Multi-organ impairment in low-risk individuals with long COVID

Article activity feed

1. 

   ScreenIT

   Mar 1, 2021

   SciScore for 10.1101/2020.10.14.20212555: (What is this?)

   Please note, not all rigor criteria are appropriate for all manuscripts.

   Table 1: Rigor

   Institutional Review Board Statement	IRB: The study protocol was approved by a UK ethics committee (20/SC/0185), registered (https://clinicaltrials.gov/ct2/show/NCT04369807) and all patients gave written informed consent. Consent: The study protocol was approved by a UK ethics committee (20/SC/0185), registered (https://clinicaltrials.gov/ct2/show/NCT04369807) and all patients gave written informed consent.
   Randomization	not detected.
   Blinding	not detected.
   Power Analysis	not detected.
   Sex as a biological variable	not detected.

   Table 2: Resources

   Software and Algorithms
   Sentences	Resources
   Patient population and study design: In an ongoing, prospective study, 201 participants were enrolled at two UK sites …

   SciScore for 10.1101/2020.10.14.20212555: (What is this?)

   Please note, not all rigor criteria are appropriate for all manuscripts.

   Table 1: Rigor

   Institutional Review Board Statement	IRB: The study protocol was approved by a UK ethics committee (20/SC/0185), registered (https://clinicaltrials.gov/ct2/show/NCT04369807) and all patients gave written informed consent. Consent: The study protocol was approved by a UK ethics committee (20/SC/0185), registered (https://clinicaltrials.gov/ct2/show/NCT04369807) and all patients gave written informed consent.
   Randomization	not detected.
   Blinding	not detected.
   Power Analysis	not detected.
   Sex as a biological variable	not detected.

   Table 2: Resources

   Software and Algorithms
   Sentences	Resources
   Patient population and study design: In an ongoing, prospective study, 201 participants were enrolled at two UK sites (Perspectum, Oxford and Mayo Clinic Healthcare, London) between April 2020 and August 2020 and completed baseline assessment by 14 September 2020 (Figure 1).	Clinic Healthcare suggested: None
   Magnetic Resonance Image Analysis: Multi-organ MRI data were collected at both□study sites (Oxford:□MAGNETOM Aera 1.5T, Mayo Healthcare London:□MAGNETOM Vida 3T; both from□Siemens Healthcare Erlangen, Germany).	Mayo Healthcare suggested: None Vida suggested: (VIDA, RRID:SCR_007111)

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   Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

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   Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:

   Strengths and limitations: Our study is an ongoing, prospective, longitudinal cohort study with detailed blood and imaging characterisation of organ function, despite limited clinical examination with video consultations in the era of COVID-19. By recruiting ambulatory patients after infection with broad inclusion criteria (e.g. SARS-CoV-2 testing by virus RNA, antibody or antigen), we focus on individuals at lower risk of severity and mortality from acute SARS-CoV-2 infection. Our cardiac MRI protocol excluded gadolinium contrast as concerns regarding COVID-19-related renal complications remain. We relied on native T1 mapping to detect and characterise myocardial inflammation, allowing non-invasive tissue characterisation which was previously evaluated as superior to gadolinium MRI for acute myocarditis(31). We report baseline findings following SARS-CoV-2 infection. In our pragmatic study design, the diagnosis of COVID-19 was by multiple methods, partly limited by access to laboratory testing during the pandemic. Causality of the relationship between organ impairment and infection cannot be deduced, but may be addressed by longitudinal follow-up of individuals with organ impairment. Our study population was limited by ethnicity despite disproportionate impact of COVID-19 in non-white individuals. Pulse oximetry and spirometry were added later to the protocol and follow up; they were not included from the outset to limit interaction and exposure between trial team and patien...

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   Results from TrialIdentifier: We found the following clinical trial numbers in your paper:
   

   Identifier	Status	Title
   NCT04369807	Recruiting	Mapping Organ Health Following COVID-19 Disease Due to SARS-…

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   Results from Barzooka: We found bar graphs of continuous data. We recommend replacing bar graphs with more informative graphics, as many different datasets can lead to the same bar graph. The actual data may suggest different conclusions from the summary statistics. For more information, please see Weissgerber et al (2015).

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   Results from JetFighter: We did not find any issues relating to colormaps.

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   Results from rtransparent:

   • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
   • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
   • No protocol registration statement was detected.

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   Read the original source
2. 

   NCRC

   Nov 2, 2020

   Our take

   This cross-sectional study, available as a preprint and thus not yet peer reviewed, described symptoms and evidence of organ impairment up to four and a half months from acute SARS-CoV-2 infection or a clinical diagnosis of COVID-19 among relatively low-risk participants at two healthcare centers in England. They documented multi-organ MRI changes (lung, heart, pancreas, kidney, liver, and spleen) in up to ⅔ of patients, adding to the growing literature that symptoms and organ abnormalities can linger several months after initial COVID-19 diagnosis. While these findings may have implications for patient management, the lack of pre-diagnosis data means they do not establish a causal relationship between SARS-CoV-2 infection and long-term organ impairment.

   Study design

   cross-sectional

   Study population …

   Our take

   This cross-sectional study, available as a preprint and thus not yet peer reviewed, described symptoms and evidence of organ impairment up to four and a half months from acute SARS-CoV-2 infection or a clinical diagnosis of COVID-19 among relatively low-risk participants at two healthcare centers in England. They documented multi-organ MRI changes (lung, heart, pancreas, kidney, liver, and spleen) in up to ⅔ of patients, adding to the growing literature that symptoms and organ abnormalities can linger several months after initial COVID-19 diagnosis. While these findings may have implications for patient management, the lack of pre-diagnosis data means they do not establish a causal relationship between SARS-CoV-2 infection and long-term organ impairment.

   Study design

   cross-sectional

   Study population and setting

   This cross-sectional pre-print reports the residual impact of COVID-19 in 201 adults (mean age 44 years, 70% female) in southern England at a median follow up of 140 days from their initial symptoms at the baseline visit of an ongoing prospective cohort study. Participants were recruited from clinics in Oxford and London, England between April and August 2020 if they had a history of a positive SARS-CoV-2 PCR (n=62), a positive antibody test (n=63), or a clinical diagnosis of COVID-19 from two independent physicians (n=73) and were excluded if they had current COVID-19 symptoms, a COVID-19 hospitalization in the last 7 days, and/or contraindications to magnetic resonance imaging (MRI) at the time of enrollment. The authors assessed lung, heart, kidney, liver, pancreas and spleen function at follow up using validated symptom assessment scales, fasting laboratory values, and MRI. They compared participants by hospitalization status while symptomatic using Wilcoxon tests, Fisher exact tests, or Spearman correlation as appropriate and created a multivariable model to assess risk factors of a previous hospitalization among participants.

   Summary of main findings

   Of the 201 participants, 20% and 18% of whom reported pre-existing obesity and asthma respectively, 99% were experiencing more than three and 42% were experiencing more than nine COVID-19 symptoms at study enrollment, which occurred a median of 140 days (interquartile range (IQR) 105-160) from participants’ initial COVID-19 symptoms. The most common reported symptoms included fatigue (98%), muscle ache (88%), shortness of breath (87%), and headache (83%), and 52% of participants reported persistent problems resuming usual activities. Participants who were hospitalized with COVID-19 were more likely to have abnormal triglycerides, cholesterol, LDL-cholesterol, and transferrin saturation than those who were not. Organ dysfunction on MRI was also more common among participants who were hospitalized, with evidence of lung (33% of all participants), heart (32%), pancreas (17%), kidney (12%), liver (10%), and spleen (6%) dysfunction on MRI in 66% of participants. Multivariable logistic regression suggested that increasing age (OR=1.06, 95% Confidence Interval (95% CI) 1.02-1.10), liver volume (OR=1.18, 95% CI 1.06-1.30), and multiorgan impairment on MRI (OR=2.75, 95% CI 1.22-6.22) were associated with prior hospitalization adjusted for sex and BMI.

   Study strengths

   This study includes a moderate number of participants with few comorbidities and describes well-measured symptom, laboratory, and MRI evidence of the persistent impacts of COVID-19 a median of four and a half months after initial symptoms.

   Limitations

   It is unclear how participants were approached for inclusion in this study, which could select for individuals still experiencing COVID-19 symptoms who are likely different from those who have recovered without lingering symptoms. This selection bias would likely artificially amplify the prevalence of the reported findings. Furthermore, we cannot conclude that the virus caused the laboratory and/or imaging findings without data from before participants were infected with SARS-CoV-2. Additionally, it is impossible to contextualize the abnormal laboratory and imaging findings without a control group of similar adults who were not exposed to SARS-CoV-2. Finally, it is difficult if not impossible to interpret a model that predicts an outcome (previous hospitalization) that occured before the recorded covariates.

   Value added

   This is one of the first studies to document the presence of symptoms and organ impairment about four and a half months after initial confirmation of SARS-CoV-2 infection or clinical diagnosis of COVID-19.

   Read the original source
3. 

   Version published to 10.1101/2020.10.14.20212555v1 on medRxiv

   Oct 16, 2020