Medium-term effects of SARS-CoV-2 infection on multiple vital organs, exercise capacity, cognition, quality of life and mental health, post-hospital discharge

Abstract

Background The medium-term effects of Coronavirus disease (COVID-19) on multiple organ health, exercise capacity, cognition, quality of life and mental health are poorly understood. Methods Fifty-eight COVID-19 patients post-hospital discharge and 30 comorbidity-matched controls were prospectively 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 persistent breathlessness and 55% complained of significant fatigue. On MRI, tissue signal abnormalities were seen in the lungs (60%), heart (26%), liver (10%) and kidneys (29%) of patients. COVID-19 patients also exhibited tissue changes in the thalamus, posterior thalamic radiations and sagittal stratum on brain MRI and demonstrated impaired cognitive performance, specifically in the executive and visuospatial domain relative to controls. Exercise tolerance (maximal oxygen consumption and ventilatory efficiency on CPET) and six-minute walk distance (405±118m vs 517±106m in controls, p<0.0001) were significantly reduced in patients. The extent of extra-pulmonary MRI abnormalities and exercise tolerance correlated with serum markers of ongoing inflammation and severity of acute illness. Patients were more likely to report symptoms of moderate to severe anxiety (35% versus 10%, p=0.012) and depression (39% versus 17%, p=0.036) and significant impairment in all domains of quality of life compared to controls. Interpretation A significant proportion of COVID-19 patients discharged from hospital experience ongoing symptoms of breathlessness, fatigue, anxiety, depression and exercise limitation at 2-3 months from disease-onset. Persistent lung and extra-pulmonary organ MRI findings are common. In COVID-19 survivors, chronic inflammation may underlie multiorgan abnormalities and contribute to impaired quality of life.

Surviving COVID-19 in Bergamo province: a post-acute outpatient re-evaluation

“…Three hundred and ninety-four participants (51.4%) were still symptomatic at the ID evaluation, which is in line with other authors' observations [31,32,34,35]. In particular, 33.5% described themselves as 'not yet recovered': at a median time of 105 days since onset, these people probably fit into the 'working definition' (still to be strictly defined) of 'long COVID sufferers' [8].…”

Hyperventilation: A Possible Explanation for Long-Lasting Exercise Intolerance in Mild COVID-19 Survivors?

“…Two recent studies with cardiac magnetic resonance imaging (MRI) ( Huang L. et al, 2020 ; Puntmann et al, 2020 ) showed ongoing cardiac involvement in a majority of patients months after a COVID-19 diagnosis. Another study by Raman et al (2020) describes persistent MRI abnormalities seen in the lungs (60%) and the heart (26%) of COVID-19 patients at 2–3 months after hospital discharge, in relation to ongoing symptoms of breathlessness and excessive fatigue (in 64 and 55% of patients respectively). In the same study, cardiopulmonary exercise testing showed that 55% of patients had peak oxygen uptake (VO 2 max) values lower than 80% of the predicted.…”

Post-COVID syndrome and suicide risk

“… 8 A recent UK study showed that at 2–3 months from disease onset COVID-19 patients were more likely to report symptoms of moderate to severe anxiety and depression in comparison to controls. 9 A study in Italy showed that 1 month after hospital treatment a considerable percentage of COVID-19 patients self-rated in the psychopathological range: 28% for PTSD, 31% for depression, 42% for anxiety, 20% for obsessive–compulsive symptoms and 40% for insomnia. 10 …”

“…Depressive symptoms appear to be common in patients with post-COVID syndrome. 7 , 9 , 10 , 15 Major depression is one of the most frequent neuropsychiatric disorders related to inflammatory damage to the brain. 7 , 15 Considerable evidence has linked depressive symptoms to pro-inflammatory factors and neuroglial failure.…”