Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study
Betty Raman, Celeste McCracken, Mark Philip Cassar, Alastair J. Moss, Lucy Finnigan, Azlan Helmy Abd Samat, Godwin Ogbole, Elizabeth M. Tunnicliffe, Fidel Alfaro‐Almagro, Ricarda Menke, Cheng Xie, Fergus Gleeson, Elena Lukaschuk, Hanan Lamlum, Kevin McGlynn, Iulia A. Popescu, Zeena‐Britt Sanders, Laura Saunders, Stefan K. Piechnik, Vanessa M. Ferreira, Chrysovalantou Nikolaidou, Najib M. Rahman, Ling‐Pei Ho, Victoria Harris, Aarti Shikotra, Amisha Singapuri, Paul Pfeffer, Charlotte Manisty, Onn Min Kon, Mark Beggs, Declan P. O’Regan, Jonathan Fuld, Jonathan Weir‐McCall, Dhruv Parekh, Rick Steeds, Krisnah Poinasamy, Dan J Cuthbertson, Graham J. Kemp, Malcolm G. Semple, Alex Horsley, Chris Miller, Caitlin E. O’Brien, Ajay M. Shah, Amedeo Chiribiri, Olivia C. Leavy, Matthew Richardson, Omer Elneima, Hamish McAuley, Marco Sereno, Ruth Saunders, Linzy Houchen‐Wolloff, Neil Greening, Charlotte E. Bolton, Jeremy Brown, Gourab Choudhury, Nawar Diar Bakerly, Nicholas Easom, Carlos Echevarria, Michael Marks, John R. Hurst, Mark G. Jones, Dan Wootton, Trudie Chalder, Melanie J. Davies, Anthony De Soyza, John Geddes, William Greenhalf, Luke Howard, Joseph Jacob, William D‐C Man, Peter Openshaw, Joanna C. Porter, Matthew Rowland, J. T. Scott, Sally Singh, David Thomas, Mark Toshner, Keir Lewis, Liam G. Heaney, Ewen M. Harrison, Steven Kerr, Annemarie B Docherty, Nazir Lone, Jennifer K Quint, Aziz Sheikh, Bang Zheng, Gísli Jenkins, Eleanor Cox, Susan Francis, Mark Halling‐Brown, James D. Chalmers, John P. Greenwood, Sven Plein, Paul Hughes, A. A. Roger Thompson, Sarah Rowland‐Jones, James M Wild, Matthew Kelly, Thomas A. Treibel, Steven Bandula
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: =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. FUNDING: UK Research and Innovation and National Institute for Health Research.