19 October 2020
Initial findings from a study looking at the longer-term impact of COVID-19 has found that a large proportion COVID-19 patients discharged from hospital were still experiencing symptoms of breathlessness, fatigue, anxiety and depression two to three months after contracting the virus.
The University of Oxford scientists carrying out the C-MORE study have also detected abnormalities on MRI in multiple organs and believe that persistent or chronic inflammation may be an underlying factor for these changes among COVID-19 survivors.
The study, whose initial findings were published online as a pre-print on MedRxiv, is being led by researchers from the university’s Radcliffe Department of Medicine and is supported by the NIHR Oxford Biomedical Research Centre (BRC) and the NIHR Oxford Health BRC, as well as the BHF Oxford Centre for Research Excellence and Wellcome Trust. The C-MORE study is also part of the national PHOSP-COVID platform, led by the University of Leicester, which is investigating the long-term effects of COVID-19 on hospitalised patients.
The study took 58 patients with moderate to severe laboratory-confirmed COVID-19, who had been admitted for treatment at the Oxford University Hospitals (OUH) NHS Foundation Trust between March and May 2020. They also recruited 30 uninfected controls from the community, group-matched for age, sex, body mass index and risk factors such as smoking, diabetes and hypertension.
The participants underwent magnetic resonance imaging (MRI) of their brain, lungs, heart, liver and kidneys; spirometry to test their lung function; a six-minute walk test; cardiopulmonary exercise test (CPET), as well as assessments of their quality of life, cognitive and mental health.
The C-MORE study found that two to three months after the onset of the disease, 64% of patients experienced persistent breathlessness and 55% complained of significant fatigue.
On MRI, tissue signal abnormalities were seen in the lungs of 60% of the COVID-19 patients, in the kidneys of 29%, in the hearts of 26%, and the livers of 10%. Organ abnormalities were seen even in patients who had not been critically ill when admitted.
MRI also detected tissue changes in parts of the brain, and patients demonstrated impaired cognitive performance. Their ability to sustain exercise was also significantly reduced, although this was due to a combination of fatigue and lung abnormalities.
The study also found that patients were more likely to report symptoms of anxiety and depression, and a significant impairment in their quality of life compared to the controls.
Dr Betty Raman, who is leading the C-MORE study along with Professor Stefan Neubauer, said: “Our study assessed patients recovering from COVID-19 following hospitalisation, two to three months from disease onset. Whilst we have found abnormalities in multiple organs, it is difficult to know how much of this was pre-existing and how much has been caused by COVID-19.
“However, it is interesting to see that the abnormalities detected on MRI and exercise capacity in patients strongly correlated with serum markers of inflammation. This suggests a potential link between chronic inflammation and ongoing organ damage among survivors.”
Dr Raman, a Clinical Research Fellow at the Radcliffe Department of Medicine, added: “These findings underscore the need to further explore the physiological processes associated with COVID-19 and to develop a holistic, integrated model of clinical care for our patients after they have been discharged from hospital.
“We would like to thank all our patients and their families who have taken part in this study. In helping us to better understand the effects of this new disease, they have made an important contribution in helping others who have contracted – and who will contract – the virus.”
Notes to Editors
The pre-print of the paper can be found here: https://medrxiv.org/cgi/content/short/2020.10.15.20205054v1
For interview requests, contact Dr Betty Ramen, email@example.com
The PHOSP-COVID study is jointly funded by UK Research and Innovation (UKRI) and the National Institute for Health Research (NIHR). This study is one of a number of COVID-19 studies that have been given urgent public health research status by the Department of Health and Social Care.
Led by the University of Leicester and supported by the National Institute for Health Research (NIHR) Leicester Biomedical Research Centre (a partnership between the University Hospitals of Leicester NHS Trust, the University of Leicester and Loughborough University), the PHOSP-COVID study draws on expertise from a consortium of leading researchers and clinicians from across the UK to assess the impact of COVID-19 on patient health and their recovery.
About the University of Oxford
Oxford University has been placed number 1 in the Times Higher Education World University Rankings for the fifth year running, and at the heart of this success is our ground-breaking research and innovation.
Oxford is world-famous for research excellence and home to some of the most talented people from across the globe. Our work helps the lives of millions, solving real-world problems through a huge network of partnerships and collaborations. The breadth and interdisciplinary nature of our research sparks imaginative and inventive insights and solutions.
The Radcliffe Department of Medicine is one of the two main departments of medicine at the University of Oxford, and aims to tackle some of the world’s biggest health challenges by integrating innovative basic biology with cutting edge clinical research. The RDM has internationally renowned programmes in a range of areas including cardiovascular sciences, diabetes and endocrinology, immunology, haematology and pathology. https://www.rdm.ox.ac.uk/
About the NIHR Oxford Biomedical Research Centre
The National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC) is based at the Oxford University Hospitals NHS Foundation Trust and run in partnership with the University of Oxford.
The NIHR is the nation's largest funder of health and care research. The NIHR:
- Funds, supports and delivers high quality research that benefits the NHS, public health and social care
- Engages and involves patients, carers and the public in order to improve the reach, quality and impact of research
- Attracts, trains and supports the best researchers to tackle the complex health and care challenges of the future
- Invests in world-class infrastructure and a skilled delivery workforce to translate discoveries into improved treatments and services
- Partners with other public funders, charities and industry to maximise the value of research to patients and the economy
The NIHR was established in 2006 to improve the health and wealth of the nation through research, and is funded by the Department of Health and Social Care. In addition to its national role, the NIHR supports applied health research for the direct and primary benefit of people in low- and middle-income countries, using UK aid from the UK government.
This work uses data provided by patients and collected by the NHS as part of their care and support and would not have been possible without access to this data. The NIHR recognises and values the role of patient data, securely accessed and stored, both in underpinning and leading to improvements in research and care. www.nihr.ac.uk/patientdata