The report is a product of the VA/HSR&D Evidence Synthesis Program.
COVID-19 Post-acute Care Major Organ Damage: A Living Rapid Review (June 2021 Update)
This is the first update of a living rapid review examining the post-acute prevalence of major organ damage and healthcare/service use needs among adults hospitalized with or for COVID-19. In addition to severe pulmonary disease, there have been reports of other major organ system manifestations and complications in patients hospitalized with COVID-19, including cardiovascular, renal, neurological, hematologic, endocrine, and gastrointestinal problems. Persistent symptoms also have been reported in patients following recovery from acute COVID-19, with fatigue, shortness of breath, muscle or body pain, and difficulty concentrating being most common. Further, multi-organ damage and long-term outcomes following other coronavirus outbreaks – severe acute respiratory syndrome (SARS) and Middle East Respiratory syndrome (MERS) – suggest the potential for similar multi-organ damage and adverse long-term clinical outcomes for those with COVID-19 infections.
A living rapid review updates a systematic review, incorporating relevant new evidence as it becomes available. This is particularly important during a pandemic.
Coronavirus disease-2019 (COVID-19) – a viral illness caused by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) – was declared a pandemic in March 2020. As of June 28, 2021, there have been more than 33 million cases and 604,000 deaths in the United States. Worldwide, COVID-19 has infected more than 181 million people and killed nearly 4 million individuals in more than 220 countries.
Investigators with VA’s Evidence Synthesis Program (ESP) Center in Minneapolis, MN searched MEDLINE®, EMBASE, and the Cochrane Library from January 1, 2019 through January 12, 2021. This living review update, includes 90 studies (51 studies from the 3-month literature search update following the original report) reporting outcomes data at the time of hospital discharge (n=36), post-discharge (n=46), or both (n=7), with 1 study that did not report time post-hospitalization. Of the 90 studies, 33 were from the United States, with 1 study exclusively of Veterans and 1 multisite study that included patients from a VA medical center.
Summary of Findings
What’s New: Prevalence estimates were updated to include 51 new studies. Conclusions from the December 2020 report are largely unchanged due to limitations of the available evidence, particularly poorly described study populations, lack of patient-centered outcomes, and few control groups or pre-COVID-19 data.
Among organ systems, pulmonary outcomes were most frequently reported with fewer studies describing cardiovascular, gastrointestinal, hematologic, neural, or renal outcomes – and no studies of endocrine or rheumatologic/musculoskeletal outcomes. Frequently reported outcomes included pulmonary fibrosis (7%-61%), pericardial effusions (0%-20%) or a need for renal replacement (4%-31%). Among healthcare/service use outcomes, hospital readmission occurred in 0%-15% of patients, and discharge disposition other than home in 3%-47%. There was little to no information about post-hospital care, monitoring, or treatments required.
Available data were mainly from convenience samples with poorly described study populations and were primarily physiologic outcomes. Few studies included control groups for comparison of COVID-19 and non-COVID-19 patients. Moreover, most studies had short follow-up post-discharge, thus long-term outcomes are unknown. The applicability of findings to patients who were not hospitalized is also unknown. There were no data on outcomes based on a patient’s living situation prior to COVID-19 infection (i.e., community dwelling vs nursing home or assisted care centers).
Practice and policy implications are difficult to determine due to study limitations. However, among patients hospitalized with or for COVID-19, short-term major organ damage (especially pulmonary), hospital readmission, and discharge disposition other than home may be common. The applicability of findings to sub-groups (i.e., age, gender, COVID severity) and non-hospitalized patients is unknown. The amount of data is increasing rapidly, thus future updates are likely to identify relevant new data.
Research Gaps/Future Research
Future research should include clear descriptions of the patient populations and the timing of outcome assessment with respect to hospitalizations. Investigators should link pre-COVID-19 data with post-COVID-19 data and assess outcomes that allow for the determination of the prevalence of major organ damage and healthcare/service use needs which were likely due to COVID-19.
Greer N, Bart B, Billington C, Diem SJ, Ensrud KE, Kaka A, Klein M, Melzer A, Reule S, Shaukat A, Sheets K, Starks J, Vardeny O, McKenzie L, Stroebel, B, Duan-Porter W, Wilt, TJ. COVID-19 Post-acute Care Major Organ Damage: A Living Rapid Review. Updated June 2021. Evidence Synthesis Program, Health Services Research and Development Service, Office of Research and Development, Department of Veterans Affairs. VA ESP Project #09-009; 2021.
To view the full report, go to http://www.hsrd.research.va.gov/publications/esp/covid19-postacute-organ-damage.cfm
ESP is currently soliciting review topics from the broader VA community. Nominations will be accepted electronically using the online Topic Submission Form. If your topic is selected for a synthesis, you will be contacted by an ESP Center to refine the questions and determine a timeline for the report.
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