Post COVID-19: Oxford Study Reveals Medium-Term Impact Of COVID-19 Including Multiple Organ Damage, Fatigue And Mental Issues
: Researchers from University of Oxford in a new study looking at the longer-term impact of COVID-19 has found that a large proportion of COVID-19 patients discharged from hospital were still experiencing symptoms of breathlessness, fatigue, anxiety and depression two to three months after contracting the virus.
The study team carrying out the C-MORE study has also detected abnormalities on MRI in multiple organs and believe that persistent or chronic inflammation may be an underlying factor for these changes among COVID-19 survivors.
The study also found that many of these recovered patients had also demonstrated impaired cognitive performance.
The research findings were published on a preprint server and are currently being peer-reviewed. https://www.medrxiv.org/content/10.1101/2020.10.15.20205054v1
The study is being led by researchers from the university's Radcliffe Department of Medicine and is supported by the NIHR Oxford Biomedical Research Center (BRC) and the NIHR Oxford Health BRC, as well as the BHF Oxford Center for Research Excellence and Wellcome Trust.
The C-MORE study is also part of the national PHOSP-COVID platform, led by the University of Leicester, which is investigating the long-term effects of COVID-19 on hospitalized patients.
The detailed research took 58 patients with moderate to severe laboratory-confirmed COVID-19, who had been admitted for treatment at the Oxford University Hospitals (OUH) NHS Foundation Trust between March and May 2020. They also recruited 30 uninfected controls from the community, group-matched for age, sex, body mass index and risk factors such as smoking, diabetes and hypertension.
The study participants underwent magnetic resonance imaging (MRI) of their brain, lungs, heart, liver and kidneys; spirometry to test their lung function; a six-minute walk test; cardiopulmonary exercise test (CPET), as well as assessments of their quality of life, cognitive and mental health.
The 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.
Significantly on MRI, tissue signal abnormalities were seen 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 seen even in patients who had not been critically ill when admitted.
Alarmingly MRI also detected tissue changes in parts of the brain, and patients demonstrated impaired cognitive performance. Their ability to sustain exercise was also significantly reduced, although this was due to a combination of fatigue and lung abnormalities.
COVID-19 patients also exhibited tissue changes in the thalamus, posterior thalamic radiations and sagittal stratum on brain MRI and demonstrated impaired cognitive performance, specifically in the executive and visuospatial domain relative to controls. Exercise tolerance (maximal oxygen consumption and ventilatory efficiency on CPET) and six-minute walk distance (405±118m vs 517±106m in controls, p<0.0001) were significantly reduc
ed in patients. The extent of extra-pulmonary MRI abnormalities and exercise tolerance correlated with serum markers of ongoing inflammation and severity of acute illness.
Also it was found that patients were more likely to report symptoms of anxiety and depression, and a significant impairment in their quality of life compared to the controls.
Dr Betty Raman, who is leading the C-MORE study along with Professor Stefan Neubauer, told Thailand Medical New, "Our study assessed patients recovering from COVID-19 following hospitalization, 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.”
Dr Raman further added, "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."
A clinical research fellow at the Radcliffe Department of Medicine, Dr Raman, added, "These 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. We would like to thank all our patients and their families who have taken part in this study. In helping us to better understand the effects of this new disease, they have made an important contribution in helping others who have contracted and who will contract the virus."
In conclusion the study team said, “A significant proportion of COVID-19 patients discharged from hospital experience ongoing symptoms of breathlessness, fatigue, anxiety, depression and exercise limitation at 2-3 months from disease-onset. Persistent lung and extra-pulmonary organ MRI findings are common. In COVID-19 survivors, chronic inflammation may underlie multiorgan abnormalities and contribute to impaired quality of life.”
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