@article{Baillie_J-2023_148428,
title = {Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study},
author = {Baillie, J. and Lone, N. and Jones, S. and Shaw, A. and Hairsine, B. and Kurasz, C. and Henson, H. and Armstrong, L. and Shenton, L. and Dobson, H. and Dell, A. and Lucey, A. and Price, A. and Storrie, A. and Pennington, C. and Price, C. and Mallison, G. and Willis, G. and Nassa, H. and Haworth, J. and Hoare, M. and Hawkings, N. and Fairbairn, S. and Young, S. and Lewis, V. and Poinasamy, K. and Walker, S. and Jarrold, I. and Sanderson, A. and David, C. and Chong-James, K. and Zongo, O. and Pfeffer, P. and James, W. and Martineau, A. and Manisty, C. and King, B. and Armour, C. and McAuley, D. and Major, E. and McGinness, J. and Heaney, L. and McGarvey, L. and Magee, N. and Stone, R. and Drain, S. and Craig, T. and Brown, V. and Bolger, A. and Haggar, A. and Lloyd, A. and Subbe, C. and Menzies, D. and Southern, D. and McIvor, E. and Davies, F. and Lewis, J. and Roberts, K. and Manley, R. and Whitehead, V. and Saxon, W. and Bularga, A. and Mills, N. and El-Taweel, H. and Dawson, J. and Robinson, L. and Saralaya, D. and Regan, K. and Storton, K. and Brear, L. and Amoils, S. and Bermperi, A. and Elmer, A. and Ribeiro, C. and Jones, H. and Cruz, I. and Fuld, J. and Taylor, J. and Worsley, J. and Dempsey, K. and Watson, L. and Toshner, M. and Jose, S. and Marciniak, S. and Parkes, M. and McQueen, A. and Oliver, C. and Williams, J. and Paradowski, K. and Broad, L. and Jones, L. and Knibbs, L. and Haynes, M. and Sabit, R. and Evans, T. and Jones, I. and Milligan, L. and Sampson, C. and Harris, E. and Hancock, A. and Evenden, C. and Lynch, C. and Davies, E. and Hancock, K. and Roche, L. and Rees, M. and Stroud, N. and Thomas-Woods, T. and Heller, S. and Chalder, T. and Shah, K. and Robertson, E. and Young, B. and Wassall, H. and Babores, M. and Holland, M. and Keenan, N. and Shashaa, S. and Price, C. and Beranova, E. and Ramos, H. and Weston, H. and Deery, J. and Austin, L. and Solly, R. and Turney, S. and Cosier, T. and Hazelton, T. and Ralser, M. and Wilson, A. and Pearce, L. and Pugmire, S. and Stoker, W. and McCormick, W. and Dewar, A. and Arbane, G. and Kaltsakas, G. and Kerslake, H. and Rossdale, J. and Bisnauthsing, K. and Aguilar Jimenez, L. and Martinez, L. and Ostermann, M. and Magtoto, M. and Hart, N. and Marino, P. and Betts, S. and Solano, T. and Arias, A. and Prabhu, A. and Reed, A. and Wrey Brown, C. and Griffin, D. and Bevan, E. and Martin, J. and Owen, J. and Alvarez Corral, M. and Williams, N. and Payne, S. and Storrar, W. and Layton, A. and Lawson, C. and Mills, C. and Featherstone, J. and Stephenson, L. and Burdett, T. and Ellis, Y. and Richards, A. and Wright, C. and Sykes, D. and Brindle, K. and Drury, K. and Holdsworth, L. and Crooks, M. and Easom, N. and Atkin, P. and Flockton, R. and Thackray-Nocera, S. and Mohamed, A. and Taylor, A. and Perkins, E. and Ross, G. and McGuinness, H. and Tench, H. and Phipps, J. and Davies, K. and O'Brien, L. and Hughes, R. and Loosley, R. and Wolf-Roberts, R. and Coetzee, S. 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and Reddington, A. and Wight, A. and Bailey, L. and Ashish, A. and Robinson, E. and Cooper, J. and Broadley, A. and Turnbull, A. and Brookes, C. and Sarginson, C. and Ionita, D. and Redfearn, H. and Elliott, K. and Howard, K. and Barman, L. and Griffiths, L. and Guy, Z. and Gill, R. and Nathu, R.},
month = {sep},
year = {2023},
abstract = {Introduction: The multiorgan impact of moderate to severe coronavirus infections in the post-acute phase is still poorly understood. We aimed to evaluate the excess burden of multiorgan abnormalities after hospitalisation with COVID-19, evaluate their determinants, and explore associations with patient-related outcome measures. Methods: In a prospective, UK-wide, multicentre MRI follow-up study (C-MORE), adults (aged ≥18 years) discharged from hospital following COVID-19 who were included in Tier 2 of the Post-hospitalisation COVID-19 study (PHOSP-COVID) and contemporary controls with no evidence of previous COVID-19 (SARS-CoV-2 nucleocapsid antibody negative) underwent multiorgan MRI (lungs, heart, brain, liver, and kidneys) with quantitative and qualitative assessment of images and clinical adjudication when relevant. Individuals with end-stage renal failure or contraindications to MRI were excluded. Participants also underwent detailed recording of symptoms, and physiological and biochemical tests. The primary outcome was the excess burden of multiorgan abnormalities (two or more organs) relative to controls, with further adjustments for potential confounders. The C-MORE study is ongoing and is registered with ClinicalTrials.gov, NCT04510025. Findings: Of 2710 participants in Tier 2 of PHOSP-COVID, 531 were recruited across 13 UK-wide C-MORE sites. After exclusions, 259 C-MORE patients (mean age 57 years [SD 12]; 158 [61%] male and 101 [39%] female) who were discharged from hospital with PCR-confirmed or clinically diagnosed COVID-19 between March 1, 2020, and Nov 1, 2021, and 52 non-COVID-19 controls from the community (mean age 49 years [SD 14]; 30 [58%] male and 22 [42%] female) were included in the analysis. Patients were assessed at a median of 5·0 months (IQR 4·2–6·3) after hospital discharge. Compared with non-COVID-19 controls, patients were older, living with more obesity, and had more comorbidities. Multiorgan abnormalities on MRI were more frequent in patients than in controls (157 [61%] of 259 vs 14 [27%] of 52; p&lt;0·0001) and independently associated with COVID-19 status (odds ratio [OR] 2·9 [95% CI 1·5–5·8]; padjusted=0·0023) after adjusting for relevant confounders. Compared with controls, patients were more likely to have MRI evidence of lung abnormalities (p=0·0001; parenchymal abnormalities), brain abnormalities (p&lt;0·0001; more white matter hyperintensities and regional brain volume reduction), and kidney abnormalities (p=0·014; lower medullary T1 and loss of corticomedullary differentiation), whereas cardiac and liver MRI abnormalities were similar between patients and controls. Patients with multiorgan abnormalities were older (difference in mean age 7 years [95% CI 4–10]; mean age of 59·8 years [SD 11·7] with multiorgan abnormalities vs mean age of 52·8 years [11·9] without multiorgan abnormalities; p&lt;0·0001), more likely to have three or more comorbidities (OR 2·47 [1·32–4·82]; padjusted=0·0059), and more likely to have a more severe acute infection (acute CRP &gt;5mg/L, OR 3·55 [1·23–11·88]; padjusted=0·025) than those without multiorgan abnormalities. Presence of lung MRI abnormalities was associated with a two-fold higher risk of chest tightness, and multiorgan MRI abnormalities were associated with severe and very severe persistent physical and mental health impairment (PHOSP-COVID symptom clusters) after hospitalisation. Interpretation: After hospitalisation for COVID-19, people are at risk of multiorgan abnormalities in the medium term. Our findings emphasise the need for proactive multidisciplinary care pathways, with the potential for imaging to guide surveillance frequency and therapeutic stratification.},
pages = {1003-1019},
volume = {11},
issue = {11},
journal = {The Lancet Respiratory Medicine},
publisher = {Elsevier},
url = {http://dx.doi.org/10.1016/S2213-2600(23)00262-X},
}
