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

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

Embodied epiphanies: Creating translocal African identity in urban America

Building on recent advances in culture theory, African diasporan studies as well as approaches from African studies, ethnohistory, participatory and public interest anthropology, this is an ethnographic study of a Minneapolis non-profit organization\u27s effort to mobilize the region\u27s growing and diverse African American, African immigrant, and Afro-Caribbean immigrant residents to promote a transnational sense of a shared “African” culture. The study examines how a sense of place or community is created under conditions of the globalization of culture. ^ It describes how the non-profit positions the body as the primary locus of identity, thus displacing territory as the primary referent for perceiving and organizing African diasporan diversity. The study suggests that more attention be given to the role of the body as a site for both grounding the construction of new African diasporan identities and resisting dominant constructs of race, culture, and power relations. By problematizing the linkages between subjective experience and structural factors, an embodiment perspective on transnational identity formation may help to more clearly highlight the culturally creative ways people are responding to shifts in the global economy in their daily lives. It concludes that the non-profit sector is a key agent in managing the construction of transnational culture connecting multiple places in the African diaspora, and explores the ways such studies might contribute to anthropology\u27s attempt to understand intercontinental cultural phenomena.

Embodied epiphanies: Creating translocal African identity in urban America

Building on recent advances in culture theory, African diasporan studies as well as approaches from African studies, ethnohistory, participatory and public interest anthropology, this is an ethnographic study of a Minneapolis non-profit organization\u27s effort to mobilize the region\u27s growing and diverse African American, African immigrant, and Afro-Caribbean immigrant residents to promote a transnational sense of a shared “African” culture. The study examines how a sense of place or community is created under conditions of the globalization of culture. ^ It describes how the non-profit positions the body as the primary locus of identity, thus displacing territory as the primary referent for perceiving and organizing African diasporan diversity. The study suggests that more attention be given to the role of the body as a site for both grounding the construction of new African diasporan identities and resisting dominant constructs of race, culture, and power relations. By problematizing the linkages between subjective experience and structural factors, an embodiment perspective on transnational identity formation may help to more clearly highlight the culturally creative ways people are responding to shifts in the global economy in their daily lives. It concludes that the non-profit sector is a key agent in managing the construction of transnational culture connecting multiple places in the African diaspora, and explores the ways such studies might contribute to anthropology\u27s attempt to understand intercontinental cultural phenomena.