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Preprint: Multi-organ impairment and Long COVID: a 1-year prospective, longitudinal cohort study, 2022, Dennis et al

Discussion in 'Long Covid research' started by Andy, Mar 22, 2022.

  1. Andy

    Andy Committee Member

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    Location:
    Hampshire, UK
    Abstract

    Importance: Multi-organ impairment associated with Long COVID is a significant burden to individuals, populations and health systems, presenting challenges for diagnosis and care provision. Standardised assessment across multiple organs over time is lacking, particularly in non-hospitalised individuals.

    Objective: To determine the prevalence of organ impairment in Long COVID patients at 6 and at 12 months after initial symptoms and to explore links to clinical presentation.

    Design: This was a prospective, longitudinal study in individuals following recovery from acute COVID-19. We assessed symptoms, health status, and multi-organ tissue characterisation and function, using consensus definitions for single and multi-organ impairment. Physiological and biochemical investigations were performed at baseline on all individuals and those with organ impairment were reassessed, including multi-organ MRI, 6 months later.

    Setting: Two non-acute settings (Oxford and London).

    Participants: 536 individuals (mean 45 years, 73% female, 89% white, 32% healthcare workers, 13% acute COVID-19 hospitalisation) completed baseline assessment (median: 6 months post-COVID-19). 331 (62%) with organ impairment or incidental findings had follow up, with reduced symptom burden from baseline (median number of symptoms: 10 and 3, at 6 and 12 months). Exposure: SARS-CoV-2 infection 6 months prior to first assessment.

    Main outcome: Prevalence of single and multi-organ impairment at 6 and 12 months post-COVID-19. Results: Extreme breathlessness (36% and 30%), cognitive dysfunction (50% and 38%) and poor health-related quality of life (EQ-5D-5L<0.7; 55% and 45%) were common at 6 and 12 months, and associated with female gender, younger age and single organ impairment. At baseline, there was fibro-inflammation in the heart (9%), pancreas (9%), kidney (15%) and liver (11%); increased volume in liver (7%), spleen (8%) and kidney (9%); decreased capacity in lungs (2%); and excessive fat deposition in the liver (25%) and pancreas (15%). Single and multi-organ impairment were present in 59% and 23% at baseline, persisting in 59% and 27% at follow-up.

    Conclusion and Relevance: Organ impairment was present in 59% of individuals at 6 months post-COVID-19, persisting in 59% of those followed up at 1 year, with implications for symptoms, quality of life and longer-term health, signalling need for prevention and integrated care of Long COVID.

    https://www.medrxiv.org/content/10.1101/2022.03.18.22272607v1
     
    Andy, Mar 22, 2022
    #1
    RedFox, Hutan, cfsandmore and 4 others like this.
  2. DokaGirl

    DokaGirl Senior Member (Voting Rights)

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    I heard a bit of a CBC Radio interview with a physician with LC. She is very unwell, and unable to work.

    I know it's early days, but still concerning that the LC phenomenon is looked at as an oddity, a curiosity, and a rarity. Something very hard to believe. LC goes against the norm, and belief that a virus is something we all bounce back from.

    However, it is encouraging that there are many biomedical studies on this illness.

    I hope there will be studies comparing brain MRIs of pwLC and pwME, and controls. Comparisons with pwMS would, I think be an idea as well.
     
    DokaGirl, Mar 22, 2022
    #2
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  3. rvallee

    rvallee Senior Member (Voting Rights)

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    13,008
    Location:
    Canada
    Yeah, CBT will definitely fix that.
     
    rvallee, Mar 22, 2022
    #3
    Hutan, DokaGirl and Peter Trewhitt like this.
  4. SNT Gatchaman

    SNT Gatchaman Senior Member (Voting Rights)

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    SNT Gatchaman, Feb 16, 2023
    #4
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  5. Hutan

    Hutan Moderator Staff Member

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    Location:
    Aotearoa New Zealand
    Very true.


    The study found quite a high rate of detectable organ impairment. There are two things to consider:
    1. What is the rate of detectable organ impairment in the general population? Perhaps issues are being picked up that are not related to Covid-19.
    2. Selection bias.
    Some of the participants were referred for this imaging by specialists. The specialists probably were more likely to refer people for imaging when they thought there would be something to find. Furthermore, 32% were healthcare workers who may have had some basis for suspecting that imaging might show something. For example, it is mentioned that blood tests could indicate organ impairment - the health care workers may have had these blood tests and known what they indicated.


    They had 536 in the cohort who did the first visit at around 4 months after infection, along with rates of impairment from healthy people. Of the 536, 388 were invited to a followup assessment after one year because they had an abnormal blood or imaging result. Of the 388, 57 were lost to followup for various reasons, so 331 participants were assessed at followup.

    The chart below, Figure 2b, relates to the 331 participants at baseline and followup. Clearly, the incidence of symptoms decreases over time, even for these people with identifiable organ impairment. In the followup group, reported fatigue went from 98% to 64%. 60 people in the followup group had no symptoms at followup.

    Screen Shot 2023-02-16 at 10.03.24 pm.png


    Figure 2c: The compares rates of organ impairment in healthy controls, in the whole cohort (536) and the followup cohort (331).
    Screen Shot 2023-02-16 at 10.11.51 pm.png
    The differences are a bit hard to see. Nearly one third of the healthy controls had least one organ impaired, so the high rate of organ impairment in this selected Long Covid sample is less impressive than it would otherwise be. That said, rates are clearly substantially higher for many of the organ types. Surprisingly, there is little difference in lung impairment rates (FAC is Fractional Area Change).

    Figure 2d: unlike the reported symptoms, the identified organ damage didn't change much over the 6 months or so from baseline to followup.

    Screen Shot 2023-02-16 at 11.01.11 pm.png



    I'm not sure that all the percentages reported are exactly right, or at least there is room for misunderstanding in some of the presentations. For example:
    I'm getting tired and so am not up to the challenge of poking into the figures, and given that the sampling is biased, the precise percentages probably don't matter that much.


    They found a major impact on employment in the followup group:
     
    Hutan, Feb 16, 2023
    #5
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  6. Hutan

    Hutan Moderator Staff Member

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    Location:
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    This looked worth noting. Until they actually looked, there wasn't necessarily much to indicate that there was organ impairment:

    I guess a question is, did people have these organ impairments before Covid-19 and the impairments predisposed the individual to post-covid symptoms? Or did Covid cause the impairment?
    Re full recovery:
    Figure 3b - predictive factors at baseline for quality of life at followup

    Screen Shot 2023-02-16 at 11.25.27 pm.png

    It's an interesting study, worth a read I think.
     
    Hutan, Feb 16, 2023
    #6
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