Short-term and Long-term Rates of Postacute Sequelae of SARS-CoV-2 Infection A Systematic Review

IMPORTANCE Short-term and long-term persistent postacute sequelae of COVID-19 (PASC) have not been systematically evaluated. The incidence and evolution of PASC are dependent on time from infection, organ systems and tissue affected, vaccination status, variant of the virus, and geographic region. EVIDENCE REVIEW PubMed (MEDLINE), Scopus, the World Health Organization Global Literature on Coronavirus Disease, and CoronaCentral databases were searched from December 2019 through March 2021. A total of 2100 studies were identified from databases and through cited references. Studies providing data on PASC in children and adults were included. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines for abstracting data were followed and performed independently by 2 reviewers. Quality was assessed using the Newcastle-Ottawa Scale for cohort studies. The main outcome was frequency of PASC diagnosed by (1) laboratory investigation, (2) radiologic pathology, and (3) clinical signs and symptoms. PASC were classified by organ system, ie, neurologic; cardiovascular; respiratory; digestive; dermatologic; and ear, nose, and throat as well as mental health, constitutional symptoms, and functional mobility. FINDINGS From a total of 2100 studies identified, 57 studies with 250351 survivors of COVID-19 metinclusioncriteria.Themean(SD)ageofsurvivorswas54.4(8.9)years,140196(56%)weremale, and 197777 (79%) were hospitalized during acute COVID-19. High-income countries contributed 45 studies (79%). categorizations on COVID-19 proportion male, proportion hospitalized, median or mean age (by study), whether the study was conducted in low- and middle-income countries (median gross national income, (cid:2) $12535) or high-income countries (median gross national income, (cid:3) $12536). We did not conduct a meta-analysis due to high heterogeneity in the outcome of interest. We summarized PASC rates descriptively, reporting medians and IQRs. PASC frequencies were summarized as short term, intermediate term, or long term and by organ system. R package ggplot2 was used to display the boxplots. 13 All statistical analyses were performed with R software version 3.6. 2 (R Project for Statistical Computing). diffusing capacity for carbon monoxide, and respiratory strength) and imaging modalities including chest radiograph, computed tomography scans, and magnetic resonance imaging. Dyspnea was mainly assessed with the Modified Medical Research Council Dyspnea Scale. Dyspnea was reported in 38 studies (median [IQR], 29.7%; [14.2%-37.0%]), and cough was reported in 26 studies (median [IQR], 13.1% [5.3%-22.6%]). Increased oxygen requirement was reported in nearly two-thirds of COVID-19 survivors (3 studies; median [IQR], 65.0% [39.3%-76.1%]). Other frequently reported sequelae included pulmonary diffusion abnormalities (4 studies; median [IQR], 30.3% [22.1%-38.5%]), ground glass opacification (7 studies; median [IQR], 23.1% [19.7%-43.0%]), restrictive patterns on spirometry (3 studies; median [IQR], 10.0% [6.1%-24.1%]), and lung fibrosis (5 studies; median [IQR], 7.0% [2.5%-17.7%]) (Figure 2C). Overall, abnormalities were present in a median (IQR) of 62.2% (45.8%-76.5%) of survivors (4 studies). by an alternative diagnosis 80 ; and (3) signs and symptoms at 12 weeks after infection and beyond. This led to considerable heterogeneity in PASC definitions among the articles synthesized in this systematic review.