Abstract

The pathophysiology and trajectory of post-Coronavirus Disease 2019 (COVID-19) syndrome is uncertain. To clarify multisystem involvement, we undertook a prospective cohort study including patients who had been hospitalized with COVID-19 (ClinicalTrials.gov ID NCT04403607). Serial blood biomarkers, digital electrocardiography and patient-reported outcome measures were obtained in-hospital and at 28–60 days post-discharge when multisystem imaging using chest computed tomography with pulmonary and coronary angiography and cardio-renal magnetic resonance imaging was also obtained. Longer-term clinical outcomes were assessed using electronic health records. Compared to controls (n = 29), at 28–60 days post-discharge, people with COVID-19 (n = 159; mean age, 55 years; 43% female) had persisting evidence of cardio-renal involvement and hemostasis pathway activation. The adjudicated likelihood of myocarditis was ‘very likely’ in 21 (13%) patients, ‘probable’ in 65 (41%) patients, ‘unlikely’ in 56 (35%) patients and ‘not present’ in 17 (11%) patients. At 28–60 days post-discharge, COVID-19 was associated with worse health-related quality of life (EQ-5D-5L score 0.77 (0.23) versus 0.87 (0.20)), anxiety and depression (PHQ-4 total score 3.59 (3.71) versus 1.28 (2.67)) and aerobic exercise capacity reflected by predicted maximal oxygen utilization (20.0 (7.6) versus 29.5 (8.0) ml/kg/min) (all P < 0.01). During follow-up (mean, 450 days), 24 (15%) patients and two (7%) controls died or were rehospitalized, and 108 (68%) patients and seven (26%) controls received outpatient secondary care (P = 0.017). The illness trajectory of patients after hospitalization with COVID-19 includes persisting multisystem abnormalities and health impairments that could lead to substantial demand on healthcare services in the future.

中文翻译：

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COVID-19 后疾病的多系统心肾调查

摘要

2019 年冠状病毒病 (COVID-19) 后综合征的病理生理学和轨迹尚不确定。为了阐明多系统参与，我们进行了一项前瞻性队列研究，包括因 COVID-19 住院的患者 (ClinicalTrials.gov ID NCT04403607)。连续血液生物标志物、数字心电图和患者报告的结果测量是在院内和出院后 28-60 天获得的，同时还获得了使用胸部计算机断层扫描、肺血管和冠状动脉造影以及心肾磁共振成像的多系统成像。使用电子健康记录评估长期临床结果。与对照组（n  = 29）相比，出院后 28-60 天，COVID-19 患者（n = 159; 平均年龄 55 岁；43% 的女性）有心肾受累和止血途径激活的持续证据。21 名 (13%) 患者心肌炎的裁定可能性为“非常可能”，65 名 (41%) 患者为“可能”，56 名 (35%) 患者为“不太可能”，17 名 (11%) 患者为“不存在”患者。在出院后 28-60 天，COVID-19 与较差的健康相关生活质量（EQ-5D-5L 评分 0.77（0.23）对 0.87（0.20））、焦虑和抑郁（PHQ-4 总分 3.59）相关（3.71）对 1.28（2.67））和有氧运动能力反映在预测的最大氧气利用（20.0（7.6）对 29.5（8.0）ml/kg/min）（所有P < 0.01)。在随访期间（平均 450 天），24 名（15%）患者和两名（7%）对照者死亡或再次住院，108 名（68%）患者和 7 名（26%）对照者接受门诊二级护理（P  = 0.017）。COVID-19 住院患者的疾病轨迹包括持续的多系统异常和健康损害，这可能导致未来对医疗服务的大量需求。