A multisystem, cardio-renal investigation of post-COVID-19 illness

Abstract

The pathophysiology and trajectory of post-Coronavirus Disease 2019 (COVID-19) syndrome is uncertain. To clarify multisystem involvement, we undertook a prospective cohort study including patients who had been hospitalized with COVID-19 (ClinicalTrials.gov ID NCT04403607). Serial blood biomarkers, digital electrocardiography and patient-reported outcome measures were obtained in-hospital and at 28–60 days post-discharge when multisystem imaging using chest computed tomography with pulmonary and coronary angiography and cardio-renal magnetic resonance imaging was also obtained. Longer-term clinical outcomes were assessed using electronic health records. Compared to controls (n = 29), at 28–60 days post-discharge, people with COVID-19 (n = 159; mean age, 55 years; 43% female) had persisting evidence of cardio-renal involvement and hemostasis pathway activation. The adjudicated likelihood of myocarditis was ‘very likely’ in 21 (13%) patients, ‘probable’ in 65 (41%) patients, ‘unlikely’ in 56 (35%) patients and ‘not present’ in 17 (11%) patients. At 28–60 days post-discharge, COVID-19 was associated with worse health-related quality of life (EQ-5D-5L score 0.77 (0.23) versus 0.87 (0.20)), anxiety and depression (PHQ-4 total score 3.59 (3.71) versus 1.28 (2.67)) and aerobic exercise capacity reflected by predicted maximal oxygen utilization (20.0 (7.6) versus 29.5 (8.0) ml/kg/min) (all P < 0.01). During follow-up (mean, 450 days), 24 (15%) patients and two (7%) controls died or were rehospitalized, and 108 (68%) patients and seven (26%) controls received outpatient secondary care (P = 0.017). The illness trajectory of patients after hospitalization with COVID-19 includes persisting multisystem abnormalities and health impairments that could lead to substantial demand on healthcare services in the future.

Reduced exercise capacity, chronotropic incompetence, and early systemic inflammation in cardiopulmonary phenotype Long COVID

“…Multiple studies have found CMR findings suggestive of myocarditis without cardiac dysfunction in the early post-acute period. 15, 92, 93 Consistent with other studies at later time points, 16, 19 our study reassuringly did not find evidence of abnormal cardiac function or late gadolinium enhancement suggestive of scar. We found higher ECV among those with symptoms, but not significant differences in native parametric mapping times nor associations with inflammatory markers early in PASC, and the clinical meaning of this isolated finding is uncertain.…”

Long COVID endotheliopathy: hypothesized mechanisms and potential therapeutic approaches

“…But apart from structural factors potentially impacting both disorders, the majority of epidemiologic and cohort studies find no impact of age, type 2 DM (DM-2), BMI, or hypertension on risk for PASC development in adults ( 11 , 15 , 58 – 60 ) or children ( 16 ) ( Figure 1A ). However, these factors must be considered in the context of acute COVID-19 severity, PASC phenotypes, ascertainment bias, and illness trajectory in hospitalized versus community-based patients, and in comparison with contemporary controls ( 61 ). Overall PASC risk may indeed be independent of initial disease severity.…”

“…Overall PASC risk may indeed be independent of initial disease severity. In contrast, multisystem illness severity in acute COVID-19, rather than preexisting comorbidities, appears to be the preeminent factor driving PASC characterized by quantifiable cardiac, pulmonary, or renal abnormalities ( 61 ).…”

Epidemiological Characteristics and Mortality Risk Factors Comparison in Dialysis and Non-Dialysis CKD Patients with COVID-19—A Single Center Experience

“…Nevertheless, based on all these findings and implications of this disease on health impairment, it should be highlighted that COVID-19 patients, especially those associated with chronic renal impairment, may present, even after discharge, with persisting multisystem anomalies, requiring further investigations (lab analysis, imagistic tests, etc.) with a direct socio-economic impact on the healthcare system [ 49 ].…”