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A multisystem, cardio-renal investigation of post-COVID-19 illness
Nature Medicine ( IF 58.7 ) Pub Date : 2022-05-23 , DOI: 10.1038/s41591-022-01837-9
Andrew J Morrow 1, 2 , Robert Sykes 1, 2 , Alasdair McIntosh 3 , Anna Kamdar 1 , Catherine Bagot 4 , Hannah K Bayes 5 , Kevin G Blyth 6, 7 , Michael Briscoe 2 , Heerajnarain Bulluck 8 , David Carrick 9 , Colin Church 6, 10 , David Corcoran 1, 2 , Iain Findlay 11 , Vivienne B Gibson 4 , Lynsey Gillespie 12 , Douglas Grieve 13 , Pauline Hall Barrientos 14 , Antonia Ho 15 , Ninian N Lang 1, 2 , Vera Lennie 16 , David J Lowe 17 , Peter W Macfarlane 18 , Patrick B Mark 1, 19 , Kaitlin J Mayne 1, 19 , Alex McConnachie 3 , Ross McGeoch 9 , Christopher McGinley 2 , Connor McKee 2 , Sabrina Nordin 2 , Alexander Payne 20 , Alastair J Rankin 1 , Keith E Robertson 10 , Giles Roditi 21 , Nicola Ryan 16 , Naveed Sattar 1 , Sarah Allwood-Spiers 5 , David Stobo 21 , Rhian M Touyz 1 , Gruschen Veldtman 22 , Stuart Watkins 10 , Sarah Weeden 3 , Robin A Weir 9 , Paul Welsh 1 , Ryan Wereski 17, 23 , , Kenneth Mangion 1, 2 , Colin Berry 1, 2, 10
Affiliation  

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:

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。

更新日期:2022-05-24
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