Signs of affection of multi-organ systems after recovery from mild to moderate COVID-19

Multi-organ assessment in mainly non-hospitalized individuals after SARS-CoV-2 infection: The Hamburg City Health Study COVID programme

Literature - Petersen EL, Grossling A, Adam G et al., - Eur Heart J 2021; https://doi.org/10.1093/eurheartj/ehab914

Introduction and methods

Background

In severely ill and deceased COVID-19 patients, impairment of pulmonary, cardiac and renal function have been reported, as well as thromboembolism and serious neurological complications [1-4]. Most reports on long term symptoms are from hospitalized cohorts [5] and data on subclinical changes of multi-organ structure and function are lacking.

In this cross-sectional study, the intermediate-term impact of mild to moderate COVID-19 (defined as not requiring intensive care unit treatment) on organ-specific function was determined.

Study design

Multi-organ function was assessed by deep phenotyping patients ~9 months after mild to moderate COVID-19 recovery and comparing data with those of age-, sex-, and education-matched subjects from a population-based cohort study.

The cohort of 443 recovered COVID-19 patients consisted of individuals from Hamburg, Germany, with a positive PCR test for SARS-CoV-2 at least 4 months prior to enrollment (median enrollment was 9.6 months after the positive test). 92.8% Of these subjects were managed as outpatients. The population-based Hamburg City Health Study (HCHS) served a as the control cohort. Controls were eligible for this study if they had been enrolled prior to being at risk of SARS-CoV-2 infection; 1328 controls were enrolled.

Both patients recovered from COVID-19 and matched controls underwent the same standardized 7h assessment at the same center [6].

Main outcomes

Surrogates of biological parameters in the respiratory, cardiac, vascular, renal, metabolic and inflammatory, and neurological systems, and of neurocognition and psychosocial outcomes were assessed.

Main results

Respiratory system

Total lung capacity was lower in recovered COVID-19 subject compared with controls (99.1% of the predictive value vs. 102.3%, regression coefficient -3.24, 95%CI:-5.57 to -0.91, adjusted=0.0014)
Specific airway resistance was higher in patients after SARS-CoV-2 infection than matched controls (77.3% of the predicted value vs. 69.8%, regression coefficient 8.11, 95%CI: 3.56 to 12.65, adjusted P=0.001).

Cardiac system

Left ventricular ejection fraction derived from transthoracic echocardiography was decreased in patients after SARS-CoV-2 infection compared with controls (57.9 vs. 59.1%, regression coefficient -0.93, 95%CI: -1.54 to -0.32, adjusted P=0.015).
Right ventricular systolic function, quantified by TAPSE using transthoracic echocardiography, was significantly reduced in patients after SARS-CoV-2 infection (23.0 vs. 23.9 mm, regression coefficient -0.72, 95%CI:-1.24 to -0.21, adjusted P=0.031).
In patients after SARS-CoV-2 infection, the cardiac biomarkers NT-proBNP and high-sensitivity cardiac troponin were higher compared with matched controls (NT-proBNP: 87.84 vs. 62.76 ng/L, multiplicative regression coefficient 1.41, 95%CI:1.29 to 1.55, adjusted P<0.001; high-sensitivity cardiac troponin I: 2.07 vs. 1.90 ng/L, multiplicative regression coefficient 1.14, 95%CI:1.05 to 1.24, adjusted P=0.010).
NT-proBNP ≥125 ng/L were more frequent in patients after SARS-CoV-2-infection than matched controls (33.2 vs. 18.2%, OR 2.39, 95%CI:1.82 to 3.12, adjusted P<0.001).

Vascular system

Sonographically non-compressible common femoral veins were more frequently observed in individuals after SARS-CoV-2 infection than in matched controls (43.2 vs. 22.2%, OR 2.68, 95%CI: 1.77-5.05, adjusted P<0.001)
Individuals after SARS-CoV-2 infection presented more often with atherosclerotic plaques (36.9 vs. 23.4%, OR 2.27, 95%CI: 1.76-2.93, adjusted P<0.001).

Renal system

eGFR based on creatinine measurements was reduced in patients after SARS-CoV-2 infection by 2.35 mL/min/1.73m2 (95%CI: -4.04 to -0.67, adjusted P=0.019).

Neurological system

Patients after SARS-CoV-2 infection had higher mean cortical thickness compared to controls (2.65 vs. 2.63 mm, regression coefficient 0.03, 95%CI: 0.01-0.05, adjusted P=0.002).

Conclusion

Subclinical multi-organ involvement related to thrombotic function and pulmonary, cardiac and renal systems was observed in mainly non-hospitalized patients who recovered ~9 months ago from mild to moderate COVID-19. There were no signs of structural brain damage, impairment in cognitive function or quality of life.

The take-home message of the authors is that a standardized exam of these conditions after recovery from COVID-19 is recommended to identify individuals at risk and initiate preventive strategies.

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