COVID-19 postacute care major organ damage: a systematic review

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.

Automated summary

Major organ damage after discharge is common among hospitalized COVID-19 patients and is likely higher compared to non-COVID-19 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.