Symptom burden and clinical profile of COVID-19 deaths: a rapid systematic review and evidence summary

Abstract

The spread of pandemic COVID-19 has created unprecedented need for information. The pandemic is the cause of significant mortality and with this the need for rapidly disseminated information for palliative care professionals regarding the prevalence of symptoms, their intensity, their resistance or susceptibility to symptom control and the mode of death for patients.MethodsWe undertook a systematic review of published evidence for symptoms in patients with COVID-19 (with a specific emphasis on symptoms at end of life) and on modes of death. Inclusion: prospective or retrospective studies detailing symptom presence and/or cause or mode of death from COVID-19.Results12 papers met the inclusion criteria and gave details of symptom burden: four of these specifically in the dying and two detailed the cause or mode of death. Cough, breathlessness, fatigue and myalgia are significant symptoms in people hospitalised with COVID-19. Dyspnoea is the most significant symptom in the dying. The mode of death was described in two papers and is predominantly through respiratory or heart failure.ConclusionsThere remains a dearth of information regarding symptom burden and mode of death to inform decisions regarding end-of-life care in patients dying with COVID-19. Rapid data gathering on the mode of death and the profile of symptoms in the dying and their prevalence and severity in areas where COVID-19 is prevalent will provide important intelligence for clinicians. This should be done urgently, within ethical norms and the practicalities of a public health, clinical and logistical emergency.

COVID-19: guidance on palliative care from a European Respiratory Society international task force

“…Breathlessness is one of the most prevalent symptoms in hospitalised patients dying from COVID-19 [ 6 , 15 , 19 , 20 ]. Opioids are widely used in palliative care with an evidence base effect for relieving breathlessness [ 21 ].…”

Predictors of in-hospital COVID-19 mortality: A comprehensive systematic review and meta-analysis exploring differences by age, sex and health conditions

“…Among the symptoms and clinical signs studied, only dyspnoea was associated with higher mortality risk in this meta-analysis. Surprisingly, this risk was reduced in the presence of fever, cough, vomiting, diarrhoea and headache, which are the most prevalent symptoms in COVID-19 [ 3 , 4 , 90 ]. Other meta-analyses found only borderline [ 8 ] or no significant association between these symptoms and mortality [ 10 ], although all included less studies than the present meta-analysis.…”

“…The rapid global spread of COVID-19 beginning in December 2019 [ 1 ] and the countless associated health, social and economic impacts have resulted in an exponential increase in scientific publications from independent groups and global coalitions [ 2 ]. In addition to aspects related to the spread of the disease, the profile and symptoms of patients [ 3 , 4 ] and the drugs being developed to prevent and treat it [ 5 ], much interest has been devoted to potential predictors of hospital mortality from COVID-19. The identification of clinical aspects observed at hospital admission among patients with a worse prognosis has been the focus of many meta-analyses.…”

Palliative care for patients with severe covid-19

“…Among decedents and survivors with covid-19, breathlessness, cough, and fatigue are the most common symptoms 9. A case series of 101 patients with severe covid-19 who were referred to three hospital palliative care teams in London, UK, found breathlessness and agitation were the most common symptoms, alongside drowsiness and delirium 10…”