Frequency Of Multi-organ Involvement In Athletes Assessed 10-28 Days After Onset Of SARS-CoV-2 Infection

Abstract

SARS-CoV-2 infection can affect multiple organ systems. The frequency of multi-organ involvement that influences clinical return-to-play (RTP) decisions in athletes with a recent COVID-19 infection is not well documented. PURPOSE: To determine the frequency (%) of multi-organ/system involvement (symptoms, clinical signs and abnormal special investigations) that influences RTP decisions in athletes with a recent SARS-CoV-2 infection. METHODS: 95 athletes (25.0 ± 7.1 years) with confirmed SARS-CoV-2 infection (polymerase chain reaction or antigen testing) attended a SARS-CoV-2 clinic for athletes to determine safe RTP. Participants were assessed 10-28 days after onset of SARS-CoV-2 infection (or + ve test if asymptomatic; n = 4). 96 athlete assessments (including 1 assessment of a participant with a repeat infection >8 weeks after initial infection) included current symptoms, physical examination and laboratory tests: resting and submaximal exercise electrocardiogram (EKG), resting and post-exercise pulmonary function tests (PFT), echocardiogram (Echo), cardiac magnetic resonance (CMR) with late gadolinium enhancement, total white cell count (WCC), neutrophil and lymphocyte counts, C-Reactive protein (CRP), high sensitivity troponin-T (hs-trop T), aspartate transaminases (AST), alanine transaminases (ALT) and creatine kinase (CK). RESULTS: 29 athletes (30%) had no abnormal findings, while 67 (70%) had evidence of organ involvement [1 organ system = 40 (42%), 2 organ systems = 19 (20%) and > 3 organ systems = 8 (8%)]. The most common systems affected were cardiovascular (n = 32; 33%) [abnormal resting EKG = 3 (3%), submaximal exercise EKG = 9 (9%), echo = 2 (2%) or CMR = 21 (22%)], nervous system (excessive tiredness = 23; 24%), digestive tract (elevated AST/ALT = 21; 22%). Less frequently affected were muscle (increased CK = 10; 10%), immune system (abnormal WCC/ CPR = 10; 10%), ocular (n = 3; 3%) and skin (n = 2; 2%). CONCLUSION: Clinical and laboratory evidence of multi-organ system involvement that influences RTP decisions in athletes 10-28 days after SARS-CoV-2 infection is common. Organ systems mostly affected are the cardiovascular and nervous system (excessive fatigue).