COVID's aftermath: Persistent organ damage at 1 year, lung abnormalities at 2

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Two studies published yesterday further reveal the extent of COVID-19's potential aftermath, with one showing residual organ damage 1 year after diagnosis—even in those who were mildly ill—and the other finding persistent lung abnormalities on chest imaging at 2 years.

59% had organ impairment at 1 year

In a study in the Journal of the Royal Society of Medicine, British researchers assessed organ impairment in 536 long-COVID patients still reporting extreme shortness of breath, brain fog, and poor health-related quality of life (HRQoL) 1 year after diagnosis. Of all participants, 13% had been hospitalized at symptom onset, and 32% were healthcare workers.

Sixty-two percent of participants had organ damage 6 months after their initial diagnosis, as did 59% of those who underwent a 40-minute multi-organ magnetic resonance imaging (MRI) scan at 1 year—even those with non-severe infections.

Among all patients, 29% had multi-organ impairment, with lingering symptoms and impaired function at 6 and 12 months, while 59% of long-COVID patients had single-organ damage at 1 year.

Long-COVID symptoms declined from 6 to 12 months, with extreme shortness of breath dropping from 38% to 30% of patients, brain fog from 48% to 38%, and poor HRQoL from 57% to 45%.

"Several studies confirm persistence of symptoms in individuals with long COVID up to one year," senior author Amitava Banerjee, MBBS, DPhil, of University College London, said in a news release from Sage, which publishes the journal. "We now add that three in five people with long COVID have impairment in at least one organ, and one in four have impairment in two or more organs, in some cases without symptoms."

Banerjee noted that many healthcare workers were previously healthy, but 19 of 172 of them still had symptoms at 1 year and were unable to work for a median of 6 months. "Impact on quality of life and time off work, particularly in healthcare workers, is a major concern for individuals, health systems and economies," he said.

Three in five people with long COVID have impairment in at least one organ, and one in four have impairment in two or more organs, in some cases without symptoms.

Amitava Banerjee, MBBS, DPhil

The researchers called for further studies on the links between symptoms, multi-organ impairment, and function in larger populations.

2 years in, 39% had impaired lung function

A team led by researchers in Wuhan, China, monitored 144 COVID-19 pneumonia patients released from the hospital from Jan 15 to Mar 10, 2020, who underwent chest computed tomography (CT) scanning at admission and still had symptoms 2 years later. Of all participants, 78% had severe COVID-19, 4.2% had been critically ill, and 19% had developed acute respiratory distress syndrome.

The investigators obtained chest CT scans and pulmonary function tests at 6 months (Jun 20 to Aug 31, 2020), 12 months (Dec 20, 2020, to Feb 3, 2021), and 2 years (Nov 16, 2021, to Jan 10, 2022). Median patient age was 60 years.

The research, published in Radiology, showed that, at 2-year CT scanning, 39% of patients still had fibrotic (23%) or nonfibrotic (16%) interstitial lung abnormalities (ILAs). The remaining 61% had complete resolution. ILAs are areas of lung damage, thickening, or scarring.

During the 2-year period, the incidence of ILAs continually declined, from 54% at 6 months to 42% at 12 months to 39% at 2 years, and lung function gradually improved. Relative to patients who had complete resolution, those who had ILAs had higher rates of respiratory symptoms (34% vs 15%) and abnormal lung diffusing capacity for carbon monoxide (DLco, 43% vs 20%).

"Interstitial lung abnormalities (ILAs) or fibrotic ILAs were associated with persistent respiratory symptoms and decreased diffusion function," the authors wrote.

At 2-year follow-up, the most common respiratory symptom was shortness of breath on exertion (14%). Mild or moderate pulmonary diffusion was seen in 38 of 129 (29%) of participants. Pulmonary diffusion is a measure of how well the air sacs in the lungs deliver oxygen to and draw carbon dioxide from the blood in the tiny blood vessels that surround them.

The researchers recommend that patients with lingering respiratory symptoms after COVID-19 see their physician to identify and manage pulmonary changes and functional impairment.