Multiorgan impairment in low-risk individuals with post-COVID-19 syndrome: a prospective, community-based study

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.

Uptake of COVID-19 vaccines among healthcare workers within primary healthcare facilities, Entebbe municipality Uganda

“…This age related perception of risk also explains why younger health care workers were less likely to be vaccinated, since the risk of severe disease has been reported to be low among younger age groups (37) although some studies have reported severe diseases among younger age groups. Andrea et al reported that almost 70% of the young 'low risk' with ongoing symptoms of COVID-19 had impairment in one or more organs four months after initial symptoms of SARS-CoV-2 infection (38). This study seems to suggest that even though low risk individuals have lower mortality rates, their severity of disease is seen by organ temporary impairment and follow up of this category is of public health importance.…”

Disfunções No Trato Gastrointestinal E Urinário, Síndrome Pré-Menstrual E Disfunções Sexuais

“…Neste estudo, a maioria das mulheres apresentou alterações no funcionamento intestinal, resultado semelhante ao encontrado em outros estudos (ANAYA et al, 2021;DENNIS et al, 2021). Ademais, foi identificada elevada prevalência de obstipação e diarreia, o que pode estar relacionado à infecção dos enterócitos pelo SARS-CoV-2, induzindo a inflamação nos tecidos que ocasiona distúrbios e redução da microbiota intestinal, os quais levam o aparecimento de sintomas que envolvem o trato gastrointestinal (TGI), sendo a diarreia o sintoma mais comumente relatado (ANDRADE et al, 2021;MAGHOOL et al, 2021).…”

Cardiac Manifestations of Post-Acute COVID-19 Infection

“…In patients with persistent symptoms 5 months after initial SARS-CoV2 infection, 39% had echocardiographic findings of RV dilatation, 16% had findings of left ventricular (LV) diastolic dysfunction, and 10% had findings of LV systolic dysfunction [ 58 •]. Another prospective cohort study in low-risk patients with PCS 4 months post-infection found that 9% of patients had some systolic dysfunction on CMR with the incidence increasing as the severity of PCS increased [ 59 •]. Acute infection with SARS-CoV2 has also been linked to the development of Takotsubo cardiomyopathy [ 60 ].…”

“…Myocarditis seems to develop in the post-acute setting of SARS-CoV2 infection regardless of patient condition and previous CVD risk factors. A prospective cohort study in otherwise low-risk patients in the general population with PCS 4 months post-infection found that 19% of patients had MRI evidence of myocarditis [ 59 •]. Risk of developing myocarditis remained even in highly trained athletes.…”