COVID-19 May Cause Lasting Damage to Multiple Organs

Megan Brooks

May 24, 2022

One in eight adults hospitalized with COVID-19 subsequently develops myocarditis, often leading to impaired exercise capacity and health-related quality of life, according to an ongoing study looking at the clinical long-term effects of the virus.

The study also revealed evidence of persistent abnormalities in heart, lung, and kidney imaging, electrocardiography, and multisystem biomarkers after COVID-19 hospital discharge.

Importantly, say the researchers, it's the severity of a patient's COVID-19 infection, not their underlying health condition, that is most closely correlated to the severity of ongoing health issues after the patient leaves the hospital.

"We found that previously healthy patients, without any underlying health conditions, were suffering with severe health outcomes, including myocarditis, post hospitalization," principal investigator Colin Berry, MBChB, PhD, professor of cardiology and imaging, University of Glasgow, United Kingdom, said in a statement.

"The reasons for this are unclear, but it may be that a healthy person who is hospitalized with COVID-19 is likely to have a worse COVID infection than someone with underlying health conditions who is hospitalized," Berry said.

The study was published online May 23 in Nature Medicine.

A Multisystem Disease

The findings are based on 159 patients who are being followed after hospitalization for COVID-19 as part of the Scottish Cardiac Imaging in SARS CoV-2 (CISCO-19) study.

Mean age of the study participants was 55 years, 43% were women, and 47% had a history of cardiovascular disease or treatment. Over an average postdischarge follow-up of 450 days, one in seven patients was readmitted to the hospital and two in three required outpatient care.

Compared with a matched control group of non-COVID patients, COVID patients showed evidence of cardio-renal inflammation, lung involvement, systemic inflammation, hemostatic pathway activation, and impairments in physical and psychological function 28 to 60 days after discharge.

The likelihood of post-COVID myocarditis (the primary outcome) was judged to be "very likely" in 13% of patients, "probable" in 41%, "unlikely" in 35%, and "not present" in 11%.

The etiology of myocarditis was predominantly SARS-COV-2 infection, and less commonly myocardial ischemia due to coronary artery disease.

Myocardial scar was "surprisingly" common, affecting one in five COVID patients, the researchers note.

The fibrosis distribution in post-COVID patients was "indicative of acute myocarditis, microvascular thrombosis, myocardial infarction, and pre-existing scar with a nonischemic pattern. The prognostic implications of these findings should be clarified through longitudinal follow-up studies," the researchers say.

Almost one-quarter of the COVID-19 patients were healthcare workers, and they had about a threefold higher likelihood of myocarditis, a finding that merits further investigation, the researchers say.

On univariate analysis, women had an increased likelihood of myocarditis, which in turn was linked to lower mental and physical well-being. This finding, they say, might provide a pathophysiologic basis for the physical limitations experienced by some women after severe COVID-19 that requires hospital care.

Myocarditis was associated with acute kidney injury during COVID admission, with evidence of kidney inflammation 28 to 60 days after discharge.

"From a clinical perspective, cardio-renal injury was associated with persisting impairments in health-related quality of life, and poorer physical and psychological well-being during convalescence," the researchers say.

"Considering clinical translation, the results support a stratified management approach for post-COVID-19 patients early during convalescence," they add.

Chest abnormalities on CT were also common 28 to 60 days after COVID discharge.

The minimum patient-level fractional flow reserve on CT was lower in COVID patients than in 27 COVID-free control subjects, "consistent with flow-limiting coronary artery disease," the authors note.

MRI showed mild differences in ventricular function.

At baseline, circulating concentrations of C-reactive protein, ferritin, D-dimers, fibrinogen, factor VIII, and von Willebrand factor were higher in post-COVID patients than control subjects, consistent with hemostatic pathway activation.

At 28 to 60 days after discharge, factor VIII concentrations remained high. Circulating concentrations of NT-proBNP were higher in COVID patients at baseline and 28 to 60 days after discharge.

Summing up, the researchers say their findings show that the illness trajectory of COVID-19 includes "persisting multisystem abnormalities that underlie impairments in health status, physical and psychological well-being during community convalescence."

The work was funded by the Scottish Government's Chief Scientist Office, and supported by the British Heart Foundation (BHF) as part of the University of Glasgow BHF Centre of Excellence. The authors have no relevant disclosures.

Nat Med. Published online May 23, 2022. Full text

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