Dataset Information

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 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 age, sex, body mass index comorbidity-matched controls were 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 breathlessness and 55% reported fatigue. On MRI, abnormalities were seen in lungs (60%), heart (26%), liver (10%) and kidneys (29%). Patients exhibited changes in the thalamus, posterior thalamic radiations and sagittal stratum on brain MRI and demonstrated impaired cognitive performance, specifically in the executive and visuospatial domains. Exercise tolerance (maximal oxygen consumption and ventilatory efficiency on CPET) and six-minute walk distance were significantly reduced. The extent of extra-pulmonary MRI abnormalities and exercise intolerance correlated with serum markers of inflammation and acute illness severity. Patients had a higher burden of self-reported symptoms of depression and experienced significant impairment in all domains of quality of life compared to controls (p<0.0001 to 0.044).

Interpretation

A significant proportion of patients discharged from hospital reported symptoms of breathlessness, fatigue, depression and had limited exercise capacity. Persistent lung and extra-pulmonary organ MRI findings are common in patients and linked to inflammation and severity of acute illness.

Funding

NIHR Oxford and Oxford Health Biomedical Research Centres, British Heart Foundation Centre for Research Excellence, UKRI, Wellcome Trust, British Heart Foundation.

SUBMITTER: Raman B

PROVIDER: S-EPMC7808914 | biostudies-literature | 2021 Jan

REPOSITORIES: biostudies-literature

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Publications

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

Raman Betty B Cassar Mark Philip MP Tunnicliffe Elizabeth M EM Filippini Nicola N Griffanti Ludovica L Alfaro-Almagro Fidel F Okell Thomas T Sheerin Fintan F Xie Cheng C Mahmod Masliza M Mózes Ferenc E FE Lewandowski Adam J AJ Ohuma Eric O EO Holdsworth David D Lamlum Hanan H Woodman Myles J MJ Krasopoulos Catherine C Mills Rebecca R McConnell Flora A Kennedy FAK Wang Chaoyue C Arthofer Christoph C Lange Frederik J FJ Andersson Jesper J Jenkinson Mark M Antoniades Charalambos C Channon Keith M KM Shanmuganathan Mayooran M Ferreira Vanessa M VM Piechnik Stefan K SK Klenerman Paul P Brightling Christopher C Talbot Nick P NP Petousi Nayia N Rahman Najib M NM Ho Ling-Pei LP Saunders Kate K Geddes John R JR Harrison Paul J PJ Pattinson Kyle K Rowland Matthew J MJ Angus Brian J BJ Gleeson Fergus F Pavlides Michael M Koychev Ivan I Miller Karla L KL Mackay Clare C Jezzard Peter P Smith Stephen M SM Neubauer Stefan S

EClinicalMedicine 20210107

<h4>Background</h4>The medium-term effects of Coronavirus disease (COVID-19) on organ health, exercise capacity, cognition, quality of life and mental health are poorly understood.<h4>Methods</h4>Fifty-eight COVID-19 patients post-hospital discharge and 30 age, sex, body mass index comorbidity-matched controls were enrolled for multiorgan (brain, lungs, heart, liver and kidneys) magnetic resonance imaging (MRI), spirometry, six-minute walk test, cardiopulmonary exercise test (CPET), quality of l ...[more]

PMID: 33490928

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Project description:BackgroundVital sign instability on discharge could be a clinically objective means of assessing readiness and safety for discharge; however, the association between vital sign instability on discharge and post-hospital outcomes is unclear.ObjectiveTo assess the association between vital sign instability at hospital discharge and post-discharge adverse outcomes.DesignMulti-center observational cohort study using electronic health record data. Abnormalities in temperature, heart rate, blood pressure, respiratory rate, and oxygen saturation were assessed within 24 hours of discharge. We used logistic regression adjusted for predictors of 30-day death and readmission.ParticipantsAdults (≥18 years) with a hospitalization to any medicine service in 2009-2010 at six hospitals (safety-net, community, teaching, and non-teaching) in north Texas.Main measuresDeath or non-elective readmission within 30 days after discharge.Key resultsOf 32,835 individuals, 18.7 % were discharged with one or more vital sign instabilities. Overall, 12.8 % of individuals with no instabilities on discharge died or were readmitted, compared to 16.9 % with one instability, 21.2 % with two instabilities, and 26.0 % with three or more instabilities (p < 0.001). The presence of any (≥1) instability was associated with higher risk-adjusted odds of either death or readmission (AOR 1.36, 95 % CI 1.26-1.48), and was more strongly associated with death (AOR 2.31, 95 % CI 1.91-2.79). Individuals with three or more instabilities had nearly fourfold increased odds of death (AOR 3.91, 95 % CI 1.69-9.06) and increased odds of 30-day readmission (AOR 1.36, 95 % 0.81-2.30) compared to individuals with no instabilities. Having two or more vital sign instabilities at discharge had a positive predictive value of 22 % and positive likelihood ratio of 1.8 for 30-day death or readmission.ConclusionsVital sign instability on discharge is associated with increased risk-adjusted rates of 30-day mortality and readmission. These simple vital sign criteria could be used to assess safety for discharge, and to reduce 30-day mortality and readmissions.

Dataset Information

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

Background

Methods

Findings

Interpretation

Funding

Publications

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

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