Medium-term effects of SARS-CoV-2 infection on multiple vital organs, exercise capacity, cognition, quality of life and mental health, post-hospital discharge.
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Raman Betty, Cassar Mark Philip, Tunnicliffe Elizabeth M, Filippini Nicola, Griffanti Ludovica, Alfaro-Almagro Fidel, Okell Thomas, Sheerin Fintan, Xie Cheng, Mahmod Masliza, Mózes Ferenc E, Lewandowski Adam J, Ohuma Eric O, Holdsworth David, Lamlum Hanan, Woodman Myles J, Krasopoulos Catherine, Mills Rebecca, McConnell Flora A Kennedy, Wang Chaoyue, Arthofer Christoph, Lange Frederik J, Andersson Jesper, Jenkinson Mark, Antoniades Charalambos, Channon Keith M, Shanmuganathan Mayooran, Ferreira Vanessa M, Piechnik Stefan K, Klenerman Paul, Brightling Christopher, Talbot Nick P, Petousi Nayia, Rahman Najib M, Ho Ling-Pei, Saunders Kate, Geddes John R, Harrison Paul J, Pattinson Kyle, Rowland Matthew J, Angus Brian J, Gleeson Fergus, Pavlides Michael, Koychev Ivan, Miller Karla L, Mackay Clare, Jezzard Peter, Smith Stephen M, Neubauer Stefan
Аннотация
METHODS: Fifty-eight COVID-19 patients post-hospital discharge and 30 age, sex, body mass index comorbidity-matched controls were enrolled for multiorgan (brain, lungs, heart, liver and kidneys) magnetic resonance imaging (MRI), spirometry, six-minute walk test, cardiopulmonary exercise test (CPET), quality of life, cognitive and mental health assessments.
FINDINGS: At 2-3 months from disease-onset, 64% of patients experienced breathlessness and 55% reported fatigue. On MRI, abnormalities were seen in lungs (60%), heart (26%), liver (10%) and kidneys (29%). Patients exhibited changes in the thalamus, posterior thalamic radiations and sagittal stratum on brain MRI and demonstrated impaired cognitive performance, specifically in the executive and visuospatial domains. Exercise tolerance (maximal oxygen consumption and ventilatory efficiency on CPET) and six-minute walk distance were significantly reduced. The extent of extra-pulmonary MRI abnormalities and exercise intolerance correlated with serum markers of inflammation and acute illness severity. Patients had a higher burden of self-reported symptoms of depression and experienced significant impairment in all domains of quality of life compared to controls (p<0.0001 to 0.044).
INTERPRETATION: A significant proportion of patients discharged from hospital reported symptoms of breathlessness, fatigue, depression and had limited exercise capacity. Persistent lung and extra-pulmonary organ MRI findings are common in patients and linked to inflammation and severity of acute illness.
FUNDING: NIHR Oxford and Oxford Health Biomedical Research Centres, British Heart Foundation Centre for Research Excellence, UKRI, Wellcome Trust, British Heart Foundation.