DISTINCT PHENOTYPES OF MULTI-ORGAN ABNORMALITIES IN LONG COVID AND TYPE 2 DIABETES IDENTIFIED BY MULTIPARAMETRIC MAGNETIC RESONANCE IMAGING

ABSTRACT

Background and Aims: Long COVID is a syndrome affecting patients infected with SARSCoV- 2 who show a broad spectrum of symptoms, such as fatigue and dyspnoea, persisting for several months after the initial infection. Patients with type 2 diabetes (T2D) have frequent co-morbidities affecting multiple organs. Both long COVID and T2D are multi-system conditions associated with abnormalities in organ structure and function. Therefore, multi-organ assessment is critical for monitoring organ health and early detection of co-morbidities in both conditions. This study aimed to define the prevalence of multi-organ abnormalities in patients with long COVID and patients with T2D with a rapid, non-contrast, magnetic resonance imaging (MRI) scan. Methods: Overall, 135 long COVID patients without diabetes were recruited in the COVERSCAN study (NCT04369807) at a median of 183 days since first COVID-19 symptoms. 135 patients with established T2D were recruited in the MODIFY study (NCT04114682). MRI data were acquired to derive abdominal organ-specific measures of size, fat deposition and fibroinflammation (CoverScan®, Perspectum Ltd.). Reference values of MRI metrics were based on 92 healthy volunteers and published literature. The prevalence of abnormalities for each measure was assessed using Fisher's exact tests in the whole cohort and in a subset of patients with obesity (BMI≥30 kg/m2). Results: The demographics of the three cohorts were as follows long COVID median age 54 yrs [interquartile interval 46–60], 56% male, BMI 27 kg/m2 [26–31];T2D 62 yrs [54–70], 59% male, BMI 32 kg/m2 [28–35], median T2D duration 11 yrs;healthy volunteers 44 yrs [32–53], 66% male, BMI 23 kg/m2 [21–25]). There was a high prevalence of abdominal organ abnormality in both long COVID and T2D patient groups (Figure, left), including increased fat deposition (steatosis) in the liver, pancreas, and kidney (Figure, right). 35% of patients with T2D had clustering of abnormalities involving at least 2 organs, compared to 23% in long COVID. Abnormalities affecting the liver (steatosis, fibroinflammation and hepatomegaly) and renomegaly were more common in T2D than in long COVID (p<0.001). Considering only patients with obesity, liver fibroinflammation, hepatomegaly, and renomegaly remained significantly more prevalent in T2D than in long COVID (p<0.05). Conclusion: Long COVID and established T2D have distinct profiles of multi-organ impairment, more prevalent with obesity but not fully explained by it. Multi-organ MRI assessment can enrich the current blunt assessment of multi-system/multi-organ abnormalities in diverse disease states to inform earlier intervention and treatments. (Figure Presented) Left Prevalence (%) of organ abnormalities in long COVID patients (black numbers) and T2D patients (grey numbers) (liver, pink;pancreas, yellow;kidney, green;spleen, blue). Right Prevalence of organ steatosis, fibroinflammation and increased organ size by patient group. Colour per organ as in left figure.