Many hospitalised COVID-19 patients were still experiencing symptoms of breathlessness, fatigue, anxiety and depression up to three months after contracting the virus, according to a new study.
The C-MORE study, led by University of Oxford, also detected abnormalities on MRI in multiple organs, which could mean that persistent or chronic inflammation may be an underlying factor for these changes among COVID-19 survivors.
The initial findings, published online as a pre-print on MedRxiv, involved 58 patients with moderate to severe laboratory-confirmed COVID-19, who had been admitted to Oxford University Hospitals (OUH) NHS Foundation Trust between March and May 2020, and 30 uninfected controls from the community, group-matched for age, sex, body mass index and risk factors such as smoking, diabetes and hypertension.
The participants underwent an MRI of their brain, lungs, heart, liver and kidneys, as well as spirometry to test their lung function; a six-minute walk test; cardiopulmonary exercise test (CPET), and assessments of their quality of life, cognitive and mental health.
The C-MORE study found that two to three months after the onset of the disease, 64% of patients experienced persistent breathlessness and 55% complained of significant fatigue.
The MRI revealed tissue signal abnormalities in the lungs of 60% of the COVID-19 patients, in the kidneys of 29%, in the hearts of 26%, and the livers of 10%. Organ abnormalities were also seen in patients who had not been critically ill when admitted.
MRI also detected tissue changes in parts of the brain, and patients had impaired cognitive performance. They had a reduced capacity for exercise, although the authors say this was due to a combination of fatigue and lung abnormalities.
Patients were more likely to report anxiety and depression and reduced quality of life compared to the controls.
Dr Betty Raman, who is leading the C-MORE with Professor Stefan Neubauer, said: “Our study assessed patients recovering from COVID-19 following hospitalisation, two to three months from disease onset. Whilst we have found abnormalities in multiple organs, it is difficult to know how much of this was pre-existing and how much has been caused by COVID-19.
“However, it is interesting to see that the abnormalities detected on MRI and exercise capacity in patients strongly correlated with serum markers of inflammation. This suggests a potential link between chronic inflammation and ongoing organ damage among survivors.”
Dr Raman said the findings underscore the need to further explore the physiological processes associated with COVID-19 and to develop a holistic, integrated model of clinical care for our patients after they have been discharged from hospital.
Raman B, Cassar MP, Tunnicliffe EM et al. Medium-term effects of SARS-CoV-2 infection on multiple vital organs, exercise capacity, cognition, quality of life and mental health, post-hospital discharge. MedRxiv 19 October 2020
https://medrxiv.org/cgi/content/short/2020.10.15.20205054v1
* Photo above: New art exhibition at Addenbrooke’s Hospital, Cambridge, features the work of staff, patients and the public.
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