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 (September 2021 Update)
A living rapid review updates a systematic review, incorporating relevant new evidence as it becomes available. This is particularly important during a pandemic.
This is the second 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. This living rapid review sought to further determine the prevalence of post-acute care major organ damage and healthcare – or service use needs – associated with major organ damage in adults who were hospitalized with or for COVID-19.
As of August 30, 2021, there have been over 38 million cases of COVID-19 that led to more than 637,000 deaths in the US. Within VA, there have been 13,601 deaths and 284,532 convalescent cases have been reported based on publicly available data, though these figures likely underestimate the number of Veterans receiving VA healthcare who are infected with or dying from COVID-19.
For this second update, investigators with VA’s Evidence Synthesis Program (ESP) Center in Minneapolis, MN made minor changes to the scope of their investigation in order to reflect the growing body of literature on post-acute COVID-19, including:
- Reporting only on outcomes post-discharge (i.e., studies that only reported outcomes at the time of discharge were excluded),
- Requiring a minimum of 50 patients with COVID-19, and
- Reporting healthcare/resource utilization outcomes that were specific to major organ damage (i.e., all-cause readmission was no longer an outcome of interest.)
They searched MEDLINE®, EMBASE, and the Cochrane Library through May 19, 2021 and included 124 reports of post-acute major organ damage or healthcare/service use outcomes in adults hospitalized with or for COVID-19. Of these studies, 33 were from the US, including 2 studies exclusively targeting Veterans and 1 multisite US study that included patients from a VA Medical Center.
Summary of Findings
What’s New: Prevalence estimates have been updated to include 34 new studies (124 total). Recent evidence includes four large database studies with control groups. Evidence from these studies suggests increased risk for disease in adults hospitalized for COVID-19. Limitations of the available evidence include poorly described study populations, lack of patient-centered clinical outcomes, and few control groups or pre-COVID-19 data. Outcomes following COVID variants are unknown.
From 124 studies, pulmonary outcomes were most frequently reported (n=50) with fewer studies reporting neuromuscular (n=30), cardiovascular (n=22), hematologic (n=18), renal (n=17), gastrointestinal (n=6), or endocrine (n=3) outcomes. In studies with control groups, incident disease was generally higher in COVID-19 groups than in matched, non-COVID groups. Among healthcare/service use outcomes, discharge disposition and readmission were most frequently reported with little or no information about post-hospital care, monitoring, or treatments required. Although recent evidence included four large database studies with COVID-19 and control groups, available data are largely from studies of convenience samples with poorly described study populations, providing wide-ranging prevalence estimates based mainly on physiologic data. Most studies had short follow-up post-discharge, thus long-term outcomes are unknown. Applicability of findings to subgroups and non-hospitalized patients also are unknown.
Research Gaps/Future Research
Future studies should include all patients or consecutive patients rather than convenience samples. Study populations should be carefully described including severity of disease and treatments received. Results should be reported for subgroups based on age, gender, race/ethnicity, pre-existing conditions/frailty, vaccine status, type of residence (i.e., independent living, assisted living, nursing home), COVID-19 severity, COVID-19 variant, and treatment received. Ideally, researchers would be able to link pre-COVID-19 data with post-COVID-19 data. Without pre- and post- data, it is difficult to isolate the effects of COVID-19. In addition, future research would include standardized and longer follow-up to identify persistence of COVID-related conditions. Information on major organ damage prevalence and healthcare/service use needs of non-hospitalized patients is also needed.
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, MacDonald R, Sowerby K, Duan-Porter W, Wilt, TJ. COVID-19 Post-acute Care Major Organ Damage: A Living Rapid Review. Updated September 2021. Evidence Synthesis Program, Health Services Research and Development Service, Office of Research and Development, Department of Veterans Affairs. VA ESP Project #09-009; September 2021
To view the full report, go to https://vaww.hsrd.research.va.gov/publications/esp/covid-organ-damage.cfm (VA intranet only)
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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