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COVID-19 postacute care major organ damage: a systematic review
Nancy Greer1, Bradley Bart2,3, Charles J Billington2,4
1Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA nancy.greer@va.gov.
Insights
Major organ damage, including cardiac, pulmonary, and kidney issues, is common after COVID-19 hospitalization and appears higher than in control groups. Further research is needed to confirm these findings and address evidence gaps.
Area of Science:
- Medical research
- Public health
- Infectious diseases
Background:
- Hospitalization for COVID-19 has been linked to major organ complications.
- Previous studies often lacked appropriate control groups for comparison.
Purpose of the Study:
- To investigate major organ damage after hospital discharge in adults who had COVID-19.
- To compare organ damage in COVID-19 patients with non-COVID-19 control groups.
Main Methods:
- Systematic review of studies published between January 2020 and May 2021.
- Included English-language studies of adults discharged from hospital for COVID-19 reporting major organ damage.
- Narrative synthesis of findings due to heterogeneity; quality assessed using Joanna Briggs Institute checklist.
Main Results:
- Nine studies with non-COVID controls were analyzed.
- Adults hospitalized for COVID-19 showed consistently greater incident cardiac, pulmonary, liver, kidney, stroke, diabetes, and coagulation disorders compared to controls.
- Follow-up ranged from 4 to 22 weeks post-discharge.
Conclusions:
- Post-acute COVID-19 major organ damage is prevalent and likely exceeds that of control groups.
- Substantial uncertainty remains regarding the exact magnitude and applicability to different subgroups.
- More consistent outcome reporting and carefully selected control groups are necessary to fill evidence gaps.
Background:
Major organ complications have been reported in patients hospitalised for COVID-19; most studies lacked controls.
Objective:
Examine major organ damage postdischarge among adults hospitalised for COVID-19 versus non-COVID-19 controls.
Data Sources:
MEDLINE, Embase and Cochrane Library from 1 January 2020 to 19 May 2021.
Study Eligibility Criteria:
English language studies of adults discharged from hospital for COVID-19; reporting major organ damage. Single review of abstracts; independent dual review of full text.
Study Appraisal And Synthesis Methods:
Study quality was assessed using the Joanna Briggs Institute Appraisal Checklist for Cohort Studies. Outcome data were not pooled due to heterogeneity in populations, study designs and outcome assessment methods; findings are narratively synthesised.
Results:
Of 124 studies in a full evidence report, 9 included non-COVID controls and are described here. Four of the nine (three USA, one UK) used large administrative databases. Four of the remaining five studies enrolled <600 COVID-19 patients. Mean or median age ranged from 49 to 70 years with 46%-94% male and 48%-78% White race; 10%-40% had been in intensive care units. Follow-up ranged from 4 weeks to 22 weeks postdischarge. Four used hospitalised controls, three non-hospitalised controls and two were unclear. Studies used various definitions of, and methods to assess, major organ damage outcomes. While the magnitude of effect differed across studies, incident cardiac, pulmonary, liver, acute and chronic kidney, stroke, diabetes, and coagulation disorders were consistently greater in adults hospitalised for COVID-19 compared with non-COVID-19 controls.
Limitations:
Applicability to subgroups (age, gender, COVID-19 severity, treatment, vaccination status) and non-hospitalised patients is unknown.
Conclusions And Implications Of Key Findings:
Postacute COVID-19 major organ damage is common and likely higher than controls. However, there is substantial uncertainty. More consistent reporting of clinical outcomes and pre-COVID health status along with careful selection of control groups are needed to address evidence gaps.
Prospero Registration Number:
CRD42020204788.
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