Adjudicated myocarditis and multisystem illness trajectory in healthcare workers post-COVID-19

Abstract

Background: We investigated the associations of healthcare worker status with multisystem illness trajectory in hospitalised post-COVID-19 individuals.

Methods and results: One hundred and sixty-eight patients were evaluated 28-60 days after the last episode of hospital care. Thirty-six (21%) were healthcare workers. Compared with non-healthcare workers, healthcare workers were of similar age (51.3 (8.7) years vs 55.0 (12.4) years; p=0.09) more often women (26 (72%) vs 48 (38%); p<0.01) and had lower 10-year cardiovascular risk (%) (8.1 (7.9) vs 15.0 (11.5); p<0.01) and Coronavirus Clinical Characterisation Consortium in-hospital mortality risk (7.3 (10.2) vs 12.7 (9.8); p<0.01). Healthcare worker status associated with less acute inflammation (peak C reactive protein 48 mg/L (IQR: 14-165) vs 112 mg/L (52-181)), milder illness reflected by WHO clinical severity score distribution (p=0.04) and shorter duration of admission (4 days (IQR: 2-6) vs 6 days (3-12)).In adjusted multivariate logistic regression analysis, healthcare worker status associated with a binary classification (probable/very likely vs not present/unlikely) of adjudicated myocarditis (OR: 2.99; 95% CI (1.01 to 8.89) by 28-60 days postdischarge).After a mean (SD, range) duration of follow-up after hospital discharge of 450 (88) days (range 290, 627 days), fewer healthcare workers died or were rehospitalised (1 (3%) vs 22 (17%); p=0.038) and secondary care referrals for post-COVID-19 syndrome were common (42%) and similar to non-healthcare workers (38%; p=0.934).

Conclusion: Healthcare worker status was independently associated with the likelihood of adjudicated myocarditis, despite better antecedent health. Two in five healthcare workers had a secondary care referral for post-COVID-19 syndrome.

Trial registration number: NCT04403607.

Keywords: COVID-19; Magnetic Resonance Imaging; Myocarditis; Risk Factors.

Figure 1

Flow diagram of the clinical study. The procedures involved screening hospitalised patients with COVID-19, defined by a PCR-positive result for SARS-CoV-2 in a nasopharyngeal swab and obtaining written informed consent. A PCR-positive result defines the analysis population. Serial investigations were initiated in-hospital or early post-discharge (visit 1) and then repeated in association with multiorgan imaging at 28–60 days post-discharge (visit 2). Clinical follow-up continued for on average (SD) 450 (88) days (range 290, 627 days) post-discharge. *Claustrophobia prevented the completion of the full imaging protocol in 14 patients—however, 7 provided data for biomarkers, patient-reported outcome measures and limited imaging acquisitions before abandonment.