Research continues to find that the effects of COVID-19 may linger long after hospital discharge. In the latest study, researchers from in England found increased rates of organ damage, or multiorgan dysfunction, in a study of patients discharged from NHS hospitals after COVID-19.

Published in The BMJ, the risk for organ failure was not just seen in elderly patients but across all age-matched groups. They did observe increased rates of multi-organ dysfunction in non-white ethnic groups.

Although COVID-19 is most well-known for causing serious respiratory problems, it can affect other organs and systems within the body, including the heart, kidneys, and liver.

Included in the study were nearly 48,000 patients (average age 65, 55% men)  hospitalized with COVID-19 and discharged by August 31, 2020 matched to a pool of about 50 million people in England for personal characteristics and medical history from 10 years of electronic health records. Health records were then used to track rates of hospital readmission (or any admission for controls), death from any cause, and diagnoses of respiratory, cardiovascular, metabolic, kidney, and liver diseases until September  30, 2020.

The study revealed three major findings: First, hospital admission for COVID-19 was associated with an increased risk of readmission and death after discharge compared with control individuals over the same period. After 140 days of follow-up, about one-third of patients discharged after acute COVID-19 were readmitted (14,060 of 47,780); more than one in ten (5,875) died after discharge. These rates were four and eight times greater than individuals in the matched control group.

Second, rates of multi-organ dysfunction after discharge were raised in individuals with COVID-19 compared with those in the matched control group, suggesting extrapulmonary pathophysiology. Rates of respiratory disease, diabetes, and cardiovascular disease  were higher in COVID-19 patients—equivalent to 27, three, and 1.5 times greater than in matched controls. Diabetes and major adverse cardiovascular event were particularly common, whether incident or prevalent disease.

Third, the absolute risk of death, readmission, and multiorgan dysfunction after discharge was greater for individuals aged 70 or more than for those aged less than 70, and for individuals of white ethnic background than non-white individuals. However, the differences in relative rates of multi-organ dysfunction between patients with COVID-19 and matched controls were greater for individuals aged less than 70 than for those aged 70 or older, and in ethnic minority groups compared with the white population, with the largest differences seen for respiratory disease.

“Our results are consistent with proposed biological mechanisms associated with respiratory, cardiovascular, metabolic, renal, and hepatic involvement in COVID-19, extending the early evidence base on post-covid syndrome,” they write.

The authors caution that since this was an observational study, they cannot rule out the possibility that rates of diagnoses in general might have decreased indirectly because of the pandemic, particularly in people not admitted to hospital with COVID-19.

This research suggests that the long-term burden of COVID-19 on individuals might be substantial and at-times, debilitating. It also shines a light on the potential healthcare inequities in access and care for some non-white patients post-COVID-19.

“Our findings across organ systems suggest that the diagnosis, treatment, and prevention of post-covid syndrome requires integrated rather than organ or disease specific approaches,” they write. They suggest that integrated care pathways, effective in other diseases, such as chronic obstructive pulmonary disease, could be useful in the management of post-COVID-19 syndrome.