SARS-CoV-2 post-acute sequelae in previously hospitalised patients: systematic literature review and meta-analysis

Abstract

BackgroundMany individuals hospitalised with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection experience post-acute sequelae of SARS-CoV-2 infection (PASC), sometimes referred to as “long COVID”. Our objective was to conduct a systematic literature review and meta-analysis to identify PASC-associated symptoms in previously hospitalised patients and determine the frequency and temporal nature of PASC.MethodsSearches of MEDLINE, Embase, Cochrane Library (2019–2021), World Health Organization International Clinical Trials Registry Platform and reference lists were performed from November to December 2021. Articles were assessed by two reviewers against eligibility criteria and a risk of bias tool. Symptom data were synthesised by random effects meta-analyses.ResultsOf 6942 records, 52 studies with at least 100 patients were analysed; ∼70% were Europe-based studies. Most data were from the first wave of the pandemic. PASC symptoms were analysed from 28 days after hospital discharge. At 1–4 months post-acute SARS-CoV-2 infection, the most frequent individual symptoms were fatigue (29.3% (95% CI 20.1–40.6%)) and dyspnoea (19.6% (95% CI 12.8–28.7%)). Many patients experienced at least one symptom at 4–8 months (73.1% (95% CI 44.2–90.3%)) and 8–12 months (75.0% (95% CI 56.4–87.4%)).ConclusionsA wide spectrum of persistent PASC-associated symptoms were reported over the 1-year follow-up period in a significant proportion of participants. Further research is needed to better define PASC duration and determine whether factors such as disease severity, vaccination and treatments have an impact on PASC.

Long COVID-associated symptoms prevalent in both SARS-CoV-2 positive and negative individuals: A prospective follow-up study

“…Although COVID-19 is generally managed in outpatient settings, studies suggesting high incidences of long-term sequelae mainly look at hospitalized patients [ [1] , [2] , [3] , [4] ]. However, CoV(−) control groups are missing in most reports, nor have they been set as inclusion criterion in the numerous reviews and meta-analyses [ [2] , [3] , [4] ].…”

“…Although COVID-19 is generally managed in outpatient settings, studies suggesting high incidences of long-term sequelae mainly look at hospitalized patients [ [1] , [2] , [3] , [4] ]. However, CoV(−) control groups are missing in most reports, nor have they been set as inclusion criterion in the numerous reviews and meta-analyses [ [2] , [3] , [4] ]. Indeed, a recent cohort study involving CoV(+) outpatients and CoV(−) controls suggests for outpatients lower long COVID symptom frequencies [ 17 ] than those previously reported for inpatients.…”

“…The clinical spectrum of COVID-19 ranges from asymptomatic to severe, life-threatening disease. Although most individuals with acute COVID-19 make full recovery, many studies – particularly the multitude conducted among hospitalized patients [ [1] , [2] , [3] , [4] ] – describe for part of them persisting symptoms, referred to by such names as long COVID, post-COVID syndrome, or post-acute sequelae of SARS-CoV-2 infection [ 1 ].…”

“…While definitions of long COVID, its prevalence and range of manifestations vary, some symptoms, particularly fatigue, shortness of breath, smell and taste impairment, and cognitive dysfunction are commonly reported [ 1 ]. The prevalence of long COVID symptoms varies by research design from 75 % after hospital discharge [ [1] , [2] , [3] , [4] ] to 10–30 % in population-based investigations [ [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] ]. Factors found to predispose to persistent symptoms include severity of disease, comorbidities, female sex, smoking, obesity, and increased age [ 1 , 13 ].…”

Identifying Long COVID Definitions, Predictors, and Risk Factors using Electronic Health Records: A Scoping Review

“…Among these studies, the majority (n = 34) had either a moderate or high risk of bias. Likewise, Kelly et al [27] identi ed a wide spectrum of symptoms and signi cant heterogeneity across the studies, noting that the population was limited to hospitalized patients. An earlier review by Iqbal et al [28] incorporated 35 articles until March 2021 and highlighted limitations pertaining to various study designs, a limited number of countries, and questionnaire-based cross-sectional studies that fail to capture the evolution of symptoms over time.…”