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

Abstract

Objectives: 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.

Keywords: COVID-19; integrated care; long COVID; organ impairment; prevention; quality of life.

Figure 1.

Study population from recruitment to follow-up.

Figure 2.

Proportion of individuals with long COVID and symptoms (a: at baseline in the whole cohort and in the follow-up groups; b: at baseline vs. at follow-up in the follow-up group) or impairment (c: in the whole cohort and in the follow-up groups vs. healthy controls; d: at baseline vs. at follow-up in the follow-up group). Significant differences (p < 0.05) are indicated with a star, numbers above columns indicate the sample size (n) for each group. Note for c: compared between healthy controls (grey) and at baseline for long COVID (blue).

Figure 3.

Association between risk factors and: (a) severe breathlessness at baseline; (b) poor HRQoL at follow-up. Note: (a) associations predicted whole cohort symptom at baseline using baseline covariates and (b) predicted follow-up symptom using follow-up covariates in the follow-up group.