

COVID-19 Post-acute Care 

Major Organ Damage: A Living 

Rapid Review 

December 2020

Prepared for:

Department of Veterans Affairs

Veterans Health Administration

Health Services Research & Development Service

Washington, DC 20420 

Prepared by:

Evidence Synthesis Program (ESP) Center

Minneapolis VA Health Care System

Minneapolis, MN 

Timothy J. Wilt, MD, MPH, Director 

Wei Duan-Porter, MD, PhD, Associate Director

Authors: 

Nancy Greer, PhD 

Bradley Bart, MD

Charles Billington, MD 

Susan J. Diem, MD, MPH 

Kristine E. Ensrud, MD, MPH 

Anjum Kaka, MD 

Mark Klein, MD

Anne Melzer, MD, MS

Scott Reule, MD

Aasma Shaukat, MD, MPH

Kerry Sheets, MD

Jamie Starks, MD

Orly Vardeny, PharmD, MS 

Lauren McKenzie, MPH

Wei Duan-Porter, MD, PhD

Timothy J. Wilt, MD, MPH 

Evidence Synthesis Program
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PREFACE

The VA Evidence Synthesis Program (ESP) was established in 2007 to provide timely and accurate 

syntheses of targeted healthcare topics of importance to clinicians, managers, and policymakers as they 

work to improve the health and healthcare of Veterans. These reports help: 

• Develop clinical policies informed by evidence;

• Implement effective services to improve patient outcomes and to support VA clinical practice 

guidelines and performance measures; and 

• Set the direction for future research to address gaps in clinical knowledge.

The program is comprised of three ESP Centers across the US and a Coordinating Center located in 

Portland, Oregon. Center Directors are VA clinicians and recognized leaders in the field of evidence 

synthesis with close ties to the AHRQ Evidence-based Practice Center Program and Cochrane 

Collaboration. The Coordinating Center was created to manage program operations, ensure 

methodological consistency and quality of products, and interface with stakeholders. To ensure 

responsiveness to the needs of decision-makers, the program is governed by a Steering Committee 

comprised of health system leadership and researchers. The program solicits nominations for review 

topics several times a year via the program website. 

Comments on this report are welcome and can be sent to Nicole Floyd, Deputy Director, ESP 

Coordinating Center at Nicole.Floyd@va.gov.

Recommended citation: 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, Duan-Porter W, Wilt, TJ. COVID19 Post-acute Care Major Organ Damage: A Living Rapid Review. Evidence Synthesis Program, 

Health Services Research and Development Service, Office of Research and Development, 

Department of Veterans Affairs. VA ESP Project #09-009; 2020.

This report is based on research conducted by the Evidence Synthesis Program (ESP) Center located at the

Minneapolis VA Health Care System, Minneapolis, MN, funded by the Department of Veterans Affairs, Veterans 

Health Administration, Health Services Research and Development. The findings and conclusions in this document 

are those of the author(s) who are responsible for its contents; the findings and conclusions do not necessarily 

represent the views of the Department of Veterans Affairs or the United States government. Therefore, no statement 

in this article should be construed as an official position of the Department of Veterans Affairs. No investigators 

have any affiliations or financial involvement (eg, employment, consultancies, honoraria, stock ownership or 

options, expert testimony, grants or patents received or pending, or royalties) that conflict with material presented 

in the report.
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TABLE OF CONTENTS

BACKGROUND ........................................................................................................................... 1

KEY QUESTIONS AND SCOPE ............................................................................................... 2

METHODS .................................................................................................................................... 3

RESULTS ...................................................................................................................................... 5

Key Findings ............................................................................................................................... 5

PRISMA Flow Diagram ............................................................................................................. 5

Overview of Included Studies ..................................................................................................... 7

Pulmonary Outcomes .................................................................................................................. 7

Cardiovascular Outcomes ......................................................................................................... 10

Neurological Outcomes ............................................................................................................ 12

Renal Outcomes ........................................................................................................................ 12

Gastrointestinal Outcomes ........................................................................................................ 13

Hematologic Outcomes ............................................................................................................. 13

Healthcare/Resource Utilization Outcomes .............................................................................. 14

DISCUSSION .............................................................................................................................. 16

Key Findings ............................................................................................................................. 17

Limitations ................................................................................................................................ 17

Future Research ........................................................................................................................ 18

Ongoing Data Collection .......................................................................................................... 19

Conclusions ............................................................................................................................... 20

ACKNOWLEDGMENTS .......................................................................................................... 21

REFERENCES ............................................................................................................................ 22

TABLES

Table 1. Study Eligibility Criteria ............................................................................................... 4

Table 2. Overview of Included Studies ....................................................................................... 8

FIGURES

Figure 1. Analytic Framework .................................................................................................... 2

Figure 2. PRISMA Flow Diagram .............................................................................................. 6

APPENDIX A. SEARCH STRATEGIES ................................................................................. 28

APPENDIX B. PEER REVIEWER COMMENTS AND RESPONSES ............................... 31

APPENDIX C. EVIDENCE TABLES ...................................................................................... 38

APPENDIX D. PRISMA CHECKLIST ................................................................................... 83
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BACKGROUND

Coronavirus disease-2019 (COVID-19) is a viral illness that, as of December 1, 2020, was 

identified in over 62 million individuals (over 13 million in the US) in 220 countries, areas, or 

territories (https://www.who.int/emergencies/diseases/novel-coronavirus-2019, 

https://coronavirus.jhu.edu/, https://covid.cdc.gov/covid-datatracker/#cases_casesper100klast7days). Over 1.4 million deaths worldwide (over 265,000 in the 

US) are attributed to COVID-19. COVID-19 is caused by the severe acute respiratory syndromecoronavirus-2 (SARS-CoV-2) and was declared a pandemic by the World Health Organization 

on March 11, 2020. In addition to the potential for severe pulmonary disease, there have been 

numerous reports of other major organ system manifestations and complications in patients 

hospitalized with COVID-19 including cardiovascular,

1,2 renal,3,4 neurological,5,6 hematologic,7-9

endocrine,10 and gastrointestinal.11

Persistent symptoms have been reported in patients following recovery from acute COVID-19

with fatigue, shortness of breath, muscle or body pain, and difficulty concentrating most 

common.12-16 Multi-organ damage17 and long-term clinical outcomes18 following other 

coronavirus outbreaks – severe acute respiratory syndrome (SARS) and Middle East Respiratory 

syndrome (MERS) – have been reported, suggesting the potential for similar multi-organ damage 

and adverse long-term clinical outcomes with COVID-19 infections. In addition, because many 

COVID-19 patients are admitted to intensive care units, outcomes similar to those observed in 

post-intensive care syndrome or post-sepsis syndrome have also been suggested as possible longterm consequences of COVID-19 infections.19

The purpose of this living rapid review is to 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. The topic was nominated by the VA Evidence 

Synthesis Program Coordinating Center in collaboration with VHA clinical and operations 

partners in order to guide future clinical care decisions and resource needs related to COVID-19. 

It is 1 in a series of 3 living rapid reviews conducted across VA ESP sites addressing post-acute 

care prevalence related to: 1) mental health, 2) rehabilitation/functional status, and 3) major 

organ damage in patients hospitalized with or for COVID-19. Our analytic framework is shown 

in Figure 1.
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Figure 1. Analytic Framework 

KEY QUESTIONS AND SCOPE

1. What is the post- acute care prevalence of major organ damage among adults hospitalized 

with or for proven COVID-19 disease?

2. Does the post-acute care prevalence of major organ damage among adults with or for 

COVID-19 disease vary by patient characteristics (eg, age, sex, race/ethnicity, preexisting comorbidities/frailty, place of residence), COVID-19 disease severity, or other factors (eg, 

treatment for COVID-19)? 

3. What are the short- (< 3 months) and long-term (≥ 3 months) healthcare or service use 

needs of adults surviving COVID-19 disease with major organ damage?

In consultation with VHA central office operational partners, we included studies of adults 

hospitalized for COVID-19 and studies of adults hospitalized for another indication who have a 

positive COVID-19 test. Additionally, in collaboration with our local clinical content experts we 

prioritized conditions likely of greatest clinical relevance and included criteria for determining 

definitions and measures of symptomatic versus asymptomatic as well as acute versus chronic 

major organ damage. All patients had laboratory-confirmed COVID-19. We defined post-acute 

to include major organ damage or healthcare/service use needs reported on the day of hospital 

discharge or any time post-discharge. We included studies reporting “surrogate measures” (eg, a 

radiologic or laboratory measure consistent with a definition of a disease such as pulmonary 

function tests, radiographic pulmonary abnormalities, laboratory liver function tests or imaging 
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studies, creatinine, glucose or hemoglobin A1c values, cardiac imaging defined as abnormal or 

imaging studies for venous thromboembolism). We excluded studies reporting only mean or 

median values for these tests as mean or median values do not provide a reliable measure of 

organ damage prevalence or healthcare/service use. We also excluded studies reporting only 

general symptoms (eg, fatigue, pain), and did not extract these data from included studies 

because symptoms are not specific to a disease or organ damage. We included studies reporting 

on dyspnea as we determined dyspnea to be most consistent with pulmonary or cardiac damage. 

As noted above, post-acute mental health and functional status are addressed in separate ESP 

reviews. We excluded studies of children and studies of adults who had COVID-19 but were not 

hospitalized. We also excluded studies that did not provide information at the time of or after 

hospital discharge even if they included patient information during hospitalization. 

METHODS

Our protocol was registered in PROSPERO: CRD42020204788.

SEARCH STRATEGY

We searched MEDLINE, Embase, and the Cochrane Library from January 1, 2019 to October 6, 

2020. The search strategy (Appendix A) was developed with input from expert medical 

librarians. We also reviewed non-peer-reviewed public postings about post-COVID-19 

complications for links to peer-reviewed data reports.

SCREENING PROCESS

Consistent with established rapid review methods, abstracts were reviewed by 1 investigator. A 

subset of 200 abstracts underwent dual independent review with substantial agreement between 

the 2 investigators. All articles identified as potentially eligible based on abstract review were 

independently reviewed by 2 investigators at the full-text level. Reasons for exclusion were 

noted. Conflicts were resolved by discussion. Our inclusion and exclusion criteria are reported in 

Table 1. We did not require studies to include a comparison group nor did we require that studies 

provide information about “preCOVID-19” health status/conditions or the primary reason for 

hospitalization (ie, due to COVID-19 compared to for other conditions where COVID-19 may be 

contributing factor or identified incidentally on screening). 

DATA ABSTRACTION

Study characteristics (location, design, funding), study inclusion and exclusion criteria, baseline 

demographic data (age, sex, race, comorbidities), hospitalization characteristics (COVID-19 

severity, ICU admission, mechanical ventilation, length of hospital stay), length of time posthospital, and outcomes data were abstracted by 1 investigator and verified by a second. 

Discrepancies were resolved by discussion

RISK OF BIAS ASSESSMENT

We did not formally rate risk of bias. We assessed study quality characteristics using the Joanna 

Briggs Critical Appraisal Tool for case series20 taking into account clarity of inclusion criteria 
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and completeness of inclusion, use of standard methods for identification and assessment of the 

condition, and inclusion of adequate information about the subjects and setting. 

SYNTHESIS

Due to heterogeneity in study populations, study designs, and methods of outcome assessment, 

we were unable to pool outcomes data. We narratively synthesized the evidence.

Table 1. Study Eligibility Criteria

Study Characteristic Include Exclude

Population Adults (age 18 and older) Children or adolescents, age 

<18; MERS; SARS

Intervention Discharge (or ready for discharge) 

from hospitalization after admission 

with or for proven COVID-19

Data collected from patients 

during ongoing hospital acutecare admission with or for

proven COVID-19

Comparator Discharge from hospitalization for 

individuals without COVID-19 

(ideally another respiratory 

condition); a comparator was not 

required

None

Outcomes Prevalence and severity of major 

organ damage (respiratory, renal, 

cardiovascular, hematologic, 

neurologic, metabolic/endocrine, 

gastrointestinal, and 

rheumatologic/musculoskeletal);

healthcare or service use needs 

related to major organ damage

No outcomes of interest

Timing Short-term (< 3 months) and longterm (≥ 3 months) post-dischargeNone

Setting Any post-discharge setting (eg, 

home, rehabilitation or long-term 

care facility); may include rehospitalization

None

Study Designs Cohort, case series, other 

observational; may prioritize articles 

using a best-evidence approach 

Case report, narrative review, 

descriptive/opinion article with 

no data

LIVING REVIEW 

We plan to update our literature search, using the search strategy outlined above, at least every 3 

months through December 2021 for new evidence related to post-acute major organ damage and 

associated healthcare/service use needs. Study eligibility criteria, procedures for data abstraction, 

and risk of bias assessment will remain the same. Our data synthesis plan may change if future 

evidence allows. New evidence that does not substantially change review conclusions will be 

summarized every 3 months. New evidence that changes review conclusions or certainty of 

evidence will be incorporated into a major update. 
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PEER REVIEW

A draft version of this report underwent peer review by content experts and clinical leadership. 

Reviewer comments and our responses are presented in Appendix B and the final report 

incorporates these comments.

RESULTS

KEY FINDINGS

Key Question 1: Limited post-hospital data with wide ranging prevalence estimates that mainly 

rely on physiologic outcomes from convenience samples without controls; most not conducted in 

US. 

Key Question 2: Information is insufficient to assess if prevalence varies by patient, disease, and 

comorbidity factors.

Key Question 3: Little information on post-hospitalization resource use including discharge 

disposition and readmission. 

PRISMA FLOW DIAGRAM

The results of our literature search and study selection process are depicted in Figure 2.
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Figure 2. PRISMA Flow Diagram 
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OVERVIEW OF INCLUDED STUDIES

We identified 42 studies reporting outcomes data (Table 2) at the time of hospital discharge

(k=17),21-37 post-discharge (10 studies at 30 days or fewer follow-up) (k=22),38-59 or both

(k=3).60-62

Twelve studies reported pulmonary outcomes,21,22,26,28,29,33,39,42,43,46,55,58,59 6 reported neurological 

outcomes,21,23,30,32,35,43 4 studies reported cardiovascular outcomes,

22,39,45,49 3 reported renal 

outcomes,24,34,39 3 reported hematologic outcomes,

22,48,51 1 reported gastrointestinal outcomes,39

and 22 reported healthcare or resource utilization outcomes.

25,27,30,31,36-38,40,41,44,47,48,50,52-57,60-62

Studies were typically described as retrospective, case series, or cross-sectional although 9 were 

described as prospective cohort studies.21,22,37,39,40,43,49,51,55 We did not formally rate study risk of 

bias. Twenty-five of 42 studies enrolled all or consecutive patients, 18 were single-site studies, 

18 provided little information about the group of patients discharged or the time of the follow-up 

with respect to the time of discharge, and many were unclear about data sources and 

completeness of follow-up. Study inclusion and exclusion criteria, patient demographics, and 

hospitalization characteristics are reported in Appendix C, Table 1; study quality assessments are 

reported in Appendix C, Table 2. 

PULMONARY OUTCOMES

Of the 12 studies reporting pulmonary outcomes (Appendix C, Tables 1 and 3), 5 were from 

China,33,46,55,58,59 6 were from Europe,

26,28,29,39,42,43 and 1 was from the Middle East.22 Sample 

sizes ranged from 18 to 131 with all but 5 studies enrolling 50 or fewer individuals. Mean or 

median ages ranged from 37 to 73 years and the percentage of males enrolled ranged from 35% 

to 84%. Seven studies reported hospital length of stay with mean or median values ranging from 

10 to 28 days.26,29,43,46,55,58,59 Eight studies reported ICU admission. One study excluded patients 

admitted to the ICU33 and 2 enrolled only post-ICU patients.22,26 In the other 5 studies, 3% to 

31% were admitted to ICUs. One study excluded patients who received mechanical ventilation33; 

in the other 5 studies reporting, between 2% and 100% received mechanical ventilation. None of 

the studies included a comparison to non-COVID-19 patients. Reported outcomes varied across 

the studies with most reporting surrogate measures of health outcomes. 

 
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Table 2. Overview of Included Studies

Major 

“Organ” of 

Interest 

# Studies* 12 4 6 3 22 0 1 3

Location 

China: 5

Europe: 6

Middle East: 1

China: 1

Europe: 2

Middle East: 1

Europe: 2

US: 2

Multiple: 2

US: 2

Europe: 1

China: 3

US: 13

Europe: 4

NA Europe US: 1

Europe: 1

Middle East: 1

Time of 

Assessment

Hospital DC: 4

Rehab Unit 

Admission: 1

Post-DC: 7

Hospital DC: 

1 

Post-DC: 3

Hospital DC: 5

Post DC: 1

Hospital 

DC: 2

Post DC: 1

Hospital DC: 6

Post-DC: 11

Hospital DC and post-DC:

5

NA Post DC Hospital DC: 1

Post DC: 2

Outcomes 

Pulmonary 

fibrosis: 7 to 

44%46,58,59

Reduced 

Pulmonary 

function: 9 to 

25%33,46,58

Reduced 

DLCO:47 to 

53%33,42,46

Dyspnea: 

100% 

(severe)26; 

29% (mild to 

severe)43

Other: 

PaO2/FiO2, 

respiratory 

support, 

impairment

Impaired EF: 

11%39

Pericardial 

effusion: 1.5% 

Ultrasound22; 

20% CMR49

LGE: 22 to 

32%45,49

Native T1, T2: 

elevated in 

COVID-1945,49

Elevated 

hsTNT: 5%49

NIH Stroke 

scale: 

moderate 

symptoms23,30 

Modified 

Rankin Scale 

“moderate-tosevere” stroke 

sequelae: 29 to 

83%21,23,30,32,35

AKD: 28 to 

35%24,34

Need for 

KRT: 31% 

survivors on 

KRT in 

hospital34

Impairment 

imaging: 

22%39

Positive SARS-CoV-2 

(post DC): 9 to 

63%44,54,55,57,60

Readmission: 2 to 

12%38,40,41,47,48,50,52,53,55,60-

62

Discharge: Home: 35 to 

93%;

Rehabilitation other care: 

2 to 50%; 

Nursing home: 6 to 

15%25,27,30,31,36,37,50,55,60-62

Other: post-DC treatment

NA Liver 

inflammation 

on imaging: 

16%39 

DVT: 12.5%22

Thromboembolism: 0.5 

to 2.5%48,51

Hemorrhage: 

3.7%48

AKD=acute kidney disease; CMR: cardiac magnetic resonance imaging; DC=discharge; DLCO=diffusing capacity for carbon dioxide; DVT=deep venous thrombosis; EF=ejection 

fraction; hsTNT=high-sensitivity Troponin; KRT=kidney replacement therapy; LGE=late gadolinium enhancement; MRI=magnetic resonance imaging; NA=not available (no 

studies reporting); US=United States

*Studies may appear in more than 1 column

Pulmonary; Cardiac; Neurologic; Renal; Resource Use; Musculoskeletal and Endocrine; Gastrointestinal; Hematologic
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Radiographic Fibrosis

Three studies reported the percentage of patients with pulmonary fibrosis. One study defined 

fibrosis on CT chest imaging as a combination of findings including parenchymal bands, 

irregular interfaces, coarse reticular pattern, and traction bronchiectasis.59 At a median of 8 days 

post-discharge, pulmonary fibrosis was identified in 44% (14/32).59 The other 2 studies did not 

report how fibrosis was diagnosed. In 1 study, at 30 days post-discharge, 7% (4/57) had 

pulmonary fibrosis.46 The other study, assessing outcomes at a mean of 38 days post-discharge,

reported 22% (4/18) with pulmonary fibrosis and 61% (11/18) with ground-glass opacity plus 

pulmonary fibrosis.58

Pulmonary Function

Pulmonary function tests were also reported by 3 studies. The percentage of patients with forced

expiratory volume in 1 second (FEV1) less than 80% of predicted was 14% (15/110) in 1 study 

assessing lung volume at discharge

33 and 9% (5/57)46 and 17% (3/18)58 in 2 studies assessing 

lung volume at ≥30 days post-discharge. In the same studies, the percentage of patients with

forced vital capacity (FVC) less than 80% of predicted was 9% (10/110) in the study assessing 

lung volume at discharge

33 and 11% (6/57)46 and 17% (3/18)58 in studies assessing lung volume 

at ≥30days. An FEV1/FVC ratio of less than 80% at 30 days post-discharge was noted in 44% 

(25/57)46 while a ratio of less than 70% was noted at discharge in 5% (5/110)33 and at 38 days 

post-discharge in 17% (3/18).58 For all 3 outcomes there were no significant differences between

subgroups based on COVID-19 severity. Total lung capacity less than 80% of predicted was 

reported in 2 studies: 12% (7/57) in 1 study46 and 25% (27/110) in the other.33 Mo et al reported

a significantly (P<.05) higher percentage of patients with TLC <80% predicted in the severe 

pneumonia subgroup (47%) than in the mild (17%) or pneumonia (21%) subgroups33 while

Huang et al reported no difference based on severity.46

Ventilation Impairment

Two studies, both assessing lung function at approximately 1 month post-discharge,

characterized ventilation impairment as restrictive or obstructive. In 1 study, 11% (6/57) were

characterized as having obstructive impairment, 12% (7/57) as restrictive impairment, and 4%

(2/57) as combined obstructive and restrictive.46In the second study, 17% (3/18) had obstructive 

impairment and 17% (3/18) had restrictive impairment.58 Another study, not yet peer-reviewed, 

measured lung impairment with MRI at a median of 105 days after a positive COVID-19 result.39

Deep breathing fractional area change of <39% was observed in 47% (16/34) evaluated. 

Diffusing Capacity

Diffusing capacity for carbon dioxide (DLCO) less than 80% of predicted was reported in 53% 

(30/57)46

and 47% (51/110)

33 of patients. Both studies also reported significant differences in 

DLCO for subgroups based on severity. In 1 study, DLCO was less than 80% predicted in 77% 

(13/17) of the severe cases and 43% (17/40) of the non-severe cases (P=.02).46 In the other study, 

DLCO was <80% predicted for 84% (16/19) of the severe pneumonia subgroup, 42% (28/67) of 

the pneumonia subgroup, and 29% (7/24) of the mild subgroup (P<.01 for the severe pneumonia 

subgroup vs the pneumonia subgroup or the mild subgroup).33 Another study reported that 26% 

(13/50) had altered diffusion capacity only, 18% (9/50) had restriction with altered diffusion 
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capacity, 8% (4/50) had restriction only, and 48% (24/50) had a normal pulmonary function 

test.42

Dyspnea

Measures of dyspnea were reported in 3 studies. Two used a modified Medical Research Council 

measure. One reported that 13% (4/32) were Grade 4 and 88% (28/32) were Grade 5 at the time 

of admission to a rehabilitation unit.26 Grade 4 indicates a need to stop for breath after 100 

meters or a few minutes on level ground while Grade 5 indicates too breathless to leave the 

house, or breathless after undressing (https://mrc.ukri.org/research/facilities-and-resources-forresearchers/mrc-scales/mrc-dyspnoea-scale-mrc-breathlessness-scale/). The second reported 29% 

(35/120) were at Grade 2 or higher at a mean of 111 days post-discharge. Grade 2 is described as 

“walks slower than people of the same age because of dyspnea or has to stop for breath when 

walking at own pace”.43 The third study used the Borg scale and assessed dyspnea following the 

6-minute walk test.28 Values were generally less than 3 (ie, “moderate” dyspnea) on a 10 point 

scale. This study also reported the presence of exercise-induced hypoxia (defined as SpO2 <90%) 

in 50% (13/26). Six of the patients underwent further testing and pulmonary embolism was 

confirmed in 67% (4/6).28

Other Outcomes

In 1 study of patients admitted to a rehabilitation unit, moderate alteration (values of 200-299 

mmHg) in PaO2/FiO2 was observed in 38% (12/32) with severe (values <200 mmHg) alteration 

in 41% (13/32). Only 13% (4/32) did not require oxygen support.26 Two studies reported 

findings from computed tomography (CT).46,55 One reported residual abnormality on CT 30 days 

post-discharge in 54% (31/57), including 94% (16/17) in the severe subgroup and 38% (15/40) in 

the non-severe subgroup.46 The other reported chest CT deterioration in 6% (2/36) at 1-2 weeks 

post-discharge but no deterioration in 54 patients evaluated with CT at 3-4 weeks.55 Another 

study reported “lung abnormalities” (worsening or appearance of X-ray pulmonary infiltrates) in 

85% (6/7) at the time of hospital discharge.29 Patients in this study were all receiving 

maintenance hemodialysis at the time of hospitalization. Finally, 1 study used point of care 

ultrasound at discharge and observed pleural effusions in 1.5% (1/64).22 At ICU admission, 

pleural effusions had been observed in 22.4% (20/89).

CARDIOVASCULAR OUTCOMES

Cardiovascular outcomes were reported in 4 studies (Appendix C, Tables 1 and 4) – 2 from 

Europe,39,49 1 from China,45 and 1 from the Middle East.22 Sample sizes range from 26 to 100, 

mean or median ages ranged from 38 to 50 years, and the percentage of males enrolled ranged 

from 38% to 84%. None of the studies reported hospital length of stay. Two studies included 

comparison groups.45,49 All cardiovascular outcomes were based on imaging or laboratory 

assessments rather than clinical definitions or patient centered outcomes.

Two studies used cardiovascular magnetic resonance (CMR) imaging to assess myocardial 

injury. In a study from Germany, 100 patients were assessed at a median of 71 days following 

diagnosis.49 Thirty-three had been hospitalized. The mean age of the patients was 49 years and 

53% were male. Among the hospitalized patients, 2 underwent mechanical ventilation and 17 

underwent non-invasive ventilation. The study also reported imaging findings for 50 healthy 

controls (age- and sex-matched, normotensive, taking no cardiac medications, with normal 
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cardiac volumes and function) and 57 risk factor-matched controls (matched for age, sex, 

hypertension, diabetes, smoking, known coronary artery disease, or comorbidities). From the 

CMR imaging, pericardial effusion (>10 mm) was observed in 20% (20/100) of the COVID-19 

patients, 0% of the healthy controls, and 15% (9/57) of the risk factor-matched controls. The 

difference between the COVID-19 group and the other groups was statistically significant

(P<.05). Late gadolinium enhancement (LGE), reflecting scarring, was observed in 32% (32/100) 

(myocardial) and 22% (22/100) (pericardial) of the COVID-19 group. Both were significantly 

more prevalent (P<.05) in the COVID-19 patients than in the healthy controls (0% for both 

measures) or the risk factor-matched controls (17% (9/57) with myocardial LGE and 15% (8/57) 

with pericardial LGE). Abnormal native T1 values were observed in 73% (73/100) of all 

COVID-19 patients with significantly higher values (P=.02) in those who had required 

hospitalization although the difference was characterized as small. Abnormal native T1 was 

reported in 6% (3/50) of the healthy controls and 40% (23/57) of the risk factor-matched controls 

(both P<.05 vs the COVID-19 group). Abnormal native T2 values were observed in 60% 

(60/100) of the COVID-19 group with no difference noted between hospitalized and nonhospitalized patients. The prevalences were 4% (2/50) and 9% (5/57) in the healthy controls and 

risk factor-matched groups, respectively (both P<.05 vs the COVID-19 group). T1 and T2 

generally reflect myocardial inflammation. The second study, from China, evaluated 26 patients 

referred for CMR due to cardiac symptoms post-discharge.45 Patients with a history of coronary 

artery disease or myocarditis were excluded. COVID-19 was reported as severe for 15% (4/26) 

and moderate for 85% (22/26). The study reported data from healthy controls (similar age and 

gender with no cardiovascular disease or systemic inflammation) who underwent CMR at the 

same hospital. CMR for the COVID-19 patients was completed at a median of 47 days after the 

onset of cardiac symptoms. Myocardial edema was noted in 54% (14/26). Of the 14 with edema, 

50% (7/14) had positive LGE and 50% (7/14) had a small pericardial effusion. A total of 8 

patients (1 without myocardial edema) had positive LGE. Native T1, T2, and extracellular 

volume (ECV) were significantly elevated in the recovered COVID-19 patients with positive 

CMR findings compared with the healthy controls. 

The study from Germany also reported blood test results.49 Detectable high sensitivity troponin T 

(hsTNT) was reported in 71% (71/100) of the COVID-19 group with significantly elevated 

hsTNT in 5% (5/100). There was no significant difference in mean hsTNT values between the 

hospitalized and non-hospitalized groups. The percentage of patients with detectable hsTNT was 

significantly higher (P<.05) in the COVID-19 group than the healthy controls (22% [11/50] or 

risk factor-matched controls (57% [31/57]). 

A study from the United Kingdom, not yet peer-reviewed, reported left ventricular ejection 

fraction data for 37 previously hospitalized patients at a median of 105 days after COVID-19 

diagnosis.39 Definite impairment (<50%) was noted in 11% (4/37) and borderline impairment 

(50-55%) in 19% (7/27) while 70% (26/37) were normal (>55%). Evidence of myocarditis was 

noted in 11% (4/37). 

A study from Saudi Arabia noted pericardial effusion on ultrasound at discharge in 1.5% (1/64 

survivors) among 89 hospitalized with severe COVID-19.22 
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NEUROLOGICAL OUTCOMES

Six studies reported neurological outcomes (Appendix C, Tables 1 and 5).21,23,30,32,35,43 Two were 

conducted in Europe,23,43 2 in the US,30,32 and 2 in multiple nations.21,35 Sample sizes ranged 

from 13 to 509, mean or median ages ranged from 58 to 76 years, and between 46% and 63% 

were male. 

Modified Rankin Scale

Five studies reported modified Rankin Scale (mRS) results at the time of hospital discharge. An 

mRS score of 0 to 2 is considered a good outcome – individuals are “able to look after their own 

affairs without assistance”. A multi-nation study enrolled patients who underwent mechanical 

thrombectomy following a stroke.21 Symptomatic patients were tested for COVID-19. An mRS 

score of 0 to 2 was observed for 17% (2/12) in the COVID-19 group compared with 30% 

(94/316) in the non-COVID-19 group. The difference was not statistically significant (P=.52). A 

study from Italy reported outcomes for patients who had been admitted for acute cerebrovascular

disease and tested positive for COVID-19.23 An mRS score of 0-2 was noted for 26% (11/43) of 

the COVID-19 group and 71% (48/68) of the non-COVID-19 group (P<.001). A study from the 

US included 6 patients who were admitted for COVID-19 and subsequently experienced a stroke 

(‘COVID’ group) and 7 patients who were admitted for a stroke and subsequently diagnosed 

with COVID-19 (‘neuro’ group).30 An mRS score of >2 (a ‘poor’ outcome) was reported for 

77% overall (10/13), including 67% (4/6) in the ‘COVID’ group and 86% (6/7) in the ‘neuro’ 

group. In a control group of non-COVID-19 patients with stroke hospitalized during the same 

time period, a ‘poor’ outcome was noted in 47% (25/53) (P=.047 vs the overall study group). A 

second study from the US compared patients with and without neurological manifestations 

during hospitalization with COVID-19.32 A history of neurological disorder was noted in 26% 

(134/509). An mRS score of 0 to 2 at discharge was reported for 71.4% (299/419) with 

neurological manifestations during hospitalization compared with 70.0% (63/90) with no 

neurological manifestations. Among patients with encephalopathy during hospitalization, 32,1% 

(52/162) had an mRS score of 0 to 2 compared with 89.3% (310/347) of those with no 

encephalopathy. Another multi-nation study reported severe disability in 51% (49 of 96 

survivors).35 The median [IQR] scores for the COVID-19 group and a propensity-matched group 

were 4 [2-6] and 2 [1-4], respectively (P<.001). 

NIH Stroke Scale

Two studies reported NIH Stroke Scale scores.

23,30 Scores range from 0 (no symptoms) and 42 

(severe symptoms) with scores between 1 and 4 indicating minor stroke symptoms and scores 

between 5 and 15 indicating moderate stroke symptoms 

(https://www.stroke.nih.gov/resources/scale.htm). The study from Italy reported median [IQR] 

scores of 9.0 [1.0-19.0] in the COVID-19 group and 2.0 [0.0-6.8] in the non-COVID-19 group 

(P=.005).23 The study from the US reported median [IQR] scores of 11 [4-23] in the overall 

study group of 13 patients and 3 [2-13] in the non-COVID comparison group.30

RENAL OUTCOMES

Renal outcomes were reported by 3 studies (Appendix C, Tables 1 and 6), 2 from the US24,34 and 

1 from Europe.39 The 2 studies from the US each reported on over 600 survivors while the study 

from Europe enrolled 37. Mean or median ages ranged from 50 to 71, with 38% to 79% male. 
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A study from the US reported acute kidney disease (AKD) at discharge in 25% (291/832).24

Twenty-three percent were Stage 1, 6% Stage 2, and 6% Stage 3. AKD stages were defined 

according to Kidney Disease: Improving Global Outcomes (KDIGO) criteria. At a median 

follow-up of 21 days, data were available for n=77 with AKD at discharge. Of those, 36% 

(29/77) had recovered, 33% (25/77) were Stage 1, 13% (10/77) were Stage 2, and 18% (14/77) 

were Stage 3. Data were also available for n=135 who had recovered kidney function at 

discharge. Of those, 86% (116/135) remained recovered, 10% (14/135) had new Stage 1 AKD, 

2% (3/135) had new Stage 2 AKD, and 2% (3/135) had new Stage 3 AKD. 

The second study from the US reported on 3,854 individuals who developed AKI while 

hospitalized for COVID-19.34 Among those who required renal replacement therapy (RRT) 

while hospitalized, 17% (108/638) survived. Of the survivors, 33% (36/108) had not recovered 

kidney function and 92% (33/36) required RRT at discharge. Authors reported that 58% (19/33) 

had underlying chronic kidney disease at hospital admission. Among those who did not require 

RRT while hospitalized, 52% (1663/3216) survived and 26% (430/1663) of those had not 

recovered kidney function. Need for post-discharge in this group was not reported. 

The study from Europe, not peer-reviewed, reported an imaging finding at a median of 105 days 

post-COVID-19 diagnosis.39 Definite impairment on kidney cortex T1 was observed in 22% 

(8/37) with normal findings in 78% (29/37). 

GASTROINTESTINAL OUTCOMES

The European study, noted above and not peer-reviewed, also reported liver imaging findings 

(Appendix C, Tables 1 and 7).39 At a median of 105 days post-COVID-19 diagnosis, liver 

inflammation (cT1 in ms) was normal (<800 ms) in 84% (31/37), borderline (800-825 ms) in 0% 

(0/37), and significant (>825 ms) in 16% (6/37). 

HEMATOLOGIC OUTCOMES

Three studies reported hematologic outcomes (Appendix C, Tables 1 and 8).22,48,51 A study from 

Saudi Arabia reported the incidence of deep venous thrombosis (DVT) at discharge (determined 

with ultrasound) was 12.5% (8/64 survivors). All patients in this study had been admitted to 

intensive care and received mechanical ventilation. The median age was 43 and 84% were male. 

The other 2 studies reported outcomes post-discharge. In a study from the US, at a median of 23 

days post-discharge, thromboembolism was observed in 2.5% (4/163).48 Twenty-six percent 

(42/163) had been hospitalized in the ICU. Events included pulmonary embolism (PE), 

intracardiac thrombus, thrombosed arteriovenous fistula, and ischemic stroke. At a median of 27 

days post-discharge, 3.7% (6/163) experienced hemorrhagic events. Two were considered ‘major 

bleeds”; both followed falls. Four were considered ‘clinically relevant non-major bleeding’. The 

patients experiencing thrombotic or hemorrhagic events had been discharged without 

anticoagulant therapy; among 13 patients discharged on thromboprophylaxis, there were no 

observed thrombotic or hemorrhagic complications. 

A study from Europe reported venous thromboembolism (VTE) post-discharge.51 Of 1877 

included patients, 208 (11%) had been admitted to critical care. At a median of 8 days postdischarge, 0.48% (9/1877) experienced DVT (n=2) or PE (n=7). In a cohort of medical 
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admissions from 2019, 0.31% (56/18,159) experienced VTE events including 23 with DVT (8 

proximal, 10 distal, and 5 line-associated upper-limb) and 33 with PE. The odds ratio for a VTE 

in the COVID-19 group was 1.6 (95%CI 0.77, 3.1) (P=.20). 

HEALTHCARE/RESOURCE UTILIZATION OUTCOMES 

Twenty-two studies – 13 from the US, 5 from China, and 4 from Europe – reported measures of 

healthcare and/or resource utilization (Appendix C, Tables 1 and 9).25,27,30,31,36-38,40,41,44,47,48,50,52-

57,60-62 Sample sizes ranged from 11 to 15,111 with 11 studies enrolling more than 

100.27,37,38,47,50,53,55,57,60-62 Mean or median ages ranged from 37 to 82; 1 study reported the range 

of ages (18 to 85).36 Between 27% and 71% were male. COVID-19 severity was reported in 7 

studies; 2 only enrolled severe47 or critically ill56 patients. Median hospital length of stay ranged 

from 2 to 24 days.) 

Discharge Disposition

Eleven studies reported on discharge disposition.25,27,30,31,36,37,50,55,60-62 Three studies enrolled 

patients with stroke or other neurological conditions.30,31,36 One US study of patients who 

experienced a stroke reported that 30% (3/10) were discharged home (including 2 of 6 

hospitalized for COVID-19 who subsequently experienced a stroke [‘COVID’] and 1 of 4 

hospitalized for stroke symptoms who subsequently tested positive for COVID-19 [‘Neuro’]), 

50% (5/10) were discharged to acute rehabilitation (3 of 6 in ‘COVID’ group, 2 of 4 in ‘Neuro’ 

group), and 20% (2/10) were discharged to long-term acute care (1 of 6 in “COVID’ group and 1 

of 4 in ‘Neuro’ group).30 Another US study of stroke patients (some had stroke onset during 

COVID-19 hospitalization and some had COVID-19 onset within 14 days of stroke onset) 

reported that 45% (25/56 discharged) were discharged home and 55% (31/56) to rehabilitation.31

An additional 30 patients had died or were in hospice care (data not reported separately for 

deaths and hospice). In a comparison group of non-COVID-19 stroke patients, 52% (228/438 

discharged) were discharged home and 48% (210/438) to rehabilitation. An additional 61 

patients had died or were in hospice care.31 The third study, from the United Kingdom, reported 

that, of COVID-19 neurological patients discharged, 56% (9/16) went home and 31% (5/16) 

went to a rehabilitation or stroke unit; the location of 13% (2/16) was not reported.36 

One US study enrolled 20 patients with HIV who were hospitalized for COVID-19; 4 patients 

(20%) were from a VA Medical Center.

25 Of patients discharged, 81% (13/16) were discharged 

home, 6% (1/6) to a nursing facility (permanent residence), and 13% (2/16) to a hotel for those 

with confirmed COVID-19. Five of the 20 patients enrolled had been living in a group living 

situation prior to hospitalization (3 in nursing homes, 1 incarcerated, 1 in a substance abuse 

recovery home). 

Another study from the US included 2 comparison groups: patients negative for COVID-19 and 

a historical control group.27 Among those who tested positive for COVID-19 and were 

discharged, 77% (1650/2142) were discharged home and 23% to a nursing home (492/2142). 

Among patients negative for COVID-19 and discharged, 83% were discharged home (788/950) 

and 17% (162/950) to a nursing home. In the historical control group, 85% (8108/9544) were 

discharged home and 15% (1436/9544) to a nursing home. It was noted that 16% of patients 

were nursing home residents prior to hospitalization. 
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Two US studies provided data for subgroups based on treatment location62 or age.50 In the first 

study, of patients treated in the general practice unit and with known discharge disposition, 96% 

(183/191) went home and 4% (8/191) went to a rehabilitation center.62 Of patients treated in the 

ICU and with known discharge disposition, 79% (49/62) went home and 21% (13/62) went to a 

rehabilitation center. In the second study, 6% (122/2081) of patients discharged alive were 

discharged to a “facility” (eg, nursing home, rehabilitation).50 The total included 0% (0/32) of 

those under 18 years, 2% (28/1,373) of those 18 to 65 years, and 14% (94/676) of those over age 

65. Ninety-four percent (1959/2081) were discharged home. 

Two studies from the United Kingdom with similar patient demographics and hospital lengths of 

stay reported that 81.0% (56/69)61 and 93% (614/664)37 of patients discharged were discharged 

to home; and 14.0% (10/69)61 and 5.1% (34/664)37 were discharged to care homes. In 1 study, it 

was reported that 7.2% (5/69) were new care home placements.61

A study from China provided information at up to 4 weeks post-discharge.55 At 1-2 weeks postdischarge, 87% (114/131) were in home quarantine, 9% (12/131) in community quarantine, 4% 

(5/131) in a “designated hospital”, and 0% had returned to work. At. 3-4 weeks post-discharge, 

the values were 92% (121/131), 3% (4/131), 2% (3/131), and 2% (3/131), respectively. 

One US study reported discharge disposition for patients who had been readmitted.60 Of 19 

readmitted, 5 (26%) were discharged to a skilled nursing facility and 14 (74%) either to home or 

a hotel for homeless persons experiencing COVID-19. 

Hospital Readmission

Hospital readmission for any reason was reported by 12 studies.38,40,41,47,48,50,52,53,55,60-62 Mean or 

median duration of follow-up to assess readmission ranged from 3 to 40 days; several studies did 

not report length of follow-up. The 2 largest studies were from Spain38 and the US.53 In the study 

from Spain, 4.8% (573/11,928) were readmitted.38 Median follow-up was 40 days postdischarge. Over 5% (31/573) of readmitted patients remained hospitalized through the follow-up 

period. Reason for readmission was not provided. In the US study, with a 14 day follow-up, 

3.6% (103/2864) returned for emergency care.53 Of those, 54.4% (56/103) were admitted. The 

most frequently reported reasons for readmission included respiratory distress (60%), chest pain 

(6%), other pain (6%), altered mental status (5%), fall (5%), and soft tissue infection (5%). ICUlevel care was required for 10.7% (6/56). 

Comparison groups were included in 2 studies from the US.40,41 In the first study, enrolling 

patients undergoing surgery for hip fracture, within 30 days of discharge, 11.8% (2/17) of 

COVID-19 positive patients had been readmitted compared with 2.8% (3/107) COVID-19 

negative patients.40 In the second study, 11% (9/92) patients were readmitted in both the 

COVID-19 acute respiratory distress syndrome (ARDS) group and a propensity match group 

with non-COVID-19 ARDS.

41 The length of follow-up post-discharge and reasons for 

readmission were not reported. 

Another US study enrolled patients with severe ARDS.47 Readmission rates ranged from 5 to 

10% with no difference between those who also had asthma and those who did not in either the 

21 to 39 year age group or the 40 to 65 year age group. Length of follow-up was not reported. 
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Readmission rates in different age groups were also reported in another US study.50 After a 

median follow-up of 4.4 days, a total of 2.2% (45/2081) were readmitted including 3% (1/32) of 

those under 18 years, 2% (22/1,373) of those 18 to 65 years, and 3% (22/676) of those over age 

65. The median time to readmission was 3 days. 

Suleyman et al, a US study, reported 30-day hospital readmission was 11% (29 patients).62 This 

included 27 patients who had been treated in the general practice unit and 2 patients treated in 

the ICU. 

In 5 other studies, readmission rates ranged from 4% to 9%.48,52,55,60,61 Three of the studies were 

from the US, 1 from the United Kingdom, and 1 from China. One of the US studies reported 

reasons for readmission.60 Bacterial pneumonia secondary to COVID-19 was documented in 

21% (4/19), a prolonged COVID-19 course in 21% (4/19), psychiatric episodes in 16% (3/19), 

metabolic encephalopathy in 11% (2/19), and thrombotic episodes in 11% (2/19). 

Positive SARS-CoV-2 Post-Discharge

Five studies reported on patients with positive tests for SARS-CoV-2 following hospital 

discharge.44,54,55,57,60 One US study, reported that 63% (12/19) tested positive at the time of 

readmission.60 The remaining studies were from China.

44,54,55,57 In 1 of the studies, patients were 

isolated and monitored for 28 days post-discharge.54 Another required 14 days quarantine and 

requested hospital visits every 2-4 weeks.57 The third asked patients to follow-up every 7 days 

for 4 weeks.55 The fourth included 2-4 week follow-up to assess short-term outcomes postdischarge.44 Positive tests were reported in 2% to 28% of patients at follow-up times to 4 weeks 

post-discharge. 

Post-discharge Treatment

Use of oxygen therapy ranged from 6% to 7% in 2 studies reporting. One study reported that 6% 

(5/85) were receiving oxygen therapy via nasal cannula at home (time post-discharge not 

specified).

56 Wang et al reported that at 1-2 weeks after discharge 7% (9/131) were treated with 

oxygen therapy.55 At 3-4 weeks, the percentage decreased to 1% (1/131). Corticosteroid use was

4% (5/131) at 1-2 weeks and 2% (2/131) at 3-4 weeks.

A US study reported need for post-acute rehabilitation in patients undergoing surgery for hip 

fracture.

40 Ninety percent (9/17) of the COVID-19 group was receiving rehabilitation compared 

with 78.3% (83/107) of patients negative for COVID-19. The difference was not statistically 

significant (P=.61). 

In a study from the United Kingdom, new “packages of care” were required for 2.9% (2/69) of 

patients discharged and an increase in mobility aids was noted for 11.6% (8/69).61

DISCUSSION

Our review identified 42 reports of post-acute major organ damage or healthcare/service use 

outcomes in patients who were hospitalized with or for COVID-19. Eighteen studies were from 

the US; 1 multisite US study included patients from a VA Medical Center. The amount of data is 

increasing rapidly. We identified an additional 25 studies in the 2.5-month interval from our 
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original July search date. Future updates are likely to identify relevant new data. We provide 

“Key Findings”, “Limitation”, and “Suggestions for Future Research”. 

KEY FINDINGS

Key Question 1

We identified limited published post-hospital data on conditions reported to be associated with 

COVID-19 during hospitalization including pulmonary, cardiovascular, gastrointestinal,

hematologic/thrombotic, neurologic, or renal. Available evidence suggests: 

• Pulmonary fibrosis in 7% to 44%, pulmonary function below thresholds in 9% to 25%, and 

diffusing capacity for carbon dioxide “altered” or below threshold in 47% to 53%, 

• Impaired cardiovascular ejection fraction in 11% and LGE abnormalities in 22% to 32%, 

• Moderate-to-severe stroke sequelae in 29% to 83%, 

• Thromboembolism in 0.5% to 12.5%, and 

• AKD in 28% to 35%. 

We found no published post-hospital information for metabolic/endocrine or 

rheumatologic/musculoskeletal conditions.

Key Question 2

We are unable to determine if post-acute care prevalence of major organ damage varies by 

patient characteristics (eg, age, sex, race/ethnicity, pre-existing comorbidities/frailty, type of 

residence), COVID-19 disease severity, or other factors (eg, treatment for COVID-19). Few 

studies reported outcomes for subgroups of patients. 

Key Question 3

Discharge disposition (other than home: 7% to 65%) and readmission (2% to 12%) were 

frequently reported outcomes. There was little or no information about other healthcare/resource 

use outcomes including post-hospital need for ambulatory care, imaging or laboratory 

monitoring needed, or treatments (ie, medications, devices, procedures, surgery) required. 

LIMITATIONS

Additional limitations of the available evidence include:

• Available data are from studies of small, convenience samples (often from a single hospital 

site) with poorly described study populations or measures of major organ damage; 11 studies

included control groups for comparison of COVID-19 and non-COVID-19 patients. 

• Major organ damage measures were not standardized and varied considerably across studies. 

Reported prevalence rates are likely highly dependent on the measures used to assess and 

define major organ damage as well as the population being evaluated. 
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• Most studies assessed outcomes at discharge or had short follow-up post-discharge; longterm major organ damage prevalence and healthcare/service use needs are unknown. 

• The contribution of comorbidities (prior to COVID-19 infection) to post-acute prevalence 

cannot be determined. 

Limitations of our review methods include: 

• We defined “post-acute COVID” as patients being post-hospital discharge. The applicability 

of these findings to non-hospitalized patients with acute COVID symptoms is unknown; this 

was out of our scope. 

• Our literature search was through October 6, 2020 and would not have included information 

published after that date. Ongoing living review rapid review methods are needed to capture 

additional information. 

FUTURE RESEARCH

Given the gaps in, and limitations of, the existing evidence, we suggest the following as a guide 

for future research to better inform healthcare systems as they plan for on-going care of patients 

recovering from COVID-19. 

Population 

We chose to define post-acute as post-hospitalization but other definitions may be appropriate. 

For example, patients with acute COVID-19 who are not hospitalized may have “post-acute” 

major organ damage. Limiting the scope of this review to patients hospitalized for acute COVID 

likely underestimates the total burden of post-acute major organ damage. This should be 

acknowledged for resource allocation planning in the future. Furthermore, we did not identify 

studies that assessed “long-haulers” or “long COVID” (ie, people who have either recovered 

from COVID-19 but still report lasting effects or who have had the usual symptoms for longer 

than might be expected).63 This is a poorly defined entity and no published data were available. 

Additionally, there are likely important difference in patients hospitalized for COVID-19 versus 

patients hospitalized for another indication who have a positive COVID-19 test.. We chose to 

include both but this could influence prevalence, severity, and causality of findings. We also 

limited eligibility to studies that assessed patients with “confirmed” COVID-19. While this 

increases the specificity and accuracy of our review it also likely underestimates the burden of 

post-acute complications when also including patients with suspected COVID-19. 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, type of residence (eg, independent living, assisted living, nursing home), 

COVID-19 severity, and treatment received. Ideally, researchers would be able to link preCOVID-19 data with post-COVID-19 data. Without pre- and post- data, it is difficult to isolate 

the effects of COVID-19. 
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Comparator

The use of matched non-COVID-19 control groups would allow for a better understanding of the 

effects of COVID-19. Without appropriate comparators and information on pre-COVID 

conditions it is not possible to accurately determine the effect that COVID-19 has on post-acute 

health outcomes or the incremental effects versus controls without COVID-19. Nonetheless, 

given ongoing health and health care concerns associated with COVID-19, uncontrolled reports 

among patients with COVID-19 are still informative for care planning.

Outcomes 

Many studies, excluded from our review, reported mean and median values of laboratory, 

radiologic, or physiologic measures. These data do not provide prevalence outcomes. Future 

research should include measures that will reflect prevalence of major organ damage or disease 

based on accepted definitions of disease, even if defined as asymptomatic laboratory, radiologic, 

or physiologic measures. Although many conditions have been reported to be associated with 

COVID-19 while patients are hospitalized, there has been little or no published post-hospital data 

for most of those conditions. Many reports were convenience samples and used testing measures 

available at that facility or selected for reporting for unclear reasons. Criteria for outcome 

assessment, reporting and definition will have important implications on major organ damage 

prevalence and severity.

Timing 

Future research should include standardized and longer follow-up. 

Setting 

Information on major organ damage prevalence and healthcare/service use needs of nonhospitalized patients is also needed.

ONGOING DATA COLLECTION

We are aware of several ongoing studies: 

• A study of COVID-19 sequelae among Veterans treated in the VA 

(https://www.hsrd.research.va.gov/research/abstracts.cfm?Project_ID=2141707422), 

• A natural history study of COVID-19 titled “Epidemiology, Immunology and Clinical 

Characteristics of Emerging Infectious Diseases with Pandemic Potential” (EPICC-EID); a 

collaboration between the VA and the Department of Defense to better understand the 

clinical course of COVID-19 (https://www.research.va.gov/covid-19.cfm) 

• Aa study sponsored by UK-based Perspectum Diagnostics 

(https://www.bioworld.com/articles/434620-perspectum-launches-study-of-post-covid-19-

organ-damage), 

• The Post-hospital COVID (PHOSP-COVID) study.63 
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• A multicenter observational registry, the North American COVID-19 ST-Segment-Elevation 

Myocardial Infarction (NACMI) registry, to collect data on ST elevation in COVID-19 

patients to determine the etiology and associated clinical outcomes.64 

Several major healthcare systems have established multidisciplinary post-COVID care clinics 

including the Mount Sinai (New York) Center for Post-COVID Care, the Penn Medicine PostCOVID Recovery Clinic, University of California San Francisco’s OPTIMAL Clinic, the 

University of Michigan’s Post ICU Longitudinal Survivor Experience (PULSE) Clinic (now 

focused on post-COVID-19), and the Mayo Clinic COVID Activity Rehabilitation Program 

(CARP). Anticipated post-acute care rehabilitation needs of patients and guidance on how to 

address those needs have been reported.65-74 There is an emphasis on multi-disciplinary programs 

to address respiratory, cardiovascular, thromboembolism, and neurological sequelae along with 

physical function and mental health needs. Patient groups have also been organized with a focus 

on long-term symptoms. These include Survivor Corps (https://www.survivorcorps.com/) and 

the COVID-19 “Long Hauler” Symptoms Survey,15 the Body Politic COVID-19 support group 

(https://www.wearebodypolitic.com/covid19), Long Covid SOS in the UK 

(www.longcovidsos.org), and the COVID Symptom Study with an app to study symptoms and 

track the spread of the virus (https://covid.joinzoe.com/us-2). 

CONCLUSIONS

Our systematic review of the literature yielded limited early published data on post-acute 

COVID-19 major organ damage and healthcare/service use needs. The majority of studies were 

from outside the United States; only 1 study enrolled patients from a VA Medical Center. There 

was little information on patient-centered, clinical health outcomes. Available data are from 

studies of convenience samples with poorly described study populations and primarily 

physiologic outcomes; few included control groups for comparison of COVID-19 and nonCOVID-19 patients. Studies of pulmonary function were most common and, although there were 

reports of pulmonary fibrosis, imaging abnormalities, and reduced pulmonary function, 

interpretation is difficult due to the absence of pre-COVID-19 data. Future research should 

attempt to include clear descriptions of the patient populations and the timing of outcome 

assessment with respect to hospitalization, link pre-COVID-19 data with post-COVID-19 data, 

and assess outcomes that allow for determination of prevalence of major organ damage and 

healthcare/service use needs.
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ACKNOWLEDGMENTS 

This topic was developed in response to a nomination by Joe Francis MD, Chief Improvement

and Analytics Officer for the Office of the Under Secretary for Health for the purpose of 

informing national VA planning efforts to support Veterans after hospital discharge for COVID19. The scope was further developed with input from the Operational Partners, the ESP

Coordinating Center, and the review team.

In designing the study questions and methodology at the outset of this report, the ESP consulted 

several technical and content experts. Broad expertise and perspectives were sought. Divergent

and conflicting opinions are common and perceived as healthy scientific discourse that results in

a thoughtful, relevant systematic review. Therefore, in the end, study questions, design, 

methodologic approaches, and/or conclusions do not necessarily represent the views of 

individual technical and content experts. 

The authors gratefully acknowledge Julia Haskin for editorial support, and the following

individuals for their contributions to this project: 

Operational Partners

Operational partners are system-level stakeholders who have requested the report to inform 

decision-making. They recommend Technical Expert Panel (TEP) participants; assure VA

relevance; help develop and approve final project scope and timeframe for completion; provide 

feedback on draft report; and provide consultation on strategies for dissemination of the report to 

field and relevant groups. 

David Atkins, MD, MPH

Director, Health Services Research and Development

Joseph Francis, MD

Chief Improvement & Analytics Officer, Office of Performance Measurement
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2020;56(6):2002197.
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APPENDIX A. SEARCH STRATEGIES

MEDLINE/EMBASE

1 (coronavir* or corona virus* or betacoronavir* or covid19 or covid 19 or nCoV or CoV 2 or CoV2 or 

sarscov2 SARS 2 or SARS-CoV-2 or 2019nCoV or 2019 novel coronavirus* or 2019 novel CoV or 

wuhan virus* or ((wuhan or hubei or huanan) and (severe acute respiratory or pneumonia*))).ti,ab,kw. 

2 Coronavirus Infections/ or Coronavirus/ or betacoronavirus/ 

3 1 or 2 

4 Pulmonary fibrosis.ti,ab,kw. or exp Pulmonary Fibrosis/ 

5 exp Lung Diseases, Obstructive/ 

6 4 or 5 

7 acute kidney injury.ti,ab,kw. or exp Acute Kidney Injury/ 

8 exp Renal Insufficiency, Chronic/ 

9 (end stage renal disease or ESRD or AKI or CKD).ti,ab,kw. 

10 7 or 8 or 9

11 myocardial infarction.ti,ab,kw. or exp Myocardial Infarction/ 

12 (heart attack or heart failure or MI).ti,ab,kw. 

13 myocarditis.ti,ab,kw. or exp Myocarditis/ 

14 exp Arrhythmias, Cardiac/ 

15 arrhythmia*.ti,ab,kw. 

16 11 or 12 or 14 or 14 or 15 

17 exp Venous Thrombosis/ 

18 exp Pulmonary Embolism/ or exp Venous Thromboembolism/ 

19 (deep ve* thrombosis or DVT or pulmonary embolism or PE).ti,ab,kw. 

20 anemia.ti,ab,kw. or exp Anemia/ 

21 17 or 18 or 19 or 20 

22 stroke.ti,ab,kw. or exp Stroke/ 

23 exp Cognitive Dysfunction/ 

24 exp Confusion/ 

25 exp Seizures/ 

26 exp Headache/ 

27 (stroke* or cerebrovascular accident* or cognitive impairment or cognitive dysfunction or delirium or 

confusion or seizure* or headache*).ti,ab,kw. 

28 22 or 23 or 24 or 25 or 26 or 27 

29 exp Diabetes Mellitus/ 

30 diabetes.ti,ab,kw. 

31 29 or 30 

32 exp Hepatitis/ 

33 exp Colitis/ 

34 (hepatitis or hepatocellular injur* or colitis).ti,ab,kw. 

35 32 or 33 or 34 

36 "Autoimmune Diseases of the Nervous System"/ 

37 autoimmune disease*.ti,ab,kw. 

38 Musculoskeletal Diseases/ 

39 musculoskeletal.ti,ab,kw. 

40 36 or 37 or 38 or 39 

41 6 or 10 or 16 or 21 or 28 or 31 or 35 or 40 

42 exp Hospitalization/ or exp Intensive Care Units/ or Inpatients/ or Subacute Care/ 

43 (hospital or hospitalized or hospitalization or intensive or ICU or care or post?acute or inpatient or 

inpatients or admit or admitted or admitting).ti,ab,kw. 

44 42 or 43 

45 3 and 41 and 44 

46 limit 45 to english language 

47 limit 46 to yr="2019 -Current" 
COVID-19 Post-acute Care Major Organ Damage Evidence Synthesis Program

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COCHRANE LIBRARY

1 MeSH descriptor: [Coronavirus] explode all trees

2 (coronavirus):ti,ab,kw

3 (betacoronavirus):ti,ab,kw

4 (covid19):ti,ab,kw

5 (covid 19):ti,ab,kw

6 (nCoV):ti,ab,kw

7 (CoV2):ti,ab,kw

8 (CoV2):ti,ab,kw

9 (OR #1-#8)

10 ("pulmonary fibrosis"):ti,ab,kw

11 MeSH descriptor: [Pulmonary Fibrosis] this term only

12 MeSH descriptor: [Lung Diseases, Obstructive] explode all trees

13 (acute kidney injury):ti,ab,kw

14 MeSH descriptor: [Acute Kidney Injury] this term only

15 MeSH descriptor: [Renal Insufficiency, Chronic] this term only

16 ("end stage renal disease"):ti,ab,kw

17 (ESRD):ti,ab,kw

18 (AKI):ti,ab,kw

19 (CKD):ti,ab,kw

20 ("myocardial infarction"):ti,ab,kw

21 MeSH descriptor: [Myocardial Infarction] this term only

22 ("heart attack"):ti,ab,kw

23 ("heart failure"):ti,ab,kw

24 (myocarditis):ti,ab,kw

25 MeSH descriptor: [Myocarditis] this term only

26 (arrhythmia*):ti,ab,kw

27 MeSH descriptor: [Arrhythmias, Cardiac] this term only

28 MeSH descriptor: [Venous Thrombosis] this term only

29 MeSH descriptor: [Pulmonary Embolism] this term only

30 MeSH descriptor: [Venous Thromboembolism] this term only

31 ("deep venous thrombosis"):ti,ab,kw

32 ("pulmonary embolism"):ti,ab,kw

33 (anemia):ti,ab,kw

34 MeSH descriptor: [Anemia] this term only

35 MeSH descriptor: [Stroke] this term only

36 MeSH descriptor: [Cognitive Dysfunction] this term only

37 MeSH descriptor: [Confusion] this term only

38 MeSH descriptor: [Seizures] this term only

39 MeSH descriptor: [Headache] this term only

40 (stroke*):ti,ab,kw

41 ("cerebrovascular accident"):ti,ab,kw

42 ("cognitive impairment"):ti,ab,kw

43 ("Cognitive dysfunction"):ti,ab,kw

44 (delirium):ti,ab,kw

45 (confusion):ti,ab,kw

46 (seizure*):ti,ab,kw

47 (Headache*):ti,ab,kw

48 (diabetes):ti,ab,kw

49 MeSH descriptor: [Diabetes Mellitus] this term only

50 MeSH descriptor: [Hepatitis] this term only

51 MeSH descriptor: [Colitis] this term only

52 (hepatitis):ti,ab,kw

53 ("hepatocellular injur*"):ti,ab,kw

54 (colitis):ti,ab,kw

55 MeSH descriptor: [Autoimmune Diseases of the Nervous System] this term only
COVID-19 Post-acute Care Major Organ Damage Evidence Synthesis Program

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56 ("autoimmune disease"):ti,ab,kw

57 MeSH descriptor: [Musculoskeletal Diseases] this term only

58 (musculoskeletal):ti,ab,kw

59 (OR #10-#58)

60 (hospitalized):ti,ab,kw

61 (hospital):ti,ab,kw

62 (hospitalization):ti,ab,kw

63 ("intensive care"):ti,ab,kw

64 (ICU):ti,ab,kw

65 (Post-acute):ti,ab,kw

66 (Post acute):ti,ab,kw

67 (inpatient*):ti,ab,kw

68 (admit*):ti,ab,kw

69 MeSH descriptor: [Hospitalization] explode all trees

70 MeSH descriptor: [Intensive Care Units] this term only

71 MeSH descriptor: [Inpatients] this term only

72 MeSH descriptor: [Subacute Care] this term only

73 (OR #60-#72)

74 #9 AND #59 AND #73
COVID-19 Post-acute Care Major Organ Damage Evidence Synthesis Program

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APPENDIX B. PEER REVIEWER COMMENTS AND RESPONSES

Question Text Comment Response

Are the objectives, 

scope, and methods 

for this review clearly 

described?

Yes Thank you

Yes 

Yes 

Yes 

Yes

Is there any indication 

of bias in our 

synthesis of the 

evidence?

No Thank you

No 

No 

No 

No 

Are there any 

published or 

unpublished studies 

that we may have 

overlooked?

No Thank you

No 

No 

No 

No 

Additional 

suggestions or 

comments can be 

provided below. If 

applicable, please 

indicate the page and 

line numbers from the 

draft report.

Comments:

- We note that this is one of a series of 3 rapid reviews by VAESP addressing post-acute care. One of the other reviews 

addresses rehab/functional status. This review focuses on 

major organ damage. The review that focuses on 

rehab/functional status is likely to be of particular interest to 

GEC.

- This review sets out in detail the thorough steps taken to 

define the topics of interest, in consultation with appropriate 

operational leadership and SMEs. The search strategy and 

steps to narrow down to the final set of papers for full review 

are clearly laid out an appear (without reading all the papers) 

to be appropriate and well done.

- The authors set out a good set of Key Questions, as follows:

- The key questions from start of report:

Thank you.
COVID-19 Post-acute Care Major Organ Damage Evidence Synthesis Program

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Question Text Comment Response

o 1. What is the post- acute care prevalence of major organ 

damage among adults hospitalized with or for proven COVID19 disease?

o 2. Does the post-acute care prevalence of major organ 

damage among adults with or for COVID-19 disease vary by 

patient characteristics (age, sex, race/ethnicity, preexisting 

co-morbidities, etc.), COVID-19 disease severity, or other 

factors (eg, treatment for COVID-19)?

o 3. What are the short (< 3 months) and long-term (≥ 3 

months) healthcare or service use needs of adults surviving 

COVID-19 disease with major organ damage?

- The flow diagram shows: Identified 2954 records from 

databases. Narrowed down to 17 references that had 

information meeting the criteria for inclusion. This is a type of 

narrowing down often seen in evidence reviews. Even with 

the relatively liberal set of inclusion criteria, in order to cast a 

wide net in search of answers to the Key Questions, only 17 

references met the criteria, which is the state of the literature 

(not surprisingly given the timing).

- For characteristics that are desirable to include but which 

are not addressed in publication, would it be possible to 

include in the report a statement about what is missing (to 

provide encouragement for the field to consider in future 

papers)?

- There is a plan to update periodically, which is good, given 

the rapidly evolving knowledge of COVID-19

- The age ranges are reported; however there is relatively 

little information about older adults specifically. Since COVID19 has a markedly higher rate among older adults it would be 

helpful if whatever data are available from the literature on 

older adults could be called out separately.

o Residents in skilled nursing facilities (SNF) account for a

very substantial portion of the overall affected deaths of 

patients with COVID-19. It would be helpful if the review could 

call out separately any information about patients from SNFs.

- Comment on Key Question 2 re patient characteristic:

o Race/ethnicity has emerged as a prominent factor in rates 

of COVID-19. There have been reports that relate these to 

living environment (eg, denser housing) and working in 

-Our Future Research section identifies 

considerations for future research studies

-We agree and anticipate more data for future 

updates. 

-Most studies included all adults (age 18 and 

older); 2 had upper age limits for inclusion (1 

enrolled only those under 85 years and 1 enrolled 

only those 65 or younger). We aren’t able to call 

out results from older adults 

-Two studies reported on residence – 16% were 

nursing home residents in 1 study; 10% were 

care home residents in another. We aren’t able to 

call out results from nursing home residents.

Thank you for the suggestion. We added several 

patient characteristics to the Analytic Framework 

and KQ2. 
COVID-19 Post-acute Care Major Organ Damage Evidence Synthesis Program

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Question Text Comment Response

settings with more exposure (eg, essential workers, work w/o 

PPE). Is it possible to include these factors in the patient 

characteristics in Key Question 2?

o Is it possible to include underlying frailty (which is related to 

but different from a count of co-morbidities and/or age) in the 

patient characteristics?

- The Key Findings reported are mostly limitations of the 

studies available rather than findings from the studies, either 

individually or pooled. Were there no findings at all that could 

help inform post-acute care? Readers of the ESP review will 

be looking for what can be gleaned from the existing literature 

to inform practice. While including the limitations of the 

literature identified is important, this can be done in the 

Limitations section. It would be more helpful to clinical 

readership if the Key Findings could include more than 

findings about the state of the literature and could include any 

observations that can be made about post-acute organ 

damage.

- Recommend that Discussion section revisits the original Key 

questions and goes through each one, describing what 

information is available or not available to answer the 

question and providing answers to the Key Questions to 

whatever extent is possible.

o If it is possible to give a prevalence based on 1 or 2 papers, 

limited in generalizability because of the limitations of the 

papers, give the prevalence from those 1 or 2 papers with the 

limitation on the population, and explain why it is not possible 

to answer the question more broadly

- 

- There were 17 included studies. Table 2 shows 18 studies. 

Presumably 1 study is in 2 columns of organ system. A table 

footnote clarifying this would be helpful

- Note that the section on Overview of included studies 

reports not only what were the outcomes tracked but also give 

the findings. This may be a part of ESP style in which case 

this is fine. Noting it in case this is not specifically ESP style

Minor/editing comments:

- No studies reported a measure of frailty; we 

agree with the suggestion and added frailty to the 

list of patient characteristics, 

- With the addition of 25 studies following peer 

review, we now offer prevalence ranges for 

several outcomes (see Table 2 and Key 

Findings). However, at this point, we also 

consider limitations of the available evidence to 

be a Key Finding. We hope that future reports of 

post-acute organ damage will allow for more 

insight into post-acute organ damage and care

needs. 

Thank you for the suggestion. The Discussion 

section has been reorganized to provide 

responses to the Key Questions. 

As noted above, we now provide prevalence 

ranges for several outcomes. 

Thank you for this observation. You are correct 

that 1 study is in 2 columns. We clarified this on 

the table. 

Thank you for noting this. The headings have 

been revised.

Thank you for these comments. We added a 

legend to Table 2. 
COVID-19 Post-acute Care Major Organ Damage Evidence Synthesis Program

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Question Text Comment Response

- In Table 2, suggest identifying the major organs of interest 

by words as well as the graphics. Could be in the table 

legend. Most are clear but a few are not.

- Should carefully distinguish patients who had COVID-19 (the 

disease) versus patients who were SARS CoV2 test positive 

and may or may not have had COVID-19. For example, on 

page 2 line 51, did all patients actually have the disease, or 

were some test positive and may have had the disease (or 

may not)?

Appendix C, Table 1. Study Characteristics 

describes the study population as reported by the 

study authors. In the Results section, we verified 

that we clearly distinguish studies where patients 

were hospitalized for another indication and 

tested positive for COVID-19.

Very nice and encouraging that more permanent organ 

damage was not found.

Thank you although we expect additional data will 

be forthcoming that may change this observation.

Thank you for the opportunity to review this rapid and 

extensive review of published literature. It is a solid report and 

extremely helpful to those of us conducting research and 

planning research on this topic. I have a couple suggestions 

that I think would improve the report, especially given that 

many of the studies rely on a wide range of data and varying 

data sources. My suggestions are below:

P.7-regarding exclusion criteria, were any studies excluded 

due to retraction or quality of the study or study data? Given 

the problems experienced during the pandemic with the rapid 

publication process of some studies, such as the Surgisphere 

authored studies, attention to potential quality of studies is a 

sensitive issue. Although some elements based on the Briggs 

model for case series are noted and presented in detail in 

Table 2, you might want to address aspects related to 

observational study (retrospective and prospective) quality 

explicitly in your review methods. Notably the table 2 currently 

lacks any assessment of the data sources or the data quality. 

You may want to consider other criteria, such as that 

described by the STROBE- Altman D, Egger M, Pocock S,

Vandenbrouke JP, von Elm E: Strengthening the reporting of 

observational epidemiological studies. STROBE Statement: 

Checklist of Essential Items; and most current Version 2007 -

https://www.strobe-statement.org/index.php?id=availablechecklists. This critical appraisal tool importantly includes 

some items to assess data and data sources.

Thank you

P.7 We did not exclude studies for study quality.

As of December 1, 2020, none of the studies has 

been retracted.

We chose to continue to use the modified version 

of the Joanna Briggs checklist to identify overall 

study limitations. Although it would provide some 

guidance for critical appraisal, the STROBE 

checklist is intended to improve reporting by 

authors of observational studies. 
COVID-19 Post-acute Care Major Organ Damage Evidence Synthesis Program

35

Question Text Comment Response

P.13-I suggest adding as part of the guidance that some 

detail about the data collection and or data sources should be 

included in the studies ( and as noted above). NHLBI also 

provides has some good guidance on study data monitoring 

that explicate the process for data monitoring. Whether such 

procedures were applied in a study and reported in their 

manuscript could also be applied in a review. Guidance to 

researchers in reporting their studies should be encouraged 

to report about the extent of oversight and principles applied. 

Such as was there a Observational Study Data Monitoring 

Board (OSMB) or a protocol review committee in place and 

the members and frequency of review. This information about 

the study may inform how well the study was conducted and 

give more confidence in the study quality and results.

I look forward to the final version of the rapid review.

P.13 As noted in the report, most of these early 

studies were convenience samples of patients 

admitted to a single hospital facility. We agree 

that data collection techniques and oversight are 

important and we will consider expanding on this 

in future versions of this living review.

I think the report could more clearly identify different 

questions of interest that have different implications for study 

design:

1) If intent is purely descriptive/predictive, no control 

group may be necessary but the study population needs to be 

carefully described – need to distinguish severity of infection 

and whether selected for organ involvement or not. I think a 

weakness worth adding is that none included an inception 

cohort – i.e. all patients infected, or all patients hospitalized 

with COVID.

2) If the purpose is to tease out COIVD specific effects, 

it is important to have a comparable control group – e.g. 

influenza for pulmonary complications; other age/matched 

hospitalized patients for other organ effects, etc. 

3) The effects of changing treatment need to be called 

out – likely different now that patients being treated earlier 

with steroids.

Thank you for the suggestions. We reviewed and 

modified our Future Research section. 

Thank you for the opportunity to review this VA Evidence 

Synthesis Program rapid review on post-acute COVID-19 

major organ damage – the topic is highly relevant to the 

ongoing care of our patients. The manuscript documents 

registration with PROSPERO and includes a detailed 

discussion of methodology (PRISMA-based).

Thank you
COVID-19 Post-acute Care Major Organ Damage Evidence Synthesis Program

36

Question Text Comment Response

1. Suggest inclusion of the PRISMA checklist as is customary 

in systematic reviews (for example, as one of your 

appendices) – the subcomponent steps appear to be present; 

linking the checklist to the document will ensure 

completeness, facilitate review(s), and enhance end-user 

confidence in your results.

2. Page 10, lines 53-56. Can you clarify what the disposition 

was of the other patients in this study (n=114)? It appears that 

49 were discharged home (35%) but only 13 (9%) were 

transferred to a “rehabilitation” center. Readers may wonder 

what happened with the majority of patients in this study (the 

other 52 patients).

3. Typos page 11, line 11-15: you’ll need to choose between 

saying a % “of patients” or just a % without an object (object 

implied). For example, line 11 currently reads “The authors 

noted that 4% (4/108) patients initially discharged home...” 

Suggest adding “of” before “patients” in this sentence. Same 

issue in the following sentence.

4. Page 11, line 17. Strongly suggest you clarify that these 

studies are not actually reporting recurrence of COVID-19, 

which are you know has indeed been reported now but which 

is not what these studies are reporting. Rather, it’s rates of 

positive testing – almost certainly rates of continued positivity 

versus reinfection.

5. Key Finding bullet point 4, “...little or no information on 

post-hospital care...” The last paragraph on page 10 

describes four studies (one very small one) that report rates 

of transfer to rehabilitation settings. Two thoughts: first, these 

rates of needing formal post-acute care in a facility seem to 

be lower than what we are seeing. Second, suggest you 

indicate in the body of the text that details on what the postacute care needs were (in these studies) was not reported. 

The key finding here reads like it’s introducing information 

(the lack of detail on post-acute care needs) rather than 

summarizing what you’ve presented in the text.

6. The last two key findings seem like limitations. Suggest 

moving them into the limitations section.

7. Page 12, line 46-7: as you are making recommendations 

1. Thank you for the suggestion. 

2. We clarified that the numbers are for patients 

who were discharged. In-hospital deaths and 

patients remaining hospitalized were not 

represented in these numbers.

3. We reviewed the document and corrected as 

needed. This particular sentence is no longer 

included in the final document. 

4. Thank you for the suggestion. We clarified the 

recurrence data.

5. Thank you. This bullet has been revised to 

provide detals on what types of post-acute care 

we were looking for (outlined in our Analytic 

Framework).

6. We modified the Key Findings and Limitations 

sections. 
COVID-19 Post-acute Care Major Organ Damage Evidence Synthesis Program

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Question Text Comment Response

around future research, suggest you not phrase this as a 

question. Rather, state what populations future research 

should / should not include and the need to define them in 

whatever ways you suggest.

7. Thank you for the suggestion. We removed this 

line.

Page 6: Under the 'Potential Healthcare or Service Use 

Needs' box in the flow map, under 'Treatments', should there 

be reference to OT and PT post discharge needs?

Thank you for the suggestion – we added OT and 

PT to the Framework.
COVID-19 Post-acute Care Major Organ Damage Evidence Synthesis Program

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APPENDIX C. EVIDENCE TABLES

Table 1. Study Characteristics 

Author, Year

Country 

Study Design

Funding

Inclusion/Exclusion Criteria Baseline Demographic Data

Hospitalization Characteristics

Time of Post-hospital Follow-up

Outcomes Reported and 

Method of Assessment

Al Kasab, 202021

USA, South

America, Europe

(28 centers)

Prospective

Funding: None

Inclusion: Consecutive patients

undergoing mechanical

thrombectomy (MT) for large

vessel occlusion; symptomatic

patients were tested with RTPCR methods

Exclusion: None reported

N=13 COVID positive (NOTE: 458

patients underwent MT; 242 were

tested for COVID)

Age (years, median): 58

Gender (% male): 62

Race: 46% white

Comorbidities: NR

CVD: 

CKD: 

COPD: 

DM: 

HTN: 

Obesity: 

Smoking:

COVID-19 severity: NR

ICU admission: NR

Mechanical ventilation: 39%

Length of hospital stay (median): 8 

days

Time post-hospital: 0 days

(discharge)

Modified Rankin Scale

Alharthy, 202022

Saudi Arabia

Prospective

Funding:

Hospital

Inclusion: Age >18 years;

confirmed serious COVID-19

pneumonia (RT-PCR for

SARS-CoV-2); ICU admission

Inclusion: Did not undergo

POCUS; 2 consecutive

negative RT-PCR results at

least 24 hours apart

N=89

Age (years, median): 43

Gender (% male): 84

Race: NR

Comorbidities: NR

CVD: 

CKD: 

COPD: 

DM: 

HTN: 

Obesity: 

Smoking:

COVID-19 severity: 100% severe

ICU admission: 100%

Mechanical ventilation: 84% on

ICU admission; 100% within 48

hours

Length of hospital stay: NR

Time post-hospital: 0 days

(discharge)

POCUS (thorax) and vascular

ultrasound of lower limbs;

chest CT if high suspicion of

PE

Atalla, 202060

USA

Inclusion: Discharged from

hospital; confirmed COVID-19

(RT-PCR for SARS-CoV-2);

N=339 (n=19 readmitted, n=320 not

readmitted)

Age (years, median): 61

COVID-19 severity: NR

ICU admission: 33%

Discharge disposition (for

readmitted patients)
COVID-19 Post-acute Care Major Organ Damage Evidence Synthesis Program

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Author, Year

Country 

Study Design

Funding

Inclusion/Exclusion Criteria Baseline Demographic Data

Hospitalization Characteristics

Time of Post-hospital Follow-up

Outcomes Reported and 

Method of Assessment

Retrospective

Funding: Not 

reported

criteria for hospital admission

were individualized – in general

patients with significant

comorbidities and moderate to

severe COVID-19 (requiring O2

and having abnormal imaging

findings) were admitted

Exclusion: None reported

Gender (% male): 56

Race: 37% Hispanic, 1% Asian, 16%

African American, 43% Caucasian, 3%

Other

Comorbidities:

CVD: NR

CKD: 11%; P=NS between groups

COPD: 15%

Readmitted: 58%, Not Readmitted:

13%; P<.001

DM: 33%

Readmitted: 58%, Not Readmitted:

32%; P=.021

HTN: 45%

Readmitted: 68%, Not Readmitted:

44%; P=.038 

Obesity: 40%; P=NS between groups

Smoking: NR

Readmitted: 11%, Not

Readmitted: 34%; P=.032

Mechanical ventilation: 19%

Readmitted: 0%, Not Readmitted:

20%; P=.030

Length of hospital stay (median): 7 

days (IQR 4-15)

Time post-hospital: followed for 30

days

Readmission to 30 days

Reason for readmission

PCR, imaging, and support

needed on readmission

NOTE: Patients discharged

were instructed to see medical

care for relapse of fever,

shortness of breath, 

neurological or thrombotic

events, or any change in

clinical status; patients

received a post-discharge

follow-up call to monitor

recovery process

Benussi, 202023

Italy

Retrospective

cohort

Funding: None

Inclusion: Adult (≥18 years)

admitted primarily for

neurological disease; had

outcome of discharge (home or

rehabilitation facility) or death;

SARS-CoV-2 detected by RTPCR methods; confirmed

COVID-19

Exclusion: None reported

NOTE: reporting data only for

patients with cerebrovascular

disease on admission

N=111 (43 with COVID-19; 68 nonCOVID-19)

Age (years, mean): 76

Gender (% male): 56

Race: NR

Comorbidities:

CVD: 14%

CKD: 5%

COPD: NR

DM: 22%

HTN: 69%

Obesity: NR

Smoking: 6%

COVID-19 severity: NR

ICU admission: NR

Mechanical ventilation: NR

Length of hospital stay: 5 days

Time post-hospital: 0 days

(discharge)

NIH Stroke Scale at discharge

for COVID-19 and nonCOVID-19 cases

“Good” outcome

Casas-Rojo,

202038

Spain

Inclusion: Spanish Society of

Internal Medicine registry; age

≥18 years; first hospital

N=15,111

Age (years, median): 69

Gender (% male): 57

COVID-19 severity: NR

ICU admission: 8%

Readmission within 30 days
COVID-19 Post-acute Care Major Organ Damage Evidence Synthesis Program

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Author, Year

Country 

Study Design

Funding

Inclusion/Exclusion Criteria Baseline Demographic Data

Hospitalization Characteristics

Time of Post-hospital Follow-up

Outcomes Reported and 

Method of Assessment

Retrospective

cohort

Funding:

Foundation/Soci

ety

admission; hospital discharge

or in-hospital death

(consecutive patients with

confirmed SARS-CoV-2 

(positive RT-PCR or positive

result on serological testing

and compatible clinical

presentation) were eligible

Exclusion: Subsequent

admissions of the same

patient; denial or withdrawal of

consent

Race: 90% Caucasian, 10% Other

Comorbidities:

CVD: 20%

CKD (moderate-severe): 6% 

COPD: 7%

DM: 19%

HTN: 51%

Obesity (BMI ≥30 kg/m2): 21%

Smoking: 69% Never, 25% Moderate,

5% Current

NOTE: 4% were healthcare workers

Mechanical ventilation: 7%

Invasive, 5% Non-invasive

Length of hospital stay: 10 days

(range 1-62) (discharged patients)

Time post-hospital: median followup 40 days (range 0-102 days)

Chan, 202024

USA

Retrospective

Funding: Several

authors report

funding; unclear

if related to

manuscript

Inclusion: Age ≥18, laboratoryconfirmed SARS-CoV-2 and

COVID-19 admitted to 1 of 5 

Mount Sinai Health System

hospitals 2/27/20-5/30/20

Exclusion: Known end stage

kidney disease prior to

admission; hospitalized <48

hours, missing laboratory and

vital signs during

hospitalization

N=3,993 (demographics for all

patients admitted; 3,869 [97%] were

discharged) (NOTE: 46% 

(1,835/3,993) experienced AKI while

hospitalized) 

Age (years, median): 64

Gender (% male): 57

Race: White 24%, Black 36%,

Hispanic 26%, Asian 4%, Other or

unknown 19% 

Comorbidities:

CVD: NR

CKD: 11% 

COPD: NR

DM: 26% 

HTN: 38% 

Obesity: NR

Smoking: NR

COVID-19 severity: NR

ICU admission: 24% (976/3993) 

Mechanical ventilation: 23% 

(929/3993) 

Length of hospital stay

(discharged patients, median): AKI

group 10 days, no AKI group 7 

days (P<.001)

Time post-hospital: 0 days

(discharge)

AKI; compared last hospital

creatinine with baseline;

grouped as recovered or with

AKI Stage 1, 2, or 3 

Recovered: difference in

creatinine is ≤0.3 and change

in % ≤25%

Stage 1: difference >0.3 and

change >25% and ≤100%

Stage 2: change in % >100%

and ≤200%

Stage 3: change in % >200%

Collins, 202025

USA

Retrospective

Inclusion: Persons with HIV

admitted with COVID-19

(detection of SARS-CoV-2 via

RT-PCR)

N=20

Age (years, median): 57

Gender (% male): 65

COVID-19 severity: NR

ICU admission: 30%

Discharge disposition
COVID-19 Post-acute Care Major Organ Damage Evidence Synthesis Program

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Author, Year

Country 

Study Design

Funding

Inclusion/Exclusion Criteria Baseline Demographic Data

Hospitalization Characteristics

Time of Post-hospital Follow-up

Outcomes Reported and 

Method of Assessment

Funding:

University

Exclusion: None reported

NOTE: study sites included

Atlanta Veterans Affairs

Medical Center

Race: 85% Non-Hispanic Black, 5%

Non-Hispanic White, 5% NonHispanic/Multiracial, 5%

Hispanic/Latino

Comorbidities:

CVD: 30%

CKD: 25%

Chronic lung disease: 30%

DM: 45%

HTN: 70%

Obesity: 30

Smoking: 50% Current, 10% Former,

40% Never

Mechanical ventilation: 15%

Length of hospital stay (days,

median): 5 

Time post-hospital: 0 days

(discharge)

Curci, 202026

Italy

Cross-sectional

Funding: None

Inclusion: Consecutive referrals

to rehabilitation unit; adults

(>18); diagnosis of viral

interstitial lung disease (CT);

positive for SARS-CoV-2 (RTPCR); previously hospitalized

in ICU; clinical stability (able to

perform bedside mobilization

without reduction in oxygen

saturation below 90%);

complete weaning from

sedative and antipsychotic

drugs

Exclusion: Respiratory distress

signs; cognitive impairment;

need of respiratory support

(FiO2 >60%); need of CPAP

devices; signs of

cardiovascular instability

N=32*

Age (years, mean): 73

Gender (% male): 69

Race: NR

Comorbidities:

CVD: NR

CKD: NR

COPD: 6%

DM: 19%

HTN: 63%

Obesity: NR

Smoking: 28%

*Subgroups

1) FiO2 ≥21% and <40% (n=13);

without oxygen support devices or

wearing nasal cannula

2) FiO2 ≥40% and <60% (n=19);

wearing non-rebreather mask, Venturi

mask, or oxygen mask

COVID-19 severity: NR

ICU admission: 100%

Mechanical ventilation: NR

Length of hospital stay: 16.4 days

(patients went from ICU to

rehabilitation unit) 

Time post-hospital: at admission

to rehabilitation unit

Degree of alteration in

PaO2/FiO2 ratio

Respiratory supports needed

Dyspnea scale (levels)
COVID-19 Post-acute Care Major Organ Damage Evidence Synthesis Program

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Author, Year

Country 

Study Design

Funding

Inclusion/Exclusion Criteria Baseline Demographic Data

Hospitalization Characteristics

Time of Post-hospital Follow-up

Outcomes Reported and 

Method of Assessment

Dennis, 202039

United Kingdom

Prospective

PREPRINT

Funding:

Government

Inclusion: Positive for SARSCoV-2 by RT-PCR (n=62),

positive antibody test (n=63), or

determined to have COVID-19

by 2 independent clinicians

based on symptoms (n=73)

Exclusion: Symptoms of active

respiratory viral infection;

discharged from hospital in last

7 days; contraindications to

MRI (metallic implanted

devices, claustrophobia)

N=37 (patients hospitalized only)

Age (years, mean): 50

Gender (% male): 38

Race/ethnicity: 76% White, 8% South

Asian, 5% Black

Comorbidities:

Previous heart disease: 3%

CKD: NR

COPD: NR 

DM: 0%

HTN: 5%

Obesity: NR

Smoking: 65% never, 35% former, 0%

current

NOTE: 35% were health care workers

COVID-19 severity: NR

ICU admission: NR

Mechanical ventilation: NR

Length of hospital stay: NR 

Time post-hospital: NR (median of

105 days after COVID-19 positive)

Organ function by patientreported questionnaires,

fasting blood investigations,

and multi-organ MRI

Egol, 202040

USA

Prospective 

Funding: None

Inclusion: Hip fracture; positive

RT-PCR test before, during, or

after (at rehabilitation)

hospitalization

Exclusion: None reported

NOTE: Included comparison

data from COVID-19

Suspected and COVID-19

Negative patients 

N=17 (COVID-19 positive)

Age (years, mean): 82

Gender (% male): 71

Race/ethnicity: 82% White, 0% African

American, 12% Hispanic, 6% Asian

Comorbidities:

CVD: 47%

CKD: 24% (renal failure)

COPD: 18%

DM: 41%

HTN: 65%

Obesity: NR

Smoking: 53% Never, 35% Former,

12% Current

COVID-19 severity: NR

ICU admission: 29%

Mechanical ventilation: 12%

Length of hospital stay: 9.8 days

Time post-hospital: to 30 days

Readmission within 30 days

Discharge post-acute

rehabilitation

El Moheb,

202041

USA

Inclusion: All patients with

confirmed SARS-CoV-2 (RTPCR) who were intubated and

admitted to ICU

N=92 (propensity matched subgroup

with COVID-19 ARDS)

Age (years, median): 62

Gender (% male): 59

COVID-19 severity: NR

ICU admission: 100% (inclusion

criteria)

Emergency department

readmission
COVID-19 Post-acute Care Major Organ Damage Evidence Synthesis Program

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Author, Year

Country 

Study Design

Funding

Inclusion/Exclusion Criteria Baseline Demographic Data

Hospitalization Characteristics

Time of Post-hospital Follow-up

Outcomes Reported and 

Method of Assessment

Retrospective

Funding: Not

reported

Exclusion: None reported

NOTE: analysis was limited to

patients whose gastrointestinal

complications while

hospitalized were previously

reported; propensity score

matching with to identify

comparably ill patients with

non-COVID-19 ARDS

Race/ethnicity: NR

Comorbidities:

CAD: 13%

CKD: 20%

Chronic lung disease: 29%

DM: 37%

HTN: 55%

Obesity: NR

Smoking: 39%

Mechanical ventilation: NR

Length of hospital stay: median 24

days 

Time post-hospital: NR

Fisher, 202027

USA

Retrospective

Funding: None

Inclusion: Age >18 years with

COVID-19 test performed upon

hospitalization; confirmed case

of COVID-19 was a positive

RT-PCR result

Exclusion: Age <18 years; end

stage kidney disease; no

creatinine values; unknown sex

assignment

NOTE: included comparison

group of patients hospitalized

during same time period in

2019

N=3,345 (positive for COVID-19; total

of 4,610 were eligible and tested

Age (years, mean): 64

Gender (% male): 53

Race: 8% Non-Hispanic White; 36%

Non-Hispanic Black, 37% Hispanic;

19% Other

Comorbidities:

CVD: NR

CKD: 12%

COPD: NR

DM: 27%

HTN: NR

Obesity: 43%

Smoking: NR

NOTE: 16% were nursing home

residents

COVID-19 severity: NR

ICU admission: 13%

Mechanical ventilation: 18%

Length of hospital stay: 5 days 

Time post-hospital: 0 days

(discharge)

Discharge disposition

Frija-Masson,

202042

France

Retrospective

Inclusion: Age <85; confirmed

SARS-CoV-2 infection (RTPCR); discharged from

hospital; evaluated with

pulmonary function tests 30

N=50

Age (years, median): 54

Gender (% male): 56

Race: NR

Comorbidities:

COVID-19 severity: 50% severe

(based on CT)

ICU admission: 14% (7/50)

Mechanical ventilation: 2% (1/50)

Pulmonary function test

interpretation
COVID-19 Post-acute Care Major Organ Damage Evidence Synthesis Program

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Author, Year

Country 

Study Design

Funding

Inclusion/Exclusion Criteria Baseline Demographic Data

Hospitalization Characteristics

Time of Post-hospital Follow-up

Outcomes Reported and 

Method of Assessment

Funding: Not

reported

days after symptom onset as

part of routine care

Exclusion: Decline to

participate; recurrence; patients

with ARDS

NOTE: 18% (9/50) treated as

outpatients

CVD: NR

CKD: NR

COPD: NR

DM: 16%

HTN: 48%

Obesity: NR

Smoking: 10% active; 18% former

Length of hospital stay: NR 

Time post-hospital: NR (30 days

after symptom onset)

Fuglebjerg,

202028

Denmark

Case series

Funding: None

Inclusion: Hospitalized with

COVID-19 confirmed by PCR

testing

Exclusion: Chronic lung

diseases or New York Heart

Association (NYHA) class II or

above

N=26

Age (years, median): 63 (range 29-85)

Gender (% male): 62

Race: NR

Comorbidities: NR (patients had a 

median of 1 (non-specified) per

patient)

CVD:

CKD:

COPD:

DM:

HTN:

Obesity:

Smoking:

COVID-19 severity: NR

ICU admission: 31%

Mechanical ventilation: 15%

Length of hospital stay: NR

Time post-hospital: 0 days

(discharge)

Hypoxia and dyspnea elicited

by 6-minute walking test 

Exercise-induced hypoxia:

Sp02 <90% (test terminated) 

Dyspnea: Borg Scale (0-10)

Garrigues,

202043

France

Prospective,

survey

Funding: None

Inclusion: Hospitalized in

COVID-19 ward; positive

SARS-CoV-2 (RT-PCR) and/or

typical abnormalities on chest

CT

Exclusion: Directly admitted to

ICU without being hospitalized

in COVID-19 unit; deceased,

unreachable by telephone,

demented, bedridden, nonFrench speaking

N=120

Age (years, mean): 63

Gender (% male): 63

Race: NR

Comorbidities: 

CVD: NR

CKD: NR

COPD: NR

DM: 22%

HTN: 47%

Obesity: NR

COVID-19 severity: NR

ICU admission: 20%

Mechanical ventilation: 12%

Length of hospital stay (days,

mean): 13

Time post-hospital (mean): 111

days

Telephone questionnaire for

post-discharge clinical

symptoms, modified Medical

Research Council (mMRC)

dyspnea scale score, 

professional and physical

activities, and attention,

memory and/or sleep

disorders
COVID-19 Post-acute Care Major Organ Damage Evidence Synthesis Program

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Author, Year

Country 

Study Design

Funding

Inclusion/Exclusion Criteria Baseline Demographic Data

Hospitalization Characteristics

Time of Post-hospital Follow-up

Outcomes Reported and 

Method of Assessment

Smoking: NR

Goicoechea,

202029

Spain

Retrospective

Funding: Not

reported

Inclusion: All patients on

maintenance hemodialysis

admitted with positive RT-PCR

testing for SARS-CoV-2 

infection

Exclusion: None reported

N=36 (7 were discharged)

Age (years, mean): 71

Gender (% male): 64

Race: NR

Comorbidities:

CVD: 22%

CKD: 100%

COPD: 19%

DM: 64%

HTN: 97%

Obesity: NR

Smoking: NR

COVID-19 severity: NR

ICU admission: 3% (1/36) (NOTE:

severe comorbidities in 11 other

patients requiring mechanical

ventilation limited invasive

measures)

Mechanical ventilation: “assisted”

33% (12/36)

Length of hospital stay

(discharged patients, median):

11.4 days 

Time post-hospital: 0 days

(discharge)

“Lung abnormalities”

Grewal, 202030

USA

Retrospective

Funding: Not 

reported

Inclusion: Diagnosis of acute

ischemic stroke (AIS)

(confirmed with MRI or CT);

positive for COVID-19 (RTPCR); divided patients into

“COVID” group (initially with

COVID-19 symptoms who

developed AIS) and “neuro”

group (admitted for AIS and

tested positive for COVID-19)

(NOTE: included control groups

of non-COVID-19 AIS patients

hospitalized during study time

frame and in 2019)

Exclusion: None reported

N=13 (6 in “COVID” group, 7 in 

“neuro” group)

Age (years, mean): 62

Gender (% male): 46

Race: 46% Latino, 31% AfricanAmerican

Comorbidities: 

CAD: 15%

CKD: NR

COPD: NR

DM: 69%

HTN: 69%

Obesity: 15%

Smoking: NR

COVID-19 severity: 8 (62%)

severe or critical; 5 (38%) mild or

regular

ICU admission: NR

Mechanical ventilation: NR

Length of hospital stay: NR

Time post-hospital: 0 days

(discharge)

Discharge disposition

Discharge mRS >2
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Author, Year

Country 

Study Design

Funding

Inclusion/Exclusion Criteria Baseline Demographic Data

Hospitalization Characteristics

Time of Post-hospital Follow-up

Outcomes Reported and 

Method of Assessment

Hong, 202044

China

Retrospective

Funding: 

Government

Inclusion: All SARS-CoV-2 

positive (RT-PCR) patients 

admitted to 2 hospitals (NOTE: 

subgroup followed after 

discharge)

Exclusion: None reported

N=29 (subgroup followed)

Age (years, mean): 44

Gender (% male): 52

Race: NR

Comorbidities: NR

CVD:

CKD:

COPD: 

DM:

HTN:

Obesity:

Smoking:

COVID-19 severity: 34% (10/29) 

mild, 41% (12/29) moderate, 17% 

(5/29) severe, 7% (2/29) critical 

(defined as needing mechanical 

ventilation or ICU admission)

ICU admission: see above

Mechanical ventilation: see above

Length of hospital stay): NR 

Time post-hospital (mean(SD)): 21

(7) days

NOTE: unclear if followed until 

or after discharge

Positive cases after recovery

Huang L, 202045

China

Retrospective

Funding: 

Foundation, 

Government

Inclusion: Consecutive patients 

referred for CMR due to 

cardiac symptoms after 

discharge; previously 

confirmed with SARS-CoV-2 

(RT-PCR); considered 

recovered by hospital 

discharge criteria

Exclusion: History of CAD or 

myocarditis; contraindication to 

gadolinium contrast; CMR 

image quality not sufficient for 

analysis

N=26

Age (years, median): 38

Gender (% male): 38

Race: NR

Comorbidities:

CAD: 0%

CKD: 0%

COPD: 0%

DM: 0%

HTN: 8%

Obesity: NR

Smoking: NR

NOTE: also included data from healthy 

controls (similar age and gender 

distribution, no CVD or systemic 

inflammation) who underwent CMR at 

same hospital

COVID-19 severity: 0 critical, 4

severe, 22 moderate

ICU admission: NR

 

Mechanical ventilation: 0% (12%

received noninvasive ventilation or

high-flow nasal cannula oxygen

Length of hospital stay: NR

Time post-hospital: NR

NOTE: Median time from cardiac

symptom onset to CMR was 47 

days

Cardiac magnetic resonance 

imaging findings 

Huang Y, 202046

China

Inclusion: Age over 18 years;

released from hospital over 1 

N=57

Age (years, mean): 

Severe: 53; Non-severe: 44; P=.03

COVID-19 severity: 17 severe, 40

non-severe

Pulmonary fibrosis
COVID-19 Post-acute Care Major Organ Damage Evidence Synthesis Program

47

Author, Year

Country 

Study Design

Funding

Inclusion/Exclusion Criteria Baseline Demographic Data

Hospitalization Characteristics

Time of Post-hospital Follow-up

Outcomes Reported and 

Method of Assessment

Retrospective

Funding: Not

reported

month; confirmed SARS-CoV-2

infection (RT-PCR)

Exclusion: Previous history of

pulmonary resection,

neurological disease, or mental

illness; could not be contacted

or declined participation

Gender (% male): Severe 71%; Nonsevere: 35%; P=.01

Race: NR

Comorbidities:

CVD: 5%

CKD: NR

COPD: 0%

DM: 7%

HTN: 19%

Obesity: NR

Smoking: 16%

ICU admission: NR

 

Mechanical ventilation: NR

Length of hospital stay: 21 days

Time post-hospital: 30 days

Impairment of diffusion

capacity 

Impairment of lung volumes

Impairment of respiratory

muscle strength

Katz, 202031

USA

Retrospective

Funding: None

Inclusion: Confirmed SARSCoV-2 infection (RT-PCR);

concurrent stroke diagnosis

(stroke symptom onset during

COVID-19 illness or onset of

COVID-19 symptoms or SARSCoV-2 positivity within 14 days

of stroke symptom onset)

confirmed by imaging

Exclusion: None reported

NOTE: included control group

of all stroke patients admitted 1 

year earlier between same

dates to same hospitals

N=86

Age (years, mean): 67

Gender (% male): 56

Race: 30% White, 31% Black, 12%

Asian, 27% Multiracial/other

Comorbidities:

CVD: NR

CKD: NR

COPD: NR

DM: NR

HTN: NR

Obesity (BMI ≥30 kg/m2): 31%

Smoking: NR

COVID-19 severity: among n=45

testing positive for COVID-19 after

stroke symptoms 51% (23/45) had

mild COVID-19 symptoms and

29% (13/45) were asymptomatic

ICU admission: 51% (critical care

admission)

Mechanical ventilation: 44%

Length of hospital stay: NR

Time post-hospital: 0 days

(discharge)

NOTE: 48% (41/86) had stroke

onset during hospitalization for

COVID-19

Discharge disposition

Knights, 202061

United Kingdom

Retrospective

Inclusion: Admitted to hospital

with positive COVID-19 test

Exclusion: None reported

N=108

Age (years, mean): 69

Gender (% male): 58

Race: White British: 76% 

COVID-19 severity: NR

ICU admission: NR

Mechanical ventilation: 8%

Discharge disposition

Readmission

Care needs
COVID-19 Post-acute Care Major Organ Damage Evidence Synthesis Program

48

Author, Year

Country 

Study Design

Funding

Inclusion/Exclusion Criteria Baseline Demographic Data

Hospitalization Characteristics

Time of Post-hospital Follow-up

Outcomes Reported and 

Method of Assessment

Funding: Not

reported

Comorbidities:

CVD: NR

CKD: 6%

COPD: 15%

DM: 23%

HTN: 45%

Obesity: 31%

Smoking: 44% Ex or current, 56%

never 

NOTE: 10% were care home

residents; 21% had a “package of

care”

Length of hospital stay (days,

median): 8 [IQR 4-13] 

Time post-hospital: median followup from time of admission to either

death or study end date: 26 days

[IQR 18-31]

Liotta, 202032

USA

Retrospective

Funding: Not

reported

Inclusion: Admitted with

COVID-19; diagnosis

confirmed by SARS-CoV-2 RTPCR

Exclusion: None reported

N=509

Age (years, mean): 59

Gender (% male): 55

Race: 53% White, 30% Black or

African American, 4% Asian, 13%

Other/Unknown/Declined

Comorbidities:

CVD: NR

CKD: 11%

COPD: Nr

DM: 30%

HTN: 54%

Obesity (BMI >30 kg/m2): 52

Smoking: 28% Current

COVID-19 severity: 26% severe

ICU admission: NR

Mechanical ventilation: 26%

Length of hospital stay (days,

median): 7 

Time post-hospital: 0 days

(discharge)

Modified Rankin Scale score

Lovinsky-Desir,

202047

USA

Retrospective

Inclusion: Sequential patients

65 years or younger; positive

for severe SARS-CoV-2 (RTPCR); hospitalized or died in

the emergency department

Exclusion: None reported

N=1243 (age 21-29 [n=300] and 40-65

[n=943] groups only)

Age (years, median): 

Age 21-39: 31-32 years

Age 40-65: 56-58 years

Gender (% male): 59

Race: 22% Black, 19% White, 1%

Asian, 35% Other (NOTE: race

COVID-19 severity: 100% severe

defined as hospitalization with

confirmed positive SARS-CoV-2 

PCR result or death in emergency

department

ICU admission: NR

Readmission
COVID-19 Post-acute Care Major Organ Damage Evidence Synthesis Program

49

Author, Year

Country 

Study Design

Funding

Inclusion/Exclusion Criteria Baseline Demographic Data

Hospitalization Characteristics

Time of Post-hospital Follow-up

Outcomes Reported and 

Method of Assessment

Funding:

Government,

Foundation

identification declined for some

patients)

Comorbidities:

CVD: NR

CKD: NR

COPD: 0% (excluded from analysis)

DM: NR

HTN: NR

Obesity: 42%

Smoking: 59% Never, 4% Current,

11% Former

(NOTE: smoking status missing for

some patients)

Mechanical ventilation: 21%

(intubation)

Length of hospital stay: 

4-6 days (medians)

Time post-hospital: NR

Mo, 202033

China

Cross-sectional

Funding:

Government

Inclusion: Hospital admitted;

laboratory confirmed noncritical

COVID-19 

Exclusion: Critical cases

N=110

Age (years, mean): 49

Gender (% male): 50%

Race: NR

Comorbidities:

CVD: 3% 

Kidney disease: 2%

Lung disease: 3%

DM: 8%

HTN: 24%

Obesity: NR

Smoking: 12%

COVID-19 severity: 22% mild,

61% pneumonia, 17% severe

pneumonia

ICU admission: 0%

Mechanical ventilation: 0%

Length of hospital stay: NR

Time post-hospital: 0 days

(discharge)

Spirometry

Diffusion capacity

Ng, 202034

USA

Retrospective

Pre-proof

Funding: Not 

reported

Inclusion: All adult (age ≥18

years) patients who tested

positive for COVID-19 (RTPCR); hospitalized in 1 of 13

hospitals in a large health

system

Exclusion: Transferred to

hospitals outside the health

N=9,657 (demographic data for 40%

[3,854/9,657] who developed AKI

while hospitalized; 638 [17%] required

KRT)

Age (years, medians): 

KRT: 64

Non-KRT: 71 (P<.001) 

Gender (% male): 

KRT: 79

COVID-19 severity: NR

ICU admission: KRT: 92%, NonKRT: 45% (P<.001)

Mechanical ventilation: KRT: 92%,

Non-KRT 41% (P<.001)

Need for dialysis at discharge

among patients who

developed AKI, required

dialysis, and survived

Kidney recovery at discharge

among patients who

developed AKI (requiring or
COVID-19 Post-acute Care Major Organ Damage Evidence Synthesis Program

50

Author, Year

Country 

Study Design

Funding

Inclusion/Exclusion Criteria Baseline Demographic Data

Hospitalization Characteristics

Time of Post-hospital Follow-up

Outcomes Reported and 

Method of Assessment

system; admitted to inpatient

obstetric service; end stage

kidney disease; prior kidney

transplant; <2 serum creatinine

levels during admission

Non-KRT: 58 (P<.001)

Race/Ethnicity: 

KRT: 25% Non-Hispanic White, 22%

Non-Hispanic Black, 22% Hispanic 

Non-KRT: 38% Non-Hispanic White,

21% Non-Hispanic Black, 19%

Hispanic (P<.001)

Comorbidities (all P<.001): 

CAD: KRT: 13%, Non-KRT: 18%

CKD: KRT: 7%, Non-KRT: 9%

COPD: KRT: 6%, Non-KRT: 8%

DM: KRT: 48%, Non-KRT: 43% 

HTN: KRT: 64%, Non-KRT: 69%

Obesity: BMI 30 or higher

KRT: 45%, Non-KRT: 32%

Smoking:

KRT: 64% never, 22% current, 14%

unknown

Non-KRT: 67% never, 23% current,

10% unknown (P<.001)

Length of hospital stay (median):

KRT: 29 days; Non-KRT: 12 days

Time post-hospital: 0 days

(discharge)

not requiring dialysis) and

survived

Ntaios, 202035

Multi-national

(Global COVID19 Stroke

Registry)

Retrospective 

Funding: None

Inclusion: Hospitalized with

laboratory-confirmed COVID19 (96% by PCR, 4% by

serology) and acute ischemic

stroke

(NOTE: median delay between

initiation of COVID-19

symptoms and stroke onset=7

days [IQR 2-15])

Exclusion: Infected after onset

of stroke

(NOTE: also included

propensity matched group of

N=174

Age (years, median): 71

Gender (% male): 62

Race: NR

Comorbidities:

CAD: 17%

CVD: NR

Kidney disease: NR

Lung disease: NR

DM: 31%

HTN: 68%

Obesity: 37%

Smoking: 28%

COVID-19 severity: NR

ICU admission: 23% (40/174)

Mechanical ventilation: 16%

(17/174)

Length of hospital stay: NR

Time post-hospital: 0 days

(discharge)

Modified Rankin Scale score
COVID-19 Post-acute Care Major Organ Damage Evidence Synthesis Program

51

Author, Year

Country 

Study Design

Funding

Inclusion/Exclusion Criteria Baseline Demographic Data

Hospitalization Characteristics

Time of Post-hospital Follow-up

Outcomes Reported and 

Method of Assessment

non-COVID-19 patients from

other registries)

Patell, 202048

USA

Retrospective

Funding: Not 

reported

Inclusion: Age ≥18 years;

positive for SARS-CoV-2 (RTPCR)

Exclusion: Hospitalized at time

of analysis; discharged without

any form of post-discharge

contact in hospital medical

records; discharged on

therapeutic anticoagulation

(separate reporting for patients

discharged on prophylacticdose anticoagulation)

N=163

Age (years, median): 58

Gender (% male): 48

Race: 37% White

Comorbidities:

Heart disease: 12%

CKD: 10%

Chronic respiratory disease: 22% 

DM: 31%

HTN: 53%

Obesity: NR 

Smoking: NR

COVID-19 severity: NR

ICU admission: 26%

Mechanical ventilation: NR

Length of hospital stay (days,

median): 6 

Time post-hospital: discharge to

30 days

Cumulative incidence of

thrombosis or hemorrhage at

30 days post-discharge

Readmission

Paterson, 202036

United Kingdom

Retrospective

case series

Funding: Several

authors receive

funding; not

specified if

related to this

project

Inclusion: Patients referred to

COVID-19

neurology/encephalitis and

neurovascular multi-disciplinary

team meetings; “definite” cases

determined with RT-PCR

Exclusion: None reported

N=43 (demographic data for 16 with

definite COVID-19 diagnosis and

discharged) 

Age (years, mean): 57

Gender (% male): 56

Race: 63% White, 23% Black, 13%

Asian

Comorbidities: 

CVD: NR

CKD: NR

COPD: NR

DM: 6^

HTN: 38%

Obesity: NR

Smoking: NR

COVID-19 severity: 13% critical,

25% severe, 63% mild

ICU admission: 25%

Mechanical ventilation: NR

Length of hospital stay: 16.6 days

(reported for 12 patients)

Time post-hospital: 0 days

(discharge)

Discharge disposition

Puntmann,

202049

Germany

Inclusion: Minimum of 2 weeks

post-diagnosis of SARS-CoV-2 

by RT-PCR; resolution of

respiratory symptoms; negative

N=100

Age (years, mean): 49

Gender (% male): 53

Race: NR

COVID-19 severity: 18%

asymptomatic, 49% mild/moderate

(both recovered at home), 33%

severe (required hospitalization)

Cardiac magnetic resonance

imaging findings

Blood test results
COVID-19 Post-acute Care Major Organ Damage Evidence Synthesis Program

52

Author, Year

Country 

Study Design

Funding

Inclusion/Exclusion Criteria Baseline Demographic Data

Hospitalization Characteristics

Time of Post-hospital Follow-up

Outcomes Reported and 

Method of Assessment

Prospective

Funding:

Government,

Industry,

Institution

results on swab test at end of

isolation period

Exclusion: Recently recovered

from COVID-19 and referred

for clinical CMR imaging;

unwilling to participate;

absolute contraindications for

contrast-enhanced magnetic

resonance study

Comorbidities:

CVD: 13%

CKD: NR

COPD: 21%

DM: 18%

HTN: 22%

Obesity: NR

Smoking: 22%

ICU admission: NR

Mechanical ventilation: 6% (2/33)

(52% (17/33) required noninvasive ventilation)

Length of hospital stay: NR 

Time post-hospital: NR (NOTE:

median time from diagnosis to

CMR was 71 [IQR 64-92] days)

Richardson,

202050

USA

Case Series

Funding:

Government

Inclusion: Consecutive patients

at 12 hospitals in an academic

health system requiring

hospital admission with

confirmed SARS-CoV-2 

infection (RT-PCR)

Exclusion: None reported

N=5,700 (2,081 were discharged)

Age (years, median): 63

Gender (% male): 60

Race: African American 23%, Asian

9%, White 40%, Multiracial 29%

Comorbidities:

CAD: 11%

CKD: 5%

COPD: 5%

DM: 34%

HTN: 57%

Obesity: 42%

Smoking:16%

COVID-19 severity: NR

ICU admission (discharged): 4%

(82/2081 ) 

Mechanical ventilation

(discharged): 2% (38/2081 

Length of hospital stay (medians,

discharged patients): <18 years

(n=32): 2.0 days

18-65 years (n=1,373): 3.8 days

>65 years (n=676): 4.5 days 

Time post-hospital (median): 4.4

days

Readmission

Discharge disposition (home

or facility [eg, nursing home or

rehabilitation)

Roberts, 202051

United Kingdom

Prospective

Funding: Not 

reported

Inclusion: Patients discharged

following admission for COVID19; 6-week follow-up for

hospital-associated VTE (HAVTE) events 

Exclusion: None reported

N=1877

Age (years, mean): NR

Gender (% male): NR

Race: NR

Comorbidities: NR

CVD: 

CKD:

COVID-19 severity: NR

ICU admission: NR (11%

[208/1877] admitted to critical

care)

Mechanical ventilation: NR

VTE episodes (medical

database) within 6 weeks of

discharge
COVID-19 Post-acute Care Major Organ Damage Evidence Synthesis Program

53

Author, Year

Country 

Study Design

Funding

Inclusion/Exclusion Criteria Baseline Demographic Data

Hospitalization Characteristics

Time of Post-hospital Follow-up

Outcomes Reported and 

Method of Assessment

NOTES:

1) patients received

thromboprophylaxis while

hospitalized

2) comparison cohort of postdischarge HA-VTE following

medical admission in 2019

COPD:

DM: 

HTN: 

Obesity: 

Smoking: 

Length of hospital stay: NR

Time post-hospital: discharge to 6 

weeks

Sachdeva,

202052

USA

Retrospective

Funding: None

Inclusion: Age ≥18 years; end

stage kidney disease on

chronic peritoneal dialysis;

hospitalized with COVID-19

(positive by PCR testing)

N=11

Age (years, median): 54 (<50: 36%;

50-59: 27%; 60-69: 27%; 70-79: 9%)

Gender (% male): 27

Race: 9% Hispanic, 45% NonHispanic Black; 9% Non-Hispanic

White; 36% Other or Unknown

Comorbidities:

CAD: 9%

CKD: 100%

COPD: 0%

DM: 45%

HTN: 91%

Obesity (BMI ≥30 kg/m2): 36%

Smoking: 82% Never, 18% Former

COVID-19 severity: NR

ICU admission: 27%

Mechanical ventilation: 27%

Length of hospital stay (days,

mean): 9 (range 2-23)

Time post-hospital: NR

Hospital readmission

Somani, 200053

USA

Retrospective 

Funding:

Government

Inclusion: Age ≥18 years;

laboratory confirmed SARSCoV-2; admitted and

subsequently discharged alive

from 5 health system hospitals

Excluded: Discharge before

April 12, 2020 (all patients had

≥14 day observation for

possible readmission); returned

<12 hours after discharge; died

during index admission

N=2,864 (n=103 returned to hospital;

2,761 did not) 

Age (years, median): 66 

Gender (% male): 58

Race: 4% Asian, 28% Black, 27%

Hispanic, 24% White; 17%

Unknown/Other 

NOTE: no differences between groups

for Age, Gender, or Race

Comorbidities:

CAD: 8.1%

CKD: 4.7%

COVID-19 severity: NR

ICU admission: 

Returned: 6%; No Return: 19%;

P=.001

Mechanical ventilation: Returned:

1%; No Return: 11%; P=.003

Length of hospital stay (days,

median): Returned: 4.7; No

Return: 7; P=.006

Return to hospital following

discharge

Reasons for return

Readmission
COVID-19 Post-acute Care Major Organ Damage Evidence Synthesis Program

54

Author, Year

Country 

Study Design

Funding

Inclusion/Exclusion Criteria Baseline Demographic Data

Hospitalization Characteristics

Time of Post-hospital Follow-up

Outcomes Reported and 

Method of Assessment

COPD:

Returned: 7%; No Return: 3%; P=.035

DM: 15%

HTN: Returned: 35%; No Return:

22%; P=.003

Obesity: NR

Smoking: NR

Time post-hospital: 14 days

Suleyman,

202062

USA

Retrospective

case series

Funding: Not

reported

Inclusion: Consecutive adult

patients evaluated at 5 

hospitals and 9 emergency

departments in a health

system; confirmed SARS-CoV2 infection (RT-PCR)

Exclusion: Lack of

demographic and baseline data

N=355 (hospitalized) (108 discharged

home after initial evaluation not

reported here)

Age (years, mean): 61

Gender (% male): 47

Race: 73% African American 

Comorbidities:

CAD: 16%

CKD: 45%

COPD: 12%

DM: 43%

HTN: 73%

Obesity: 59%

Smoking: 39%

COVID-19 severity: NR

ICU admission: 40%

Mechanical ventilation: 

General practice unit: 0% (0/234)

ICU: 81% (114/141)

P<.001

Length of hospital stay (days,

median [IQR]):

General practice unit: 5 [3-7]

ICU: 15 [9-23]

P<.001

Time post-hospital: discharge to

30 days

Discharge disposition

30-day hospital readmission

30-day mortality

Tian, 202054

China

Retrospective

Funding: Not

reported

Inclusion: COVID-19 patients

discharged from hospital;

discharge criteria included 2 

consecutive RT-PCR tests

(sampling interval at least 24

hours) 

Exclusion: 

NOTE: patients were placed in

designated locations for

centralized isolation and health

N=20 (“re-positive” cases from n=147

patients followed)

Age (years, mean): 37

Gender (% male): 55

Race: NR

Comorbidities:

CVD: 5% (coronary heart disease)

CKD: 0%

COPD: 0%

DM: 10%

HTN: 25%

COVID-19 severity: 10% critical,

15% severe, 60% ordinary

(moderate), 15% mild

ICU admission: NR

Mechanical ventilation: NR

Length of hospital stay: 18.7 days

“Re-positive’ RT-PCR postdischarge
COVID-19 Post-acute Care Major Organ Damage Evidence Synthesis Program

55

Author, Year

Country 

Study Design

Funding

Inclusion/Exclusion Criteria Baseline Demographic Data

Hospitalization Characteristics

Time of Post-hospital Follow-up

Outcomes Reported and 

Method of Assessment

monitoring for at least 28 days

after discharge

Obesity: NR

Smoking: NR

Time post-hospital: average of

17.3 days to ‘re-positive’ results

(range 7-47)

Vizcaychipi,

202037

United Kingdom

Prospective

Funding: None

Inclusion: Admitted to

Emergency Department;

completed hospital encounter

(discharged alive or died)

Exclusion: Remained in

admitting hospital; transferred

to another hospital

NOTE: study was designed to

evaluate the effect of an

electronic medical record alert

system on early mortality

related to COVID-19

N=1,039 admitted; data for n=939 who

completed hospital encounter

Age (years, median): 67

Gender (% male): 60

Race: 62% White

Comorbidities:

CVD: NR

CKD: NR

COPD: 10%

DM: 38%

HTN: 53%

Obesity: NR

Smoking: NR

COVID-19 severity: NR

ICU admission: 14.4% (150/1039)

Mechanical ventilation: NR

Length of hospital stay (days,

median): 7 

Time post-hospital: 0 days

(discharge)

Discharge disposition

Wang, 202055

China

Prospective

cohort

Funding:

Government

Inclusion: Confirmed COVID-19

patients discharged from

hospital

Exclusion: Could not be

contacted or refused to

participate

N=131

Age (years, median): Non-severe: 38;

Severe: 60 (P<.0)

Gender (% male): 45

Race: NR

Comorbidities:

CVD: NR

CKD: NR

COPD: NR

DM: 2%

HTN: 3%

Obesity: NR

Smoking: NR

COVID-19 severity: 53% (69/131)

severe

ICU admission: NR (NOTE:

“severe” category did not require

ICU admission)

Mechanical ventilation: NR

Length of hospital stay (median):

15 days 

Time post-hospital: 7 to 28 days

SARS-CoV-2 status

Complete blood count

Chest CT

Readmission

Post-discharge treatments

Xu, 202056

China

Inclusion: Adults with confirmed

SARS-CoV-2 infections (RTPCR); critically ill (admitted to

ICU, requiring mechanical

N=92 (survivors; data from 147 nonsurvivors not reported here)

Age (years, mean): 58

Gender (% male): 58

COVID-19 severity: 100% critically

ill

ICU admission: 100%

Oxygen therapy postdischarge

60-day mortality
COVID-19 Post-acute Care Major Organ Damage Evidence Synthesis Program

56

Author, Year

Country 

Study Design

Funding

Inclusion/Exclusion Criteria Baseline Demographic Data

Hospitalization Characteristics

Time of Post-hospital Follow-up

Outcomes Reported and 

Method of Assessment

Retrospective

case series

Funding:

Government

ventilation or fraction of

inspired oxygen concentration

≥60%)

Exclusion: Deceased within 48

hours after ICU admission

Race: NR

Comorbidities:

CVD: 15%

CKD: NR

COPD: 3%

DM: 20%

HTN: 45%

Obesity: NR

Smoking: NR

Mechanical ventilation: 50%

Length of hospital stay: NR

Time post-hospital: NR (followed

to 60 days from admission)

Yan, 202057

China

Retrospective

Funding:

Program of

Human Science

and Technology

Department

Inclusion: Confirmed SARSCoV-2 (RT-PCR)

Exclusion: Suspected patients

with negative results after

multiple tests during

hospitalization

N=218

Age (years, median): 43

Gender (% male): 56

Race: NR

Comorbidities:

CVD: 17%

CKD: 2%

COPD: 6%

DM: 12%

HTN: NR

Obesity: NR

Smoking: 11% Current

COVID-19 severity: 6% critical,

11% severe, 67% moderate, 5%

mild, 11% asymptomatic

ICU admission: 11% of the severe

and critical patients

Mechanical ventilation: 7%

Length of hospital stay (days,

mean): 12.2 (for 217 discharged

patients)

Time post-hospital: unclear;

quarantined for 14 days; asked to

return every 2-4 weeks

“Re-positive” for SARS-CoV-2

You, 202058

China

Case series

Funding: None

Inclusion: Laboratory confirmed

COVID-19; pulmonary function

test after discharge from

hospital

Exclusion: None reported

N=18

Age (years, mean): 51

Gender (% male): 56

Race: NR

Comorbidities:

CVD: NR

CKD: NR

COPD: NR

DM: 6%

COVID-19 severity: 67% (12/18)

moderate, 28% (5/18) severe, 6%

(1/18) critical

ICU admission: NR

Mechanical ventilation: NR

Length of hospital stay (mean): 28

days

Lung volume

Pulmonary ventilation function

Ventilation impairment

CT changes
COVID-19 Post-acute Care Major Organ Damage Evidence Synthesis Program

57

Author, Year

Country 

Study Design

Funding

Inclusion/Exclusion Criteria Baseline Demographic Data

Hospitalization Characteristics

Time of Post-hospital Follow-up

Outcomes Reported and 

Method of Assessment

HTN: 17%

Obesity: NR

Smoking: NR

Time post-hospital (mean, SD): 38

(13) days (to pulmonary function

test)

Yu, 202059

China

Retrospective

case series

Funding:

Government

Inclusion: COVID-19 positive

confirmed by pharyngeal swab

nucleic acid testing;

hospitalized then discharged

after treatment; underwent thinsection chest CT scans at least

twice while hospitalized and at

least once following discharge

Exclusion: None reported

N=32 (n=14 fibrosis group, n=18; nonfibrosis group)

Age (years, medians): fibrosis group

54; non-fibrosis group 37; P=.008

Gender (% male): 69

Race: NR

Comorbidities:

CVD: 6%

CKD: NR

COPD: 3%

DM: 6%

HTN: 13%

Obesity: NR 

Smoking: NR

COVID-19 severity: NR

ICU admission: fibrosis group

35.7% (5/14); non-fibrosis group

0% (0/18); P=.01

Mechanical ventilation: NR

Length of hospital stay (medians):

fibrosis group 19.5 days; nonfibrosis group 10.0 days; P=.001

Time post-hospital (median [IQR]):

fibrosis group 9 [7-11] days; nonfibrosis group 9 [7.8-11.3] days

Pulmonary fibrosis via thinsection CT scan at the end of

full inspirations

Pulmonary fibrosis defined

as a combination of

parenchymal bands, irregular

interfaces, coarse reticular

pattern, and traction

bronchiectasis

AKI=acute kidney injury; ARDS=acute respiratory distress syndrome; CAD=coronary artery disease; CMR=cardiovascular magnetic resonance; COVID-19, SARS-CoV-2: 2019 

novel coronavirus; CPAP=continuous positive airway pressure; CT=computed tomography; CVD=cardiovascular disease: CKD=chronic kidney disease; COPD=chronic

obstructive pulmonary disease; DM=diabetes mellitus; HTN=hypertension; IQR=interquartile range; KRT=kidney replacement therapy; MRI=magnetic resonance imaging; 

PE=pulmonary embolism; POCUS=point-of-care ultrasound; RT-PCR: reverse transcriptase polymerase chain reaction; VTE=venous thromboembolism
COVID-19 Post-acute Care Major Organ Damage Evidence Synthesis Program

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Table 2. Study Quality Appraisal

Author, Year

Country 

Study Design

Clear Inclusion

Criteria/Consecutive/

Complete?

Adequate Sample

Size?

Condition/Outcome

Measured in a Standard 

Reliable Way?

Valid Methods for

Identification of the 

Condition/Outcome?

Adequate Information

about Subjects & 

Setting?

Al Kasab, 202021

USA, South

America, Europe 

Prospective

Consecutive patients

meeting eligibility criteria

Multisite; n=13 Unclear how modified

Rankin Scale was

administered

Yes No information about

comorbidities; little

information about

hospitalization

Alharthy, 202022

Saudi Arabia

Prospective

Unclear if consecutive

patients

Single site; n=89 Unclear how ultrasound

was analyzed

Unclear – used point-of-care

ultrasound (noted limited

evidence supporting its

diagnostic utility in COVID-19)

Unclear how subjects

were identified for

enrollment; limited

patient information

Atalla, 202060

USA

Retrospective

Unclear if all patients were

reviewed for eligibility

2 sites; n=339 (19

readmitted)

Only captured patients

who presented to hospital

they were discharged

from

Medical records and postdischarge call to patientsYes

Benussi, 202023

Italy

Retrospective

cohort

Included all patients

meeting eligibility criteria

Single site (“hub” for

acute cerebrovascular

diseases); n=56 with

COVID-19

Unclear how Stroke Scale

was administered

Unclear how stroke was

diagnosed; NIH Stroke Scale

for assessment

Yes

Casas-Rojo,

202038

Spain

Retrospective

cohort

Consecutive patients 150 hospitals in

registry; n=15,111

Unclear how patients

were followed for

readmission data; unclear

if patients may have

presented to other

hospitals

Electronic data capture system

with procedures for verification

of data

Yes

Chan, 202024

USA

Retrospective

Unclear if consecutive

patients

5 sites; n=3993 (1835

with AKI while

hospitalized; 212 with

post-discharge followup)

Unclear – AKI defined

based on change from

baseline creatinine; 63%

had missing data and

creatinine was imputed;

used creatinine from 7 to

365 days prior to

admission for others

Yes - dataset No patient

characteristics for the

n=212 patients with

post-discharge followup data
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Author, Year

Country 

Study Design

Clear Inclusion

Criteria/Consecutive/

Complete?

Adequate Sample

Size?

Condition/Outcome

Measured in a Standard 

Reliable Way?

Valid Methods for

Identification of the 

Condition/Outcome?

Adequate Information

about Subjects & 

Setting?

Collins, 202025

USA

Retrospective

All patients reviewed for

eligibility

3 sites; n=20 Yes Electronic medical records Yes

Curci, 202026

Italy

Cross-sectional

Consecutive patients

reviewed for eligibility; all

eligible included

Single site; n=32 Yes No spirometry measures Yes

Dennis, 202039

United Kingdom

Preprint

Prospective

Unclear if consecutive

patients; described

population as “low-risk”

(eg, younger, largely

without risk factors, preexisting disease, or

hospitalization) but

inclusion criteria don’t

require that

2 sites; n=37

hospitalized (of n=201

included)

Unclear whether MRI was

dual-reviewed; unclear

how questionnaires were

administered 

Validated questionnaires

(patient-reported), blood tests,

MRI

Unclear how subjects

were identified for

enrollment

Egol, 202040

USA

Prospective

Consecutive patients 7 hospitals served by

a university orthopedic

department; n=17

Unclear how patients

were followed after

discharge

Unclear – source of data not

reported

Unclear how many were

COVID-19 positive at

admission vs during

admission

El Moheb, 202041

USA

Retrospective

All patients meeting

eligibility criteria identified;

report focused on 141 of

242 (58%) with COVID-19

whose gastrointestinal

complications while

hospitalized were

previously reported; after

propensity matching, 92

COVID-19 patients were

included

Single site with 13

ICUs; n=92

Unclear – length of followup for emergency

department readmission

not reported

Unclear – source of data not

reported

No information about

patient disposition at

discharge, postdischarge monitoring, or

length of follow-up 

Fisher, 202027

USA

Retrospective

Unclear whether age 18

was included or excluded;

not specified if all patients

were reviewed for eligibility

3 hospitals in a

healthcare system;

n=3,345

Yes Medical records Disposition of all

patients is unclear
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Author, Year

Country 

Study Design

Clear Inclusion

Criteria/Consecutive/

Complete?

Adequate Sample

Size?

Condition/Outcome

Measured in a Standard 

Reliable Way?

Valid Methods for

Identification of the 

Condition/Outcome?

Adequate Information

about Subjects & 

Setting?

Frija-Masson,

202042

France

Retrospective

Unclear if all patients were

reviewed for eligibility

Single site; n=50 Yes Did not perform CT measures

at 30 days 

Unclear how 30 days

post-symptom onset

relates to time postdischarge

Fuglebjerg, 202028

Denmark

Case series

Consecutive patients

reviewed for eligibility; all

eligible included

Single site; n=26 Yes Authors note that clinical

implications of hypoxia are not

well describe in the literature

Little information about

patients (eg, comorbid

conditions, COVID

severity)

Garrigues, 202043

France

Prospective,

survey

Contacted all eligible

patients 

Single site, n=120 Telephone questionnaire

administered by trained

physicians

Some elements of

questionnaire were developed

by the study authors

Limited information

Goicoechea,

202029 

Spain

Retrospective

All admitted patients on

maintenance hemodialysis

meeting eligibility criteria

Single site; n=36 No information Unclear (“worsening or

appearance of X-ray

pulmonary infiltrates”) 

No information about

patients who were

discharged

Grewal, 202030

USA

Retrospective

All patients admitted

meeting eligibility criteria

Single site; n=13 Yes Yes Little information about

hospitalization (eg, ICU

admission, ventilation)

Hong, 202044

China

Cross-sectional

All admitted patients

meeting eligibility criteria

2 sites; n=29

(subgroup followed

after discharge)

Unclear if all patients

received follow-up tests

for COVID-19

Yes Little information on

follow-up subgroup and

unclear whether followup was until or after

discharge

Huang L, 202045

China

Retrospective

Consecutive patients

meeting eligibility criteria

Single site; n=26 Yes Yes No information on time

post-discharge

Huang Y, 202046

China

Retrospective

Unclear if all patients were

reviewed for eligibility

Single site; n=57 19% (13/70) eligible could

not be contacted or

declined participation

Yes Little information about

ICU and mechanical

ventilation while

hospitalized
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Author, Year

Country 

Study Design

Clear Inclusion

Criteria/Consecutive/

Complete?

Adequate Sample

Size?

Condition/Outcome

Measured in a Standard 

Reliable Way?

Valid Methods for

Identification of the 

Condition/Outcome?

Adequate Information

about Subjects & 

Setting?

Katz, 202031

USA

Retrospective

All patients meeting

eligibility criteria 

11 hospitals in a

health system; n=86

Yes Yes – chart review and other

databases

Yes

Knights, 202061

United Kingdom

Retrospective

All admitted patients Single site; n=69

(survivors)

Unclear how postdischarge care needs

were captured

Data from electronic and

paper medical records;

additional information from

patients

No information about

patients discharged to

care home or other

Liotta, 202032

USA

Retrospective

Consecutive patients 10 hospitals in a

health system; n=509

Modified Rankin Scale

scores determined

independently by 2 

reviewers

Data from electronic medical

records (including templates

specific to COVID-19), clinical

notes, diagnostic studies, and

physician-documented

diagnoses; modified Rankin

Scale

Yes

Lovinsky-Desir,

202047

USA

Retrospective

Sequential patients 2 hospitals in network;

n=1243 (n=95 in <21

age group not

included - median age

14-15)

Unclear how patients

were followed for

readmission data

Yes – medical records Length of follow-up for

readmission unclear

Mo, 202033

China

Retrospective

Unclear if all patients were

reviewed for eligibility

Unclear if single site;

n=110

Yes Lung function tests but no

imaging

Yes

Ng, 202034

USA

Retrospective

Pre-proof

All admitted patients

meeting eligibility criteria

13 hospitals in a

health system; 

n=3,854 (2,771

survivors)

Yes Data from chart reviews

(hospital progress, discharge,

and social worker notes)

Yes

Ntaios, 202035

Multi-national

Retrospective

Consecutive patients

meeting eligibility criteria 

28 sites in 16

countries; n=174 (96

survivors)

Unclear how modified

Rankin Scale was

administered

Global COVID-19 Stroke

registry

Yes

Patell, 202048

USA

Retrospective

Consecutive patients

meeting eligibility criteria

Single site; n=163 Unclear if all patients

were followed

Medical records Yes
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Author, Year

Country 

Study Design

Clear Inclusion

Criteria/Consecutive/

Complete?

Adequate Sample

Size?

Condition/Outcome

Measured in a Standard 

Reliable Way?

Valid Methods for

Identification of the 

Condition/Outcome?

Adequate Information

about Subjects & 

Setting?

Paterson, 202036

United Kingdom

Retrospective

Cases referred to COVID

team meetings (“selective”)

Single site; n=43 (29

with definite COVID19)

Unclear Unclear – little information

about source of data

Yes

Puntmann, 202049

Germany

Prospective

Unselected cohort Single site; n=100 Yes Yes Little information about

hospitalized patients vs

home recovery

Richardson, 202050

USA

Case series

All admitted patients

meeting eligibility criteria

12 sites; n=5,700 Authors note median

follow-up of 4.4 days postdischarge

Yes – electronic medical

records

Little information on

patients who were

discharged

Roberts, 202051

United Kingdom

Prospective

All events at designated

sites (patients may have

presented elsewhere

during follow-up)

2 sites of 1 hospital No routine contact during

follow-up (only captured

patients who presented to

hospital they were

discharged from)

Yes - imaging required No patient demographic

data

Sachdeva, 202052

USA

Retrospective

All patients meeting

eligibility criteria

13 hospitals of a

health system; n=11

Unclear – methods for

obtaining follow-up

information not specified;

unclear if patients may

have presented to other

hospitals

Yes – electronic and manual

chart review

Length of follow-up not

reported

Somani, 200053

USA

Retrospective 

Unclear if all patients were

reviewed for eligibility

5 hospitals of a health

system; n=103

No systematic follow-up;

unclear if patients may

have presented to other

hospitals

Yes – electronic health

records

Yes

Suleyman, 202062

USA

Retrospective case

series

Consecutive patients 5 sites; n=355

hospitalized patients

Follow-up to 30 days

post-discharge 

Yes – electronic medical

records

Yes

Tian, 202054

China

Retrospective

All patients who were

discharged

Multiple hospitals;

n=20 “re-positive’

cases

Patients were discharged

to designated locations for

isolation and monitoring

RT-PCR testing; frequency of

testing not reported

No information on

protocol for monitoring 
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Author, Year

Country 

Study Design

Clear Inclusion

Criteria/Consecutive/

Complete?

Adequate Sample

Size?

Condition/Outcome

Measured in a Standard 

Reliable Way?

Valid Methods for

Identification of the 

Condition/Outcome?

Adequate Information

about Subjects & 

Setting?

Vizcaychipi, 202037

United Kingdom

Prospective

Consecutive admissions

evaluated for eligibility

2 hospitals of 1

institution; n=939

Source of disposition data

not reported

Unclear No information on

COVID-19 severity

Wang, 202055

China

Prospective cohort

Unclear if all patients were

reviewed for eligibility

Single site; n=131 Followed every 7 days up

to 4 weeks; methods for

follow-up data collection

unclear

Data obtained by

questionnaire

Yes

Xu, 202056

China

Retrospective case

series

Unclear if all patients were

reviewed for eligibility

3 sites; n=239 ICU

patients

Unclear if follow-up was

complete for postdischarge patients 

Self-report Yes

Yan, 202057

China

Retrospective

Unclear if all patients were

reviewed for eligibility

3 hospitals; n=218 After discharge, patients

were required to

quarantine and monitor

their health for 14 days;

requested to return to

hospital for follow-up

exams every 2-4 weeks

Data source not reported Unclear how many

patients complied with

requested follow-up

You, 202058

China

Case series

Unclear if study included all

or consecutive patients

Single site; n=18 Yes CT scans not completed at the

same time as pulmonary

function tests; CT scans

reviewed independently by 2 

cardiothoracic radiologists

blinded to clinical information

Yes

Yu, 202059

China

Retrospective case

series

Unclear if study included all

patients

Single site; n=32 Specific criteria provided

for many of the outcomes

assessed from the CT

scan

CT scans reviewed

independently by 3 

experienced radiologists

Yes

CT=computed tomography; MRI=magnetic resonance imaging

Reference: JBI Critical Appraisal Checklist for Case Series
COVID-19 Post-acute Care Major Organ Damage Evidence Synthesis Program

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Table 3. Pulmonary Outcomes 

Author, Year

Country 

Study Design

Pulmonary Fibrosis 

% (n/N) Lung Volume Diffusion Capacity Other

Alharthy, 202022

Saudi Arabia

Prospective

NR NR NR Pleural Effusions at Discharge

1.5% (1/64) (n=64 survivors)

Curci, 202026

Italy

Cross-sectional

NR NR NR PaO2/FiO2 (mmHg)

Mild alteration (300-399): 22% (7/32)

Moderate alteration (200-299): 38%

(12/32)

Severe alteration (<200): 41% (13/32)

Respiratory Supports Needed

None: 13% (4/32)

Nasal cannula: 41% (13/32)

Oxygen mask: 13% (4/32)

Venturi mask: 25% (8/32)

Non-rebreather mask: 9% (3/32) 

mMRC Dyspnea Scale

Grade 4: 13% (4/32)

Grade 5: 88% (28/32)

Dennis, 202039

United Kingdom

Prospective

PREPRINT

NR NR NR Deep Breathing Fractional Area

Change <39%

47% (16/34)

(n=3 missing data)

Frija-Masson,

202042

France

Retrospective

NR NR Pulmonary Function Test

Interpretation 

Normal: 48% (24/50)

Restrictive pattern: 8% (4/50)

Restriction with altered

diffusion capacity: 18% (9/50)

Altered diffusion capacity only:

26% (13/50)

NR

Fuglebjerg,

202028

Denmark

Case series

NR NR NR Exercise-Induced Hypoxia, % (n/N)

50% (13/26)

NOTE: PE confirmed in 67% (4/6) who

underwent further testing
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Author, Year

Country 

Study Design

Pulmonary Fibrosis 

% (n/N) Lung Volume Diffusion Capacity Other

SpO2 <90% was not associated with

an increase in subjective dyspnea

(Borg scale)

Garrigues,

202043

France

Prospective,

survey

NR NR NR mMRC Dyspnea Scale

Grade 2 or More 

29% (35/120)

Ward patients: 28% (27/96)

ICU patients: 33% (8/24)

Goicoechea,

202029

Spain

Retrospective

NR NR NR “Lung Abnormalities”

86% (6/7)

(Worsening or appearance of X-ray

pulmonary infiltrates)

Huang Y,

202046

China

Retrospective

7% (4/57) FEV1 <80% Predicted

9% (5/57) (mild impairment)

FVC<80% Predicted

11% (6/57) (5 mild impairment, 1 

moderate)

FEV1/FVC <80% 

44% (25/57) (mild impairment)

TLC <80% of Predicted

12% (7/57) (6 mild, 1 moderate)

Outcomes did not differ by severity of

COVID-19

DLCO <80% Predicted

53% (30/57) (26 mild

impairment, 4 moderate)

Subgroups

Severe COVID-19: 77%

(13/17)

Non-severe: 43% (17/40)

P=.02

Respiratory Muscle Strength

Pimax <80% Predicted

49% (28/57)

Pemax <80% Predicted

23% (13/57)

CT Residual Abnormality 

54% (31/57)

Subgroups

Severe COVID-19: 94% (16/17)

Non-severe: 38% (15/40)

P Not Reported

Obstructive Pulmonary Dysfunction 

11% (6/57)

Restrictive Pulmonary Function 

12% (7/57)

Combined Obstructive and

Restrictive

4% (2/57)

Mo, 202033

China

Cross-sectional

NR FEV1 <80% Predicted

14% (15/110)

FVC <80% Predicted

9% (10/110)

DLCO <80% Predicted 47%

(51/110)

COVID-19 Severity

Subgroups

NR
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Author, Year

Country 

Study Design

Pulmonary Fibrosis 

% (n/N) Lung Volume Diffusion Capacity Other

FEV1/FVC <70%

5% (5/110)

Outcomes above did not differ by severity

of COVID-19

TLC <80% Predicted

25% (27/110)

COVID-19 Severity Subgroups

Mild: 17% (4/24)

Pneumonia: 21% (14/67)

Severe Pneumonia: 47% (9/19)

P<.05 overall and for Severe Pneumonia

vs Pneumonia or vs Mild

Mild: 30% (7/24)

Pneumonia: 42% (28/67)

Severe Pneumonia: 84%

(16/19)

P=.001 overall 

P<.01 for Severe Pneumonia

vs Pneumonia or vs Mild

Wang, 202055

China

Prospective

cohort

NR NR NR Chest CT deteriorated

1-2 weeks post-discharge

5.6% (2/36) (1 with enhanced

inflammatory infiltrates, 1 with multiple

bilateral GGO) 

3-4 weeks post-discharge

0% (0/54)

Outcomes did not differ by severity of

COVID-19

You, 202058

China

Case Series

Pulmonary fibrosis: 22%

(4/18)

GGO plus pulmonary

fibrosis: 61% (11/18)

Normal: 6% (1/18)

Not available: 11%

(2/18)

VCmax <80% Predicted

17% (3/18)

FEV1 <80% Predicted

17% (3/18)

FVC <80% Predicted

17% (3/18)

FEV1/FVC <70%

17% (3/18)

Outcomes did not differ by severity of

COVID-19

NR Ventilation Impairment

Normal: 67% (12/18)

Obstructive Ventilatory Impairment:

17% (3/18)

Restrictive Ventilatory Impairment:

17% (3/18)

Yu, 202059

China

44% (14/32) NR NR NR
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Author, Year

Country 

Study Design

Pulmonary Fibrosis 

% (n/N) Lung Volume Diffusion Capacity Other

Retrospective

case series

DLCO=diffusing capacity of the lung for carbon monoxide; FEV1 =forced expiratory volume in 1 sec; FVC=forced vital capacity; GGO=ground-glass opacity; mMRC=modified 

Medical Research Council; NR=not reported; PE=pulmonary embolism; TLC=total lung capacity
COVID-19 Post-acute Care Major Organ Damage Evidence Synthesis Program

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Table 4. Cardiovascular Outcomes 

Author, Year

Country 

Study Design

Cardiac Magnetic Resonance Imaging Blood Tests Other

Alharthy, 202022

Saudi Arabia

Prospective

NR NR Pericardial

Effusion

(Ultrasound) at

Discharge 

1.5% (1/64) (n=64

survivors)

Dennis, 202039

United Kingdom

Prospective

PREPRINT

Left Ventricular Ejection Fraction (%)

Normal (>55%): 70% (26/37)

Borderline impairment (50-55%): 19% (7/37)

Definite impairment (<50%): 11% (4/37)

Evidence of Myocarditis

11% (4/37)

NR NR

Huang L, 202045

China

Retrospective

NOTE: of 26 patients

tested, 15 (58%) were

considered positive

based on presence of

positive conventional

CMR findings

(increased myocardial

edema ratio [>2.0]

(n=7) and/or LGE

presence (n=8)) and

11 (42%) were

negative

Myocardial Edema

54% (14/26)

50% (7/14) with positive LGE

50% (7/14) with small pericardial effusion

LGE

31% (8/26) with focal linear subepicardial and patchy mid-wall LGE 

Native T1, T2, and ECV values were significantly elevated in recovered

COVID-19 patients with positive CMR findings compared with healthy

controls

Right ventricular ejection fraction, cardiac index, and stroke volume area

were decreased in recovered COVID-19 patients with positive CMR

findings compared with healthy controls

NR NR

Puntmann, 202049

Germany

Prospective

Abnormal Native T1

COVID-19: 78% (73/100)

Healthy Controls: 6% (3/50)

Risk Factor-matched Controls: 40% (23/57)

Abnormal Native T2:

Detectable hsTNT (≥3 pg/mL)

COVID-19: 71% (71/100)

Healthy Controls: 22% (11/50)

Risk Factor-matched Controls: 57%

(31/57)

P<.05 for COVID-19 vs Controls

NR
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NOTE: Data for 100

patients; 33%

hospitalized

COVID-19: 60% (60/100)

Healthy Controls: 4% (2/50)

Risk Factor-matched Controls: 9% (5/57)

LGE 

Myocardial 

COVID-19: 32% (32/100)

Healthy Controls: 0%

Risk Factor-matched Controls: 17% (9/57)

Pericardial

COVID-19: 22% (22/100)

Healthy Controls: 0%

Risk Factor-matched Controls: 15% (8/57)

Pericardial Effusion >10 mm

COVID-19: 20% (20/100)

Healthy Controls: 0%

Risk Factor-matched Controls: 15% (8/57)

All measures: P<.05 for COVID-19 vs Controls

Significantly elevated hsTNT (≥13.9

pg/mL) 

COVID-19: 5% (5/100)

Healthy Controls: 0%

Risk Factor-matched Controls: 0%

P<.05 for COVID-19 vs Controls

hsTNT=high-sensitivity Troponin T; LGE=late gadolinium enhancement
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Table 5. Neurological Outcomes

Author, Year

Country 

Study Design

NIH Stroke Scale Modified Rankin Scale Other

Al Kasab, 202021

USA, South America, Europe 

Prospective

NR “Functional Independence on

Discharge” 

Score 0-2 

17% (2/12)

NOTE: missing data for n=1

Non-COVID-19 group

30% (94/316)

P=.52

NOTE: missing data for n=129

NR

Benussi, 202023

Italy

Retrospective cohort

Median (IQR)

COVID-19 group (n=43)

9.0 (1.0-19.0)

Non-COVID-19 group (n=68)

2.0 (0.0-6.8)

P=.005

“Good Outcome”

Score ≤2 at Discharge 

COVID-19 group: 25.6% (11/43)

Non-COVID-19 group: 70.6% (48/68)

P<.001

NR

Garrigues, 202043

France

Prospective, survey

NR NR Attention Disorder

27% (32/120)

Ward patients: 29% (28/96)

ICU patients: 17% (4/24)

P=.327

Memory Loss 

34% (41/120)

Ward patients: 38% (36/96)

ICU patients: 21% (5/24)

P=.194

Grewal, 202030

USA

Retrospective

Median (IQR)

COVID-19 group (n=13)

11 (4-23)

2020 Comparison Cohort: 3 (2-13)

2019 Comparison Cohort: 4 (1-11)

“Poor Outcome”

Score >2 at Discharge 

COVID-19 group: 77% (10/13)

2020 Comparison Cohort: 47% (25/53)

2019 Comparison Cohort: 41% (36/88)

NR
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Author, Year

Country 

Study Design

NIH Stroke Scale Modified Rankin Scale Other

Liotta, 202032

USA

Retrospective

NR Score ≤2 at Discharge

Overall: 71.1% (362/509)

No neurological manifestation (during

hospitalization): 70.0% (63/419)

Any neurological manifestation: 71.4

(299/419)

No encephalopathy (during

hospitalization): 89.3% (310/347)

Encephalopathy: 32.1% (52/162)

Ntaios, 202035

Multi-national registry

Retrospective

NR Severe Disability at Discharge

COVID-19 group: 51% (49/96 survivors)

Median Score (propensity matched

population (n=330)

COVID-19 group: 4 [IQR 2-6]

Matched group: 2 [IQR 1-4]

P<.001

NR
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Table 6. Renal Outcomes 

Author, Year

Country 

Study Design

Acute Kidney Disease Imaging Findings Need for Kidney Replacement Therapy

Chan, 202024

USA

Retrospective

At Discharge

35% (291/832)*

AKD Stage 1: 23%

AKD Stage 2: 6%

AKD Stage 3: 6%

Follow-up (median 21 [IQR 8-38] days) 

Data available for n=77 with AKD at

discharge

Recovered: 36% (28/77)

AKD Stage 1: 33% (25/77)

AKD Stage 2: 13% (10/77)

AKD Stage 3: 18% (14/77)

Data available for n=135 who had recovered

at discharge

Remain recovered: 86% (116/135)

New AKD Stage 1: 10% (14/135)

New AKD Stage 2: 2% (3/135)

New AKD Stage 3: 2% (3/135)

NR

Dennis, 202039

United Kingdom

Prospective

PREPRINT

NR Kidney Cortex T1

Normal: 78% (29/37)

Definite Impairment: 22% (8/37)

Ng, 202034

USA

Retrospective

Pre-proof

At Discharge

KRT

17% (108/638) survived; 33% (36/108) had

not recovered kidney function

Non-KRT

52% (1663/3216) survived; 26% (430/1663)

had not recovered kidney function

NR KRT

92% (33/36) who had not recovered

needed KRT at discharge (30.6%

[33/108] of survivors who required

hospital KRT)

NOTE: 58% (19/33) had underlying CKD

on admission

AKD=acute kidney disease; CKD=chronic kidney disease; IQR=interquartile range; KRT=kidney replacement therapy

*Of 1835 with AKI while hospitalized, 832 were discharged; 291 with acute kidney disease
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Table 7. Gastrointestinal Outcomes

Author, Year

Country 

Study Design

Imaging Findings

Dennis, 202039

United Kingdom

Prospective

PREPRINT

Liver Inflammation (cT1 in ms)

Normal (<800 ms): 84% (31/37)

Borderline (800-825 ms): 0% (0/37)

Significant (>825 ms): 16% (6/37)
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Table 8. Hematologic Outcomes

Author, Year

Country 

Study Design

Thromboembolism Hemorrhage 

Alharthy, 202022

Saudi Arabia

Prospective

DVT at Discharge

12.5% (8/64) (n=64 survivors)

NR

Patell, 202048

USA

Retrospective

2.5% (4/163) at median of 23 days [IQR 12-

33]

1 each: PE, intracardiac thrombus,

thrombosed arteriovenous fistula, ischemic

stroke

Among 13 patients discharged on

thromboprophylaxis: no observed thrombotic

or hemorrhagic complications

3.7% (6/163) at median of 27 days [IQR

16-31]

2 “major bleeds” (both following falls), 4 

“clinically relevant non-major bleeding”

Roberts, 202051

United Kingdom

Prospective

VTE

COVID-19 Cohort

0.48% (9/1877) at median of 8 days [range

3-33]

2 DVT, 7 PE

Comparison Cohort (Medical Admissions in

2019)

0.31% (56/18,159) 

8 proximal, 10 distal, 5 line-associated

upper-limb DVT, 33 PE

OR 1.6 (95%CI 0.77, 3.1); P=.2

NR

DVT=deep venous thrombosis; IQR=interquartile range; PE=pulmonary embolism
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Table 9. Healthcare/Resource Utilization Outcomes

Author, Year

Country 

Study Design

Positive SARSCoV-2 Readmission Discharge Disposition Post-discharge 

Treatment Other

Atalla, 202060

USA

Retrospective

On Readmission

63% (12/19)

5.6% (19/339)

Median of 5 days {IQR 3-13]

post discharge

Clinical Course During 2nd

Admission

Length of Stay: 7 days 

Intensive Care: 31%

NOTE: 3 patients required a 

third admission

For 19 Patients Readmitted

Skilled Nursing Facility: 26%

(5/19)

Home (n=11) or Hotel for

COVID+Homeless (n=3): 74%

(14/19)

NR Reasons for Readmission

Bacterial pneumonia secondary

to COVID-19 infection: 21%

(4/19)

Prolonged COVID-19 Course:

21% (4/19)

Psychiatric episodes: 16%

(3/19)

Metabolic encephalopathy: 11%

(2/19)

Thrombotic episodes: 11%

(2/19)

Alcohol intoxication, orthostatic

hypotension, gastroenteritis,

fall/trauma (1 each): 21% (4/19)

Casas-Rojo,

202038

Spain

Retrospective

cohort

NR 3.9% (573/14,709)

Of patients discharged: 4.8%

(573/11,928)

Not discharged at end of

follow-up (after readmission)

0.2% (31/15,150)

Of patients readmitted: 5.4%

(31/573)

NR NR NR

Collins, 202025

USA

Retrospective

NR NR Home: 65% (13/20) or 81%

(13/16 discharged)

Nursing facility (permanent

residence): 5% (1/20) or 6%

(1/16 discharged)

Hotel for those with confirmed

COVID-19: 10% (2/20) or 13%

(2/16 discharged)

NR NR
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Author, Year

Country 

Study Design

Positive SARSCoV-2 Readmission Discharge Disposition Post-discharge 

Treatment Other

Egol, 202040

USA

Prospective

NR Within 30 Days

COVID-19 Positive:

11.8% (2/17)

COVID-19 Suspected: 7.1%

(1/14)

COVID-19 Negative: 2.8%

(3/107)

P=.21

NR Post-Acute

Rehabilitation

COVID-19 Positive:

90.0% (9/17)

COVID-19

Suspected: 84.6%

(11/14)

COVID-19

Negative: 78.3%

(83/107)

P=.61

NR

El Moheb,

202041

USA

Retrospective

NR Emergency Department

Readmission

11% (10/92)

Matched comparison group of

non-COVID-19 ARDS

patients: 11% (10/92)

Length of follow-up not

reported

NR NR NR

Fisher, 202027

USA

Retrospective

NR NR Nursing Home

COVID-19 positive: 14.7%

(492/3345) or 23% (492/2142

discharged)

COVID-19 negative: 12.8%

(152/1265) or 17% (162/950

discharged)

RR (total study population): 1.2

(95%CI 1.0, 1.4)

Historical control: 14.6%

(1436/9859) or 15%

(1436/9544 discharged)

RR (COVID positive vs control, 

total study population): 1.0

(95%CI 0.9, 1.1)

NR NR
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Author, Year

Country 

Study Design

Positive SARSCoV-2 Readmission Discharge Disposition Post-discharge 

Treatment Other

Home

COVID-19 positive: 49.3%

(1650/3345) or 77%

(1650/2142 discharged)

COVID-19 negative: 62.3%

(788/2365) or 83% (788/950

discharged)

RR (total study population): 

0.08 (95%CI 0.7, 0.8)

Historical control: 82,2%

(8108/9859) or 85%

(8108/9544 discharged)

RR (COVID positive vs control, 

total study population): 0.6

(95%CI 0.57, 0.62)

Grewal, 202030

USA

Retrospective

NR NR Disposition reported for 10/13

survivors (remaining patients: 2 

deaths, 1 unknown disposition) 

Home: 30% (3/10) (2/6 in

‘COVID’ group, 1/4 in ‘Neuro’

group)

Acute rehabilitation: 50%

(5/10) (3/6 in ‘COVID’ group,

2/4 in ‘Neuro’ group)

Long-term acute care: 20%

(2/10) (1/6 in ‘COVID’ group,

1/4 in ‘Neuro’ group)

NR NR

Hong, 202044

China

Retrospective

28% (8/29) NR NR NR NR

Katz, 202031

USA

Retrospective

NR NR COVID-19 group

Home: 29% (25/86) or 45%

(25/56 discharged)

Rehabilitation: 36% (31/86) or

55% (31/56 discharged)

NR NR
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Author, Year

Country 

Study Design

Positive SARSCoV-2 Readmission Discharge Disposition Post-discharge 

Treatment Other

(Additional 30 patients died or

in hospice care)

Non-COVID-19 group

Home: 46% (228/499) or 52%

(228/438 discharged)

Rehabilitation: 42% (210/499)

or 48% (210/438 discharged)

(Additional 61 patients died or

in hospice care)

Overall P<.001

Knights,

202061

United

Kingdom

Retrospective

NR 5.4% (3/56 patients

discharged home)

Home: 81% (56/69 discharged)

Care Home: 14% (10/69

discharged)

Other (not specified): 4% (3/69

discharged)

New “packages of

care”: 2.9% (2/69

discharged)

New care home

placement: 7.2%

(5/69 discharged)

Increase in mobility

aids: 11.6% (8/69

discharged)

NR

LovinskyDesir, 202047

USA

Retrospective

NR Age 21-39

No Asthma: 5% (12/261)

Asthma: 10% (4/39)

P=.14

Age 40-65

No Asthma: 5% (40/832)

Asthma: 5% (5/111)

P=1.0

NR NR NR

Patell, 202048

USA

Retrospective

NR 7% (12/163) NR NR NR
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Author, Year

Country 

Study Design

Positive SARSCoV-2 Readmission Discharge Disposition Post-discharge 

Treatment Other

Paterson,

202036

United

Kingdom

Retrospective

NR NR Patients with

Encephalopathy (n=7

discharged)

Home: 86% (6/7)

Rehabilitation Unit: 14% (1/7)

Patients with Inflammatory 

Central Nervous System

Syndromes (n=2 discharged)

Home: 100% (2/2)

Patients with Ischemic

Stroke (n=4 discharged)

Rehabilitation Unit: 75% (3/4)

Stroke Unit: 25% (1/4)

Patients with Peripheral 

Neurological Syndromes 

(n=2 discharged; location NR

Uncharacterized Condition 

(n=1 discharged to home)

NR NR

Richardson,

202050

USA

Case series

NR Overall: 2.2% (45/2081)

<18 years: 3.1% (1/32)

18-65 years: 1.6% (22/1,373)

>65 years: 3.3% (22/676)

Time to Readmission

(median [IQR]) 

3 [1.0, 4.5) days

Facility (eg, nursing home,

rehabilitation) 

Overall: 5.9% (122/2081)

<18 years: 0% (0/32)

18-65 years: 2.0% (28/1373)

>65 years: 13.9% (94/676)

Home

Overall: 94.1% (1959/2081)

<18 years: 100% (32/32)

18-65 years: 98% (1345/1373)

>65 years: 86% (582/676)

NR NR

Sachdeva,

202052

USA

Retrospective

NR 9% (1/9 discharged home)

Length of follow-up NR

NR NR NR

Somani,

200053

NR Returned for Emergency

Care

NR NR Reasons for Return

Respiratory distress: 50%
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Author, Year

Country 

Study Design

Positive SARSCoV-2 Readmission Discharge Disposition Post-discharge 

Treatment Other

USA

Retrospective

3.6% (103/2864)

Median 4.5 days

Inpatient Admission

54.4% (56/103)

Chest pain: 6%

Other pain: 6%

Altered mental status: 5%

Falls: 5%

Soft tissue infection: 5%

Need for ICU level care

10.7% (6/56)

Suleyman,

202062

USA

Retrospective

case series

NR 30-day Hospital

Overall: 11.2% (29 cases) 

General practice unit: 27

cases

ICU: 2 cases

P<.001

NOTE: among patients

initially discharged home from

ED, 4% (4/108) were

readmitted within 30 days

Home

General practice unit: 96%

(183/191 with known discharge

disposition) 

ICU: 79% (49/62 with known

discharge disposition) 

Rehabilitation center

General practice unit: 4%

(8/191) 

ICU: 21% (13/62)

NR 30-day Mortality (includes

hospital mortality) 

General practice unit: 7%

(15/214)

ICU: 40% (57/141) 

P<.001

Tian, 202054

China

Retrospective

‘Re-positive” RTPCR 

13.6% (20/147)

Median 17.3 days

post-discharge

(range 7-47 days)

All were

asymptomatic with

no progressive

lesions on chest CT

compared to images

at first discharge

8 cases showed

alternating PRC

positivity and

negativity
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Author, Year

Country 

Study Design

Positive SARSCoV-2 Readmission Discharge Disposition Post-discharge 

Treatment Other

Vizcaychipi,

202037

United

Kingdom

Prospective

NR NR Home (usual residence)

92.5% (614/664 discharged

alive)

Temporary Home

2.4% (16/664)

Residential Care Home

5.1% (34/664)

NR NR

Wang, 202055

China

Prospective

cohort

1-2 weeks postdischarge

17% (6/36)

3-4 weeks postdischarge

2.4% (2/83)

1-2 weeks post-discharge

4% (5/131)

3-4 weeks post-discharge

2% (3/131)

Home Quarantine

1-2 weeks post-discharge

87% (114/131)

3-4 weeks post-discharge

92% (121/131)

Community Quarantine 

1-2 weeks post-discharge

9% (12/131)

3-4 weeks post-discharge

3% (4/131)

Designated Hospital 

1-2 weeks post-discharge

4% (5/131)

3-4 weeks post-discharge

2% (3/131)

Return to Work 

1-2 weeks post-discharge

0% (0/131)

3-4 weeks post-discharge

2% (3/131)

Outcomes did not differ by

severity of COVID-19

Oxygen therapy

1-2 weeks postdischarge

7% (9/131)

3-4 weeks postdischarge

1% (1/131)

Corticosteroids 

1-2 weeks postdischarge

4% (5/131)

3-4 weeks postdischarge

2% (2/131)

Outcomes did not

differ by severity of

COVID-19

CBC abnormal

1-2 weeks post-discharge

14% (2/14)

3-4 weeks post-discharge

8% (4/50)

Outcomes did not differ by

severity of COVID-19

Xu, 202056

China

Retrospective

case series

NR NR NR Oxygen therapy

6% (5/85)

(nasal cannula)

60-day mortality (overall)

62% (147/239)

NOTE: Predictors included age

>65, lymphocyte and platelet

count, ARDS, acute cardiac
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Author, Year

Country 

Study Design

Positive SARSCoV-2 Readmission Discharge Disposition Post-discharge 

Treatment Other

injury, AKI, liver dysfunction,

and coagulopathy

Yan, 202057

China 

Retrospective

9% (20/218) retested

positive for SARSCoV-2 after recovery

and hospital

discharge

(18 from moderate

disease group, 2 

from mild group)

NR NR NR NR

ARDS=acute respiratory distress syndrome; ED=emergency department: ICU=intensive care unit; IQR=interquartile range
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APPENDIX D. PRISMA CHECKLIST

Section/topic # Checklist item Reported 

on page #

TITLE 

Title 1 Identify the report as a systematic review, meta-analysis, or both. Title page

ABSTRACT 

Structured 

summary 

2 Provide a structured summary including, as applicable: background; 

objectives; data sources; study eligibility criteria, participants, and 

interventions; study appraisal and synthesis methods; results; 

limitations; conclusions and implications of key findings; systematic 

review registration number. 

Separate 

document

INTRODUCTION 

Rationale 3 Describe the rationale for the review in the context of what is already 

known. 

1 

Objectives 4 Provide an explicit statement of questions being addressed with 

reference to participants, interventions, comparisons, outcomes, and 

study design (PICOS). 

1 

METHODS 

Protocol and 

registration 

5 Indicate if a review protocol exists, if and where it can be accessed 

(e.g., Web address), and, if available, provide registration information 

including registration number. 

3 

Eligibility 

criteria 

6 Specify study characteristics (e.g., PICOS, length of follow-up) and 

report characteristics (e.g., years considered, language, publication 

status) used as criteria for eligibility, giving rationale. 

3-4 

Information 

sources 

7 Describe all information sources (e.g., databases with dates of 

coverage, contact with study authors to identify additional studies) in 

the search and date last searched. 

3 

Search 8 Present full electronic search strategy for at least one database, 

including any limits used, such that it could be repeated. 

Appendix A

Study 

selection 

9 State the process for selecting studies (i.e., screening, eligibility, 

included in systematic review, and, if applicable, included in the metaanalysis). 

3 

Data collection 

process 

10 Describe method of data extraction from reports (e.g., piloted forms, 

independently, in duplicate) and any processes for obtaining and 

confirming data from investigators. 

3 

Data items 11 List and define all variables for which data were sought (e.g., PICOS, 

funding sources) and any assumptions and simplifications made. 

3 

Risk of bias in 

individual 

studies 

12 Describe methods used for assessing risk of bias of individual studies 

(including specification of whether this was done at the study or 

outcome level), and how this information is to be used in any data 

synthesis. 

3 

Summary 13 State the principal summary measures (e.g., risk ratio, difference in 3 
COVID-19 Post-acute Care Major Organ Damage Evidence Synthesis Program

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measures means). 

Synthesis of 

results 

14 Describe the methods of handling data and combining results of 

studies, if done, including measures of consistency (e.g., I2) for each 

meta-analysis. 

3 

Risk of bias 

across studies 

15 Specify any assessment of risk of bias that may affect the cumulative 

evidence (e.g., publication bias, selective reporting within studies). 

N/A

Additional 

analyses 

16 Describe methods of additional analyses (e.g., sensitivity or subgroup 

analyses, meta-regression), if done, indicating which were prespecified. 

N/A

RESULTS 

Study 

selection 

17 Give numbers of studies screened, assessed for eligibility, and 

included in the review, with reasons for exclusions at each stage, 

ideally with a flow diagram. 

6 

Study 

characteristics 

18 For each study, present characteristics for which data were extracted 

(e.g., study size, PICOS, follow-up period) and provide the citations. 

7 and 

Appendix C

Risk of bias 

within studies 

19 Present data on risk of bias of each study and, if available, any 

outcome level assessment (see item 12). 

7 

Results of 

individual 

studies 

20 For all outcomes considered (benefits or harms), present, for each 

study: (a) simple summary data for each intervention group (b) effect 

estimates and confidence intervals, ideally with a forest plot. 

7-17 and 

Appendix C

Synthesis of 

results 

21 Present results of each meta-analysis done, including confidence 

intervals and measures of consistency. 

N/A

Risk of bias 

across studies 

22 Present results of any assessment of risk of bias across studies (see 

Item 15). 

N/A

Additional 

analysis 

23 Give results of additional analyses, if done (e.g., sensitivity or 

subgroup analyses, meta-regression [see Item 16]). 

N/A

DISCUSSION 

Summary of 

evidence 

24 Summarize the main findings including the strength of evidence for 

each main outcome; consider their relevance to key groups (e.g., 

healthcare providers, users, and policy makers). 

18

Limitations 25 Discuss limitations at study and outcome level (e.g., risk of bias), and 

at review-level (e.g., incomplete retrieval of identified research, 

reporting bias). 

18

Conclusions 26 Provide a general interpretation of the results in the context of other 

evidence, and implications for future research. 

21

FUNDING 

Funding 27 Describe sources of funding for the systematic review and other 

support (e.g., supply of data); role of funders for the systematic 

review. 

Preface

From: Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009). Preferred Reporting Items for 

Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med 6(7): e1000097. 

doi:10.1371/journal.pmed1000097