Organ issues linked with 'long COVID-19'

Long-term COVID-19 symptoms include fatigue, "brain fog," and, according to a study published yesterday in BMJ, organ problems like respiratory or heart disease.

Compared with the general population, patients who were discharged from COVID-related hospitalization were six times more likely to develop respiratory disease and three times more likely to develop a major cardiovascular disease. They also had a 29.4% rate of readmission and a 12.2% death rate).

These results are in line with other recent studies, according to the researchers.

After discharge, COVID lingers

The researchers analyzed data on 47,780 people—90.8% of all COVID-hospitalized patients in the United Kingdom who were discharged by Aug 31, 2020, and had a recorded birth date and sex.

The average patient age was 64.5 years, and 54.9% were men. About 1 in 10 (9.9%) had required intensive care. Within an average of 140 days post-discharge, 29.4% of the cohort was readmitted and 12.2% died.

Compared with a matched cohort made up of the general population, those hospitalized for COVID-19 were 3.5 times and 7.7 times more likely to be readmitted to the hospital or die, respectively (95% confidence interval [CI], 3.4 to 3.6 and 7.2 to 8.3). COVID patients were also more likely to experience respiratory disease (6.0 greater odds; 95% CI, 5.7 to 6.2; 29.6% of cohort), including the onset of new respiratory disease (27.3 greater odds; 95% CI, 24.0 to 31.2; 12.7% of cohort).

The researchers also noted diabetes (4.9%), major adverse cardiovascular events (4.8%), chronic kidney disease (1.5%), and chronic liver disease (0.3%) among the COVID-19 patients during follow-up. The likelihood of these outcomes was, respectively, 3.0, 2.8, 1.9, and 1.5 times greater than that of the control group.

"Individuals discharged from hospital after covid-19 had increased rates of multiorgan dysfunction compared with the expected risk in the general population. The increase in risk was not confined to the elderly and was not uniform across ethnicities," the researchers write. They add that patients with long-term health problems require an integrated, not disease- or organ-specific, approach.

"Organ dysfunction in hospital patients represents only part of the problem," the authors conclude. "Other symptomatic manifestations of post-covid syndrome in individuals not requiring admission to hospital have the potential to be debilitating for patients, placing a considerable burden on healthcare resources, particularly in primary care."

"The importance of long term chronic conditions such as diabetes and cardiovascular disease is underlined, not only as risk factors for hospitalisation and mortality from covid-19, but also as medium- to long-term complications of infection in hospitalised individuals after recovery," writes senior author Amitava Banerjee, DPhil, MPH, MA MBBCh, in a corresponding BMJ blog post.

The average time for follow-up was slightly longer for the control group (153 days). The researchers factored in sex, age, ethnicity, region, deprivation, comorbidities, and conditions such as smoking status and body mass.

Demographics linked with COVID outcomes

Similar to previous COVID-19 studies, the researchers found that COVID patients who were 70 years or older had a greater absolute risk of death, hospital readmission, and multiorgan dysfunction after discharge compared with younger patients.

The greatest relative risk differences between COVID-19 and controls were seen in death and respiratory disease. Those younger than 70 had a rate ratio (RR) of 14.1 for death compared with controls, while those 70 and above had a 7.8 RR. With respiratory disease, the RR was 10.5 in the younger group and 4.6 in those 70 and older.

Ethnicity was also independently associated with a large difference in rate ratios: 11.4 for non-White individuals (95% CI, 9.8 to 13.3) versus 5.2 for those who were White (95% CI, 5.0 to 5.5).

"In addition to the respiratory, cardiac, renal, and endocrine pathology shown by this population level study and others, clusters of patients seem to have features of immunological dysfunction, dysautonomia, mast cell dysfunction, and neurological diagnoses," write Manoj Sivan, MD, MBBS, FRCP; Clare Rayner; and Brendan Delaney, BM BCh, MSC, in a BMJ editorial.

The UK National Health Service (NHS) usually operates on a single-specialty referral model, but because of the cross-effects of long COVID, perhaps that should change, according to the editorial authors. "Pathways must focus on capturing patients' multisystem symptoms and rehabilitation needs and provide individualised management programmes that aim for medical management and a return to normal functioning, including work," they conclude.

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