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.