Multi-organ impairment and long COVID: a 1-year prospective, longitudinal cohort study

  1. Andrea Dennis
  2. Daniel J Cuthbertson
  3. Dan Wootton
  4. Michael Crooks
  5. Mark Gabbay
  6. Nicole Eichert
  7. Sofia Mouchti
  8. Michele Pansini
  9. Adriana Roca-Fernandez
  10. Helena Thomaides-Brears
  11. Matt Kelly
  12. Matthew Robson
  13. Lyth Hishmeh
  14. Emily Attree
  15. Melissa Heightman
  16. Rajarshi Banerjee
  17. Amitava Banerjee

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Abstract

To determine the prevalence of organ impairment in long COVID patients at 6 and 12 months after initial symptoms and to explore links to clinical presentation.

Design

Prospective cohort study.

Participants

Individuals.

Methods

In individuals recovered from acute COVID-19, we assessed symptoms, health status, and multi-organ tissue characterisation and function.

Setting

Two non-acute healthcare settings (Oxford and London). Physiological and biochemical investigations were performed at baseline on all individuals, and those with organ impairment were reassessed.

Main outcome measures

Primary outcome was prevalence of single- and multi-organ impairment at 6 and 12 months post COVID-19.

Results

A total of 536 individuals (mean age 45 years, 73% female, 89% white, 32% healthcare workers, 13% acute COVID-19 hospitalisation) completed baseline assessment (median: 6 months post COVID-19); 331 (62%) with organ impairment or incidental findings had follow-up, with reduced symptom burden from baseline (median number of symptoms 10 and 3, at 6 and 12 months, respectively). Extreme breathlessness (38% and 30%), cognitive dysfunction (48% and 38%) and poor health-related quality of life (EQ-5D-5L < 0.7; 57% and 45%) were common at 6 and 12 months, and associated with female gender, younger age and single-organ impairment. Single- and multi-organ impairment were present in 69% and 23% at baseline, persisting in 59% and 27% at follow-up, respectively.

Conclusions

Organ impairment persisted in 59% of 331 individuals followed up at 1 year post COVID-19, with implications for symptoms, quality of life and longer-term health, signalling the need for prevention and integrated care of long COVID.

Trial Registration: ClinicalTrials.gov Identifier: NCT04369807

Article activity feed

  1. Version published to 10.1177/01410768231154703
  2. ScreenIT

    SciScore for 10.1101/2022.03.18.22272607: (What is this?)

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

    Table 1: Rigor

    EthicsConsent: Patient Population and Study Design: Recruitment was by response to advertisement or specialist referral to two non-acute sites (Perspectum, Oxford and Mayo Clinic Healthcare, London) from April 2020 to August 2021, based on prior SARS-CoV-2 infection and written informed consent.
    IRB: Ethical Approval: The protocol was approved by a UK ethics committee (20/SC/0185) and registered (https://clinicaltrials.gov/ct2/show/NCT04369807).
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Cell Line AuthenticationAuthentication: HRQoL was assessed by validated EQ-5D-5L (EuroQOL), comprising: (1) five health dimensions (mobility, self-care, usual activities, pain and discomfort, and anxiety and depression) each at five severity levels (none, slight, moderate, severe, and extreme); (2) self-rated health using visual analogue scale (VAS) from 0 (worst imaginable) to 100 (best imaginable); (3) derived EQ-5D ‘utility’ or index score from 0 (‘dead’) to 1 (‘full health’)10.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Patient Population and Study Design: Recruitment was by response to advertisement or specialist referral to two non-acute sites (Perspectum, Oxford and Mayo Clinic Healthcare, London) from April 2020 to August 2021, based on prior SARS-CoV-2 infection and written informed consent.
    Clinic Healthcare
    suggested: None
    Participants underwent a 40-minute MRI scan of lungs, heart, kidney, liver, pancreas and spleen on 1.5T or 3T Siemens scanners at three imaging sites (Oxford: MAGNETOM Aera 1.5T, Mayo Healthcare London: MAGNETOM Vida 3T
    Mayo Healthcare
    suggested: None
    Vida
    suggested: (VIDA, RRID:SCR_007111)

    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).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Strengths and Limitations: To date, this is the largest, comprehensive, systematic, multi-organ, post-COVID study over 1 year. The study cohort is representative of UK Long COVID populations in terms of risk factors and acute COVID-19 hospitalisation8,9. There are limitations. We did not have history and imaging prior to the pandemic and so it is difficult to determine if COVID-19/Long Covid caused impairment. There was no assessment of brain function. Not all participants had a laboratory-confirmed COVID-19 diagnosis. 38% of participants were not followed up. Generalizability of results from the UK’s first COVID-wave to the global population requires further exploration. We successfully delivered multi-organ MRI to assess organ health, but clinical utility remains to be determined. Health utilisation (e.g. primary care interactions) and economic burden of Long COVID were not assessed. Time off work was not assessed at baseline when the UK was in lockdown with a national furlough scheme in operation. Patients with normal assessment at baseline were not followed up due to resource and funding constraints. Therefore, whilst 222/536 (41%) patients at baseline were defined as normal after assessment, we cannot say they had better outcomes. Nevertheless, we can model cost-saving of a single assessment versus multiple assessments to achieve a discharge decision.

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

    IdentifierStatusTitle
    NCT04369807Active, not recruitingMapping Organ Health Following COVID-19 Disease Due to SARS-…

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

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

    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.
    • Thank you for including a protocol registration statement.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

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  3. Version published to 10.1101/2022.03.18.22272607v1 on medRxiv