Multiorgan impairment in low-risk individuals with post-COVID-19 syndrome: a prospective, community-based study

Abstract

Objective: To assess medium-term organ impairment in symptomatic individuals following recovery from acute SARS-CoV-2 infection.

Design: Baseline findings from a prospective, observational cohort study.

Setting: Community-based individuals from two UK centres between 1 April and 14 September 2020.

Participants: Individuals ≥18 years with persistent symptoms following recovery from acute SARS-CoV-2 infection and age-matched healthy controls.

Intervention: Assessment of symptoms by standardised questionnaires (EQ-5D-5L, Dyspnoea-12) and organ-specific metrics by biochemical assessment and quantitative MRI.

Main outcome measures: Severe post-COVID-19 syndrome defined as ongoing respiratory symptoms and/or moderate functional impairment in activities of daily living; single-organ and multiorgan impairment (heart, lungs, kidneys, liver, pancreas, spleen) by consensus definitions at baseline investigation.

Results: 201 individuals (mean age 45, range 21-71 years, 71% female, 88% white, 32% healthcare workers) completed the baseline assessment (median of 141 days following SARS-CoV-2 infection, IQR 110-162). The study population was at low risk of COVID-19 mortality (obesity 20%, hypertension 7%, type 2 diabetes 2%, heart disease 5%), with only 19% hospitalised with COVID-19. 42% of individuals had 10 or more symptoms and 60% had severe post-COVID-19 syndrome. Fatigue (98%), muscle aches (87%), breathlessness (88%) and headaches (83%) were most frequently reported. Mild organ impairment was present in the heart (26%), lungs (11%), kidneys (4%), liver (28%), pancreas (40%) and spleen (4%), with single-organ and multiorgan impairment in 70% and 29%, respectively. Hospitalisation was associated with older age (p=0.001), non-white ethnicity (p=0.016), increased liver volume (p<0.0001), pancreatic inflammation (p<0.01), and fat accumulation in the liver (p<0.05) and pancreas (p<0.01). Severe post-COVID-19 syndrome was associated with radiological evidence of cardiac damage (myocarditis) (p<0.05).

Conclusions: In individuals at low risk of COVID-19 mortality with ongoing symptoms, 70% have impairment in one or more organs 4 months after initial COVID-19 symptoms, with implications for healthcare and public health, which have assumed low risk in young people with no comorbidities.

Trial registration number: NCT04369807; Pre-results.

Keywords: COVID-19; epidemiology; health policy; public health.

Figure 1

Flow from recruitment to enrolment of 201 patients with post-COVID-19 syndrome.

Figure 2

Percentage of patients (black) and controls (grey) with individual organ measures outside of the predefined normal range. Lines represent significant difference in the proportions between the two groups, with *p<0.05, **p<0.01, ***p<0.001. LV, left ventricular.

Figure 3

Multiorgan impairment in low-risk individuals with post-COVID-19 syndrome by gender and hospitalisation.

Figure 4

Percentage of reported symptoms during the acute phases of the illness within those with evidence of organ impairment for each organ separately. Darker red indicates higher percentage of reported symptoms per impaired organ. There are no distinct patterns of symptoms relating to each impaired organ, but a high burden of symptoms in individuals is highlighted.

Figure 5

Natural history of post-COVID-19 syndrome, the COVERSCAN study in low-risk individuals (N=201) and policy recommendations.