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In the largest study of its kind to date researchers have found that 1 in 8 people hospitalised with COVID-19 subsequently developed myocarditis, with the severity of infection most closely linked to the severity of long-COVID symptoms.
For the new prospective cohort study, led by the University of Glasgow in collaboration with NHS Greater Glasgow and Clyde (NHS GGC), and published in Nature Medicine, researchers investigated why some patients experienced long-term ill health after hospitalisation with COVID.
The findings come from the ongoing CISCO-19 (Cardiac Imaging in SARS Coronavirus disease-19) study, and followed 159 patients (mean age 55 years, 43% female) in real time after they had been hospitalised (between May 2020 and March 2021) with COVID-19. It compared their health to a control group of 27 individuals of similar age, sex, and medical background. Participants’ health was assessed with blood tests, and CT and MRI scans of multiple organs, including the heart, kidneys, and lungs, as well as measuring patients’ opinions on their ongoing health via questionnaires. Also assessed were survival, hospital readmission, and referral to outpatient clinics.
The authors explained that until now it has been speculated that “previous underlying health conditions may be linked to the severity of post-COVID long-term effects”. However, Colin Berry, principle investigator of the CISCO-19 study and professor of cardiology and imaging at the University of Glasgow, said: “One of the most important findings of the CISCO study is that it is the severity of a patient’s COVID-19 infection – not their underlying health conditions – that is most closely correlated with the severity of any ongoing health outcomes post discharge.”
COVID-19 – a Multi-System Disease
One in eight people who were hospitalised with COVID-19 were later diagnosed with myocarditis, said the authors, who also found that female sex was associated with myocarditis, which in turn was linked with “lower mental and physical wellbeing”. Long-COVID has been found to predominately affect females, and the researchers believe their findings provide some answers that could explain the physical limitations experienced by some female patients after being hospitalised with COVID-19.
Hospitalisation with COVID was also found to cause a number of long-term health problems, whilst “inflammation across the body” and damage to other organs, such as the kidneys, was also common, said the authors. Specifically, compared to the control group, at 28 to 60 days post-discharge, people with COVID-19 had “persisting evidence of cardio-renal involvement, systemic inflammation, and haemostasis pathway activation”.
These problems clustered in individuals pointed to the “overall severity of COVID-19 as being the main driver of illness”, the authors explained.
In addition, exercise capacity and health-related quality of life – including illness perception, anxiety, and depression – were markedly impaired initially after discharge from hospital and remained reduced one to two months after discharge, especially in patients with myocarditis.
During a period of 450 days after discharge from hospital, 1 in 7 patients died or were re-admitted to hospital, and 2 in 3 patients required NHS outpatient care.
Previously Healthy People Developed Severe Health Outcomes
Professor Berry emphasised that COVID-19 is a multi-system disease, and explained how the study shows that “injury on the heart, lungs and kidneys can be seen after initial hospitalisation in scans and blood tests”. He emphasised how these results “bridge a vital knowledge gap” between current understanding of post-COVID syndromes, such as long-COVID.
“We found that previously healthy patients, without any underlying health conditions, were suffering with severe health outcomes, including myocarditis, post hospitalisation,” he said. “The reasons for this are unclear, but it may be that a healthy person who is hospitalised with COVID-19 is likely to have a worse COVID infection than someone with underlying health conditions who is hospitalised.”
Prof David Crossman, chief scientist (Health) for Scotland at the time the study was funded, said: “This study provides important insight into the longer-term effects of COVID-19 infection, and will help inform approaches to treatment going forward.”
Patients in the study were enrolled during the first and second waves of the pandemic, until March 2021, and as a result they were mainly unvaccinated, highlighted the authors, who pointed out that their results reinforced the importance of avoiding severe COVID-19, such as through vaccination.
As part of the ongoing CISCO study further assessments of the patients will be made at the 18-month and 5-year marks of the study.
Créditos: Comité científico Covid