirus patients and 52 people who did not have the virus – a control group.
The study found that while some organ-specific symptoms correlated with the scans – for example, chest tightness and cough with lung MRI abnormalities – not all symptoms could be directly linked to MRI-detected anomalies.
The paper also confirmed that multi-organ MRI abnormalities were more common in patients previously admitted to hospital who reported severely impaired physical and mental health after Covid, as previously described by the PHOSP-Covid study investigators.
Raman said: “What we are seeing is that people with multi-organ pathology on MRI – that is, they had more than two organs affected – were four times more likely to report severe and very severe mental and physical impairment.
“Our findings also highlight the need for longer-term multidisciplinary follow-up services focused on pulmonary and extra-pulmonary health (kidneys, brain and mental health), particularly for those hospitalised for Covid-19.”
Although the researchers conducted analysis to reduce this risk of over-estimating organ abnormalities, they say a limitation of their study is that they are unable to eliminate organ damage existing before the infection.
Study details
Multi-organ MRI findings after hospitalisation with Covid-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study
The C-MORE/PHOSP-COVID Collaborative Group
Published in The Lancet Respiratory Medicine on 22 September 2023
Summary
Introduction
The multi-organ impact of moderate to severe coronavirus infections in the post-acute phase is still poorly understood. We aimed to evaluate the excess burden of multi-organ abnormalities after hospitalisation with Covid-19, evaluate their determinants, and explore associations with patient-related outcome measures.
Methods
In a prospective, UK-wide, multi-centre MRI follow-up study (C-MORE), adults (aged ≥18 years) discharged from hospital following COVID-19 who were included in Tier 2 of the Post-hospitalisation COVID-19 study (PHOSP-COVID) and contemporary controls with no evidence of previous COVID-19 (SARS-CoV-2 nucleocapsid antibody negative) underwent multi-organ MRI (lungs, heart, brain, liver, and kidneys) with quantitative and qualitative assessment of images and clinical adjudication when relevant. Individuals with end-stage renal failure or contraindications to MRI were excluded. Participants also underwent detailed recording of symptoms, and physiological and biochemical tests. The primary outcome was the excess burden of multi-organ abnormalities (two or more organs) relative to controls, with further adjustments for potential confounders. The C-MORE study is ongoing and is registered with ClinicalTrials.gov, NCT04510025.
Findings
Of 2710 participants in Tier 2 of PHOSP-COVID, 531 were recruited across 13 UK-wide C-MORE sites. After exclusions, 259 C-MORE patients (mean age 57 years [SD 12]; 158 [61%] male and 101 [39%] female) who were discharged from hospital with PCR-confirmed or clinically diagnosed COVID-19 between March 1, 2020, and Nov 1, 2021, and 52 non-COVID-19 controls from the community (mean age 49 years [SD 14]; 30 [58%] male and 22 [42%] female) were included in the analysis. Patients were assessed at a median of 5·0 months (IQR 4·2–6·3) after hospital discharge. Compared with non-COVID-19 controls, patients were older, living with more obesity, and had more comorbidities. Multi-organ abnormalities on MRI were more frequent in patients than in controls (157 [61%] of 259 vs 14 [27%] of 52; p<0·0001) and independently associated with COVID-19 status (odds ratio [OR] 2·9 [95% CI 1·5–5·8]; padjusted=0·0023) after adjusting for relevant confounders. Compared with controls, patients were more likely to have MRI evidence of lung abnormalities (p=0·0001; parenchymal abnormalities), brain abnormalities (p<0·0001; more white matter hyperintensities and regional brain volume reduction), and kidney abnormalities (p=0·014; lower medullary T1 and loss of corticomedullary differentiation), whereas cardiac and liver MRI abnormalities were similar between patients and controls. Patients with multi-organ abnormalities were older (difference in mean age 7 years [95% CI 4–10]; mean age of 59·8 years [SD 11·7] with multi-organ abnormalities vs mean age of 52·8 years [11·9] without multi-organ abnormalities; p<0·0001), more likely to have three or more comorbidities (OR 2·47 [1·32–4·82]; padjusted=0·0059), and more likely to have a more severe acute infection (acute CRP >5mg/L, OR 3·55 [1·23–11·88]; padjusted=0·025) than those without multiorgan abnormalities. Presence of lung MRI abnormalities was associated with a two-fold higher risk of chest tightness, and multi-organ MRI abnormalities were associated with severe and very severe persistent physical and mental health impairment (PHOSP-COVID symptom clusters) after hospitalisation.
Interpretation
After hospitalisation for COVID-19, people are at risk of multi-organ abnormalities in the medium term. Our findings emphasise the need for proactive multidisciplinary care pathways, with the potential for imaging to guide surveillance frequency and therapeutic stratification.
The Independent article – Organ abnormalities detected in post-hospital Covid patients (Open access)
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