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Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study

C-MORE/PHOSP-COVID Collaborative Group; Raman, Betty; McCracken, Celeste; Cassar, Mark P.; Moss, Alastair J.; Finnigan, Lucy; Samat, Azlan A.; Ogbole, Godwin; Tunnicliffe, Elizabeth M.; Alfaro-Almagro, Fidel; Menke, Ricarda; Xie, Cheng; Gleeson, Fergus; Lukaschuk, Elena; Lamlum, Hanan; McGlynn, Kevin; Cox, Eleanor; Francis, Susan

Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study Thumbnail


Authors

C-MORE/PHOSP-COVID Collaborative Group

Betty Raman

Celeste McCracken

Mark P. Cassar

Alastair J. Moss

Lucy Finnigan

Azlan A. Samat

Godwin Ogbole

Elizabeth M. Tunnicliffe

Fidel Alfaro-Almagro

Ricarda Menke

Cheng Xie

Fergus Gleeson

Elena Lukaschuk

Hanan Lamlum

Kevin McGlynn

ELEANOR COX ELEANOR.COX@NOTTINGHAM.AC.UK
Senior Research Fellow



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<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<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<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 >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.

Citation

C-MORE/PHOSP-COVID Collaborative Group, Raman, B., McCracken, C., Cassar, M. P., Moss, A. J., Finnigan, L., …Francis, S. (2023). Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study. Lancet Respiratory Medicine, 11(11), 1003-1019. https://doi.org/10.1016/S2213-2600%2823%2900262-X

Journal Article Type Article
Acceptance Date Jun 30, 2023
Online Publication Date Sep 22, 2023
Publication Date 2023-11
Deposit Date Sep 18, 2023
Publicly Available Date Sep 22, 2023
Journal Lancet Respiratory Medicine
Print ISSN 2213-2600
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 11
Issue 11
Pages 1003-1019
DOI https://doi.org/10.1016/S2213-2600%2823%2900262-X
Public URL https://nottingham-repository.worktribe.com/output/24575839
Publisher URL https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(23)00262-X/fulltext

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