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

Authors: 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, Raminder Aul, Karla L. Miller, Peter Jezzard, Stephen M. Smith, Thomas E. Nichols, Gerry P McCann, Rachael A Evans, Louise V. Wain, Christopher E. Brightling, Stefan Neubauer, J. Kenneth Baillie, Alison Shaw, Brigid Hairsine, Claire Kurasz, Helen Henson, Lisa Armstrong, L Shenton, Hannah Dobson, Amanda Dell, Alice Lucey, Andrea Price, A. Storrie, Christopher Pennington, Claire Price, Georgia Mallison, Gemma Willis, H Nassa, J Haworth, Michaela Hoare, N Hawkings, Sara Fairbairn, Susan Young, S Walker, Ian Jarrold, Amy Sanderson, C David, K Chong-James, O Zongo, W Y James, Adrian R. Martineau, Bernie King, Chérie Armour, D McAulay, Eugene O. Major, J McGinness, Lorcan McGarvey, N Magee, Roisin Stone, S Drain, Tom Craig, A Bolger, Ahmed M. Haggar, Arwel Lloyd, Christian P Subbe, Daniel Menzies, David Southern, E McIvor, K. Roberts, R Manley, Victoria Whitehead, W Saxon, Anda Bularga, Nicholas L. Mills, H El-Taweel, Joy Dawson, Leanne J. Robinson, Dinesh Saralaya, Karen Regan, Kim Storton, Lucy Brear, S Amoils, Areti Bermperi, Anne Elmer, Carla Ribeiro, Isabel Cf da Cruz, Jessica Taylor, J Worsley, K Dempsey, Lea C. Watson, Sherly Jose, Stefan J. Marciniak, Miles Parkes, Alison McQueen, Catherine Oliver, Jenny Williams, Kerry Paradowski, Lauren Broad, Lucy Knibbs, Matthew Haynes, Ramsey Sabit, Lea Milligan, Claire Sampson, Alyson Hancock, C Evenden, Ceri Lynch, Kia Hancock, L Roche, M. Agnes van Rees, Natalie Stroud, T Thomas-Woods, Simon Heller, Elizabeth J. Robertson, Bob Young, Helen Wassall, Marta Babores, Maureen Holland, Natalie Keenan, S Shashaa, Carly Price, Eva Beranová, Hazel Ramos, Heather Weston, Joanne Deery, Liam Austin, Reanne Solly, Sharon Turney, Tracey Cosier, Tracy Hazelton, Markus Ralser, Ann Wilson, Lorraine Pearce, S. Pugmire, Wendy Stoker, W McCormick, Amy Dewar, Gill Arbane, Georgios Kaltsakas, Helen Kerslake, J Rossdale, Karen Bisnauthsing, L A Aguilar Jimenez, Leonardo Martín Vásquez Martínez, Marlies Ostermann, M M Magtoto, Nicholas Hart, Philip Marino, Sarah Betts, Teresa S Solano, Ava Maria Arias, A Prabhu, Annabel Reed, Caroline Wrey Brown, Denise Griffin, Emily Bevan, Jane Martin, J. Owen, Maria Alvarez Corral, Nick Williams, Sheila Payne, Will Storrar, A Layton, Cathy Lawson, E. N. Clare Mills, James Featherstone, Lorraine Stephenson, Tracy Burdett, Y Ellis, A Richards, Clinton B. Wright, Dominic L. Sykes, Khara Croswaite Brindle, Katie Drury, Luke Holdsworth, Michael G. Crooks, Paul Atkin, Rachel Flockton, Susannah Thackray-Nocera, Abdelrahman Mohamed, Abigail Taylor, Emma Perkins, Gavin J. S. Ross, Heather McGuinness, Helen Tench, Janet Phipps, Ronda Loosley, Rebecca Wolf-Roberts, S Coetzee, Zohra Omar, Alexandra Ross, Bethany Card, Caitlin Carr, Clara King, C Wood, Debra Copeland, E Calvelo, Edwin R. Chilvers, Emily Russell, Hussain Gordon, J Nunag, J Schronce, Katherine March, Katherine Samuel, L. Burden, Lynsey Evison, L McLeavey, L. Orriss-Dib, Lawrence Tarusan, Myril Mariveles, Maura Roy, Noura Mohamed, Neil Simpson, Najira Yasmin, Paul Cullinan, Patrick Daly, Sulaimaan Haq, S Moriera, T Fayzan, Unber Munawar, U Nwanguma, Anne Lingford‐Hughes, Danny Altmann, D Johnston, J Mitchell, Jonathan Valabhji, L Price, Philip L. Molyneaux, Ryan S. Thwaites, S Walsh, Adam Frankel, Liz Lightstone, M Wilkins, Michelle Willicombe, Stephen P. McAdoo, Rhian M. Touyz, Anne-Marie Guerdette, Katie Warwick, Melanie Hewitt, Raghunath Reddy, Sonia White, Anne McMahon, Amy Hoare, Abigail Knighton, Albert Ramos, Amelie Te, Caroline J. Jolley, F Speranza, H Assefa-Kebede, Ida Peralta, Jonathon Breeze, K Shevket, Natassia Powell, Oluwaseun Adeyemi, P Dulawan, Rita Adrego, Suzanne Byrne, Sheetal Patale, Adrian Hayday, Michael H. Malim, Carmine M. Pariante, Claire C. Sharpe, Julie Whitney, Kate Bramham, Khalida Ismail, Simon Wessely, Timothy R. 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Stensel, Lisa Bishop, K McIvor, Pilar Rivera‐Ortega, B Al-Sheklly, Cristina Avram, David Faluyi, J Blaikely, Karen Piper Hanley, Kavita Radhakrishnan, Mamta Buch, Neil A. Hanley, Natasha Odell, R Osbourne, Sue Stockdale, Tim Felton, T Gorsuch, Tracy Hussell, Zunaira Kausar, T Kabir, R. Hamish McAllister‐Williams, Stella‐Maria Paddick, David J. Burn, A Ayoub, Alan Greenhalgh, Avan Aihie Sayer, Alison L. Young, D Price, G Burns, Guy MacGowan, Helen L. Fisher, H Tedd, Jennifer Simpson, Kasim Jiwa, Miles D. Witham, Philip J. Hogarth, Sophie West, S. Wright, Michael McMahon, Paula Neill, Andrew Dougherty, A Morrow, David Anderson, D Grieve, Hannah Bayes, K Fallon, Kenneth Mangion, L Gilmour, N Basu, Robert Sykes, Colin Berry, Iain B. McInnes, A Donaldson, Elizabeth K. Sage, Fiona Barrett, B Welsh, Murdina Bell, Jackie Quigley, Karen Leitch, L Macliver, Manish Patel, R Hamil, Andrew Deans, James Furniss, Sara Clohisey, Anne Elliott, A R Solstice, C Deas, Caroline Tee, David Connell, Debbie Sutherland, J George, Sarhan Mohammed, J Bunker, Katie Holmes, A Dipper, Anna Morley, David Arnold, Huzaifa Adamali, H Welch, Leigh Morrison, Louise Stadon, Nick Maskell, Shaney Barratt, Sarah Dunn, Samuel Waterson, Bhagy Jayaraman, Tessa Light, Nicholas M. Selby, Akram A. Hosseini, Karen Shaw, Paula Almeida, Robert Needham, Andrew K Thomas, Laura Matthews, Ayushman Gupta, A. Nikolaidis, Cathérine Dupont, James Bonnington, M Chrystal, Paul L. Greenhaff, S Linford, S. Prosper, Wooyoung Jang, Asma Alamoudi, Angela Bloss, Clare Megson, Debby Nicoll, Emily Fraser, Edmund Pacpaco, F Conneh, Graham S. Ogg, H McShane, Ivan Koychev, Jin Chen, John Pimm, Mark Ainsworth, M Pavlides, Michael Sharpe, May Havinden-Williams, Nayia Petousi, Nick P. 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Jones, Gareth E. Jones, Heather Jones, Don Jones, Ffyon Davies, Ellie Davies, Kim Davies, Gareth Davies, Gwyneth A. Davies, Kirsten Howard, Julie Porter, J Rowland, A Rowland, Kathryn Scott, Suver Singh, Claire Singh, S Thomas, Caradog Thomas, Victoria Lewis, J. R. Lewis, Daniel J. Lewis, Phillippa Harrison, C Francis, Rebecca Francis, Rachel Ann Hughes, Joan Hughes, Alun D. Hughes, T Thompson, Sophie Kelly, D Smith, Darren Smith, Andrew Smith, Jacqui Smith, Laurie Smith, Susan Smith, Teriann Evans, Ranuromanana I Evans, D Evans, Rachael A Evans, Helen Evans, Jonathan Evans - The Lancet 2023 cited by 54

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.