Persisting symptoms correlated with Worgan damage, especially liver steatosis.

What explains the symptoms in people with debilitating lingering symptoms after ‘recovery’ from acute COVID-19 – people with ‘long COVID’? A UK team followed 331 people who had some evidence of organ damage during acute SARS- CoV-2 infection (as determined by haematology or chemistry findings or magnetic resonance imaging [MRI]) with questionnaires, repeat laboratory testing and repeat MRI after initial infection.

At six and 12 months, respectively, cognitive dysfunction was reported by 48% and 38%, and extreme breathlessness was reported by 38% and 30%. On multiorgan, whole-body MRI testing, evidence of damage to one or more organ was found in 69% of people at six months and in 59% at 12 months. Damage to two or more organs was found in 29% and 27%. Organ damage was more common in those with persisting symptoms than in those without. The most common abnormalities were liver steatosis, kidney fibro-inflammation and splenomegaly. However, the only organ abnormality that correlated strongly with persisting symptoms was liver steatosis.

Comment: This prospective study provides MRI imaging evidence of structural damage to many organs at least six to 12 months after acute infection; this damage is more common in postacute COVID-19 patients with persisting symptoms than in those who become asymptomatic. However, whether these MRI abnormalities indicate impaired function of these organs, and whether the organ damage explains any of the persisting symptoms, remains to be determined. On balance, the findings suggest long COVID might well have an ‘organic’ basis.

Anthony L. Komaroff, MD, Professor of Medicine, Harvard Medical School, Boston, USA.

Dennis A et al. Multi-organ impairment and long COVID: a 1-year prospective, longitudinal cohort study. J R Soc Med 2023; 116: 97-112.