EClinicalMedicine (Jan 2021)
Medium-term effects of SARS-CoV-2 infection on multiple vital organs, exercise capacity, cognition, quality of life and mental health, post-hospital discharge
- Betty Raman,
- Mark Philip Cassar,
- Elizabeth M. Tunnicliffe,
- Nicola Filippini,
- Ludovica Griffanti,
- Fidel Alfaro-Almagro,
- Thomas Okell,
- Fintan Sheerin,
- Cheng Xie,
- Masliza Mahmod,
- Ferenc E. Mózes,
- Adam J. Lewandowski,
- Eric O. Ohuma,
- David Holdsworth,
- Hanan Lamlum,
- Myles J. Woodman,
- Catherine Krasopoulos,
- Rebecca Mills,
- Flora A. Kennedy McConnell,
- Chaoyue Wang,
- Christoph Arthofer,
- Frederik J. Lange,
- Jesper Andersson,
- Mark Jenkinson,
- Charalambos Antoniades,
- Keith M. Channon,
- Mayooran Shanmuganathan,
- Vanessa M. Ferreira,
- Stefan K. Piechnik,
- Paul Klenerman,
- Christopher Brightling,
- Nick P. Talbot,
- Nayia Petousi,
- Najib M. Rahman,
- Ling-Pei Ho,
- Kate Saunders,
- John R. Geddes,
- Paul J. Harrison,
- Kyle Pattinson,
- Matthew J. Rowland,
- Brian J. Angus,
- Fergus Gleeson,
- Michael Pavlides,
- Ivan Koychev,
- Karla L. Miller,
- Clare Mackay,
- Peter Jezzard,
- Stephen M. Smith,
- Stefan Neubauer
Affiliations
- Betty Raman
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC), University of Oxford, Oxford, United Kingdom; Radcliffe Department of Medicine, British Heart Foundation Centre for Research Excellence, University of Oxford, Oxford, United Kingdom; Corresponding author.
- Mark Philip Cassar
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC), University of Oxford, Oxford, United Kingdom
- Elizabeth M. Tunnicliffe
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC), University of Oxford, Oxford, United Kingdom
- Nicola Filippini
- Wellcome Centre for Integrative Neuroimaging, Oxford Centre for Human Brain Activity, Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Ludovica Griffanti
- Wellcome Centre for Integrative Neuroimaging, Oxford Centre for Human Brain Activity, Department of Psychiatry, University of Oxford, Oxford, United Kingdom; Wellcome Centre for Integrative Neuroimaging (WIN FMRIB), Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
- Fidel Alfaro-Almagro
- Wellcome Centre for Integrative Neuroimaging (WIN FMRIB), Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
- Thomas Okell
- Wellcome Centre for Integrative Neuroimaging (WIN FMRIB), Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
- Fintan Sheerin
- Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
- Cheng Xie
- Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Masliza Mahmod
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC), University of Oxford, Oxford, United Kingdom
- Ferenc E. Mózes
- Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine, John Radcliffe Hospital Oxford, University of Oxford, Oxford, United Kingdom
- Adam J. Lewandowski
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC), University of Oxford, Oxford, United Kingdom
- Eric O. Ohuma
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
- David Holdsworth
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, United Kingdom
- Hanan Lamlum
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC), University of Oxford, Oxford, United Kingdom
- Myles J. Woodman
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC), University of Oxford, Oxford, United Kingdom
- Catherine Krasopoulos
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC), University of Oxford, Oxford, United Kingdom
- Rebecca Mills
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC), University of Oxford, Oxford, United Kingdom
- Flora A. Kennedy McConnell
- Division of Clinical Neuroscience, Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, United Kingdom
- Chaoyue Wang
- Wellcome Centre for Integrative Neuroimaging (WIN FMRIB), Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
- Christoph Arthofer
- Wellcome Centre for Integrative Neuroimaging (WIN FMRIB), Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
- Frederik J. Lange
- Wellcome Centre for Integrative Neuroimaging (WIN FMRIB), Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
- Jesper Andersson
- Wellcome Centre for Integrative Neuroimaging (WIN FMRIB), Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
- Mark Jenkinson
- Wellcome Centre for Integrative Neuroimaging (WIN FMRIB), Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
- Charalambos Antoniades
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC), University of Oxford, Oxford, United Kingdom; Radcliffe Department of Medicine, British Heart Foundation Centre for Research Excellence, University of Oxford, Oxford, United Kingdom
- Keith M. Channon
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC), University of Oxford, Oxford, United Kingdom; Radcliffe Department of Medicine, British Heart Foundation Centre for Research Excellence, University of Oxford, Oxford, United Kingdom
- Mayooran Shanmuganathan
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC), University of Oxford, Oxford, United Kingdom
- Vanessa M. Ferreira
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC), University of Oxford, Oxford, United Kingdom
- Stefan K. Piechnik
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC), University of Oxford, Oxford, United Kingdom
- Paul Klenerman
- Nuffield Department of Medicine, NIHR Oxford BRC, University of Oxford, Oxford, United Kingdom
- Christopher Brightling
- Institute for Lung Health, Department of Respiratory Sciences, NIHR Leicester BRC, University of Leicester, Leicester, United Kingdom
- Nick P. Talbot
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, United Kingdom
- Nayia Petousi
- Nuffield Department of Medicine, NIHR Oxford BRC, University of Oxford, Oxford, United Kingdom
- Najib M. Rahman
- Nuffield Department of Medicine, NIHR Oxford BRC, University of Oxford, Oxford, United Kingdom
- Ling-Pei Ho
- Weatherall Institute of Molecular Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Kate Saunders
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- John R. Geddes
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Paul J. Harrison
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Kyle Pattinson
- Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, United Kingdom
- Matthew J. Rowland
- Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, United Kingdom
- Brian J. Angus
- Experimental Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Fergus Gleeson
- Department of Oncology, Medical Science Department, University of Oxford, Oxford, United Kingdom
- Michael Pavlides
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC), University of Oxford, Oxford, United Kingdom; Translational Gastroenterology Unit, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Ivan Koychev
- Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, United Kingdom
- Karla L. Miller
- Wellcome Centre for Integrative Neuroimaging (WIN FMRIB), Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
- Clare Mackay
- Wellcome Centre for Integrative Neuroimaging, Oxford Centre for Human Brain Activity, Department of Psychiatry, University of Oxford, Oxford, United Kingdom; Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, United Kingdom
- Peter Jezzard
- Wellcome Centre for Integrative Neuroimaging (WIN FMRIB), Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
- Stephen M. Smith
- Wellcome Centre for Integrative Neuroimaging (WIN FMRIB), Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
- Stefan Neubauer
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC), University of Oxford, Oxford, United Kingdom; Radcliffe Department of Medicine, British Heart Foundation Centre for Research Excellence, University of Oxford, Oxford, United Kingdom
- Journal volume & issue
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Vol. 31
p. 100683
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.
