Long-term clinical outcomes in survivors of severe acute respiratory syndrome and Middle East respiratory syndrome coronavirus outbreaks after hospitalisation or ICU admission: A systematic review and meta-analysis.

Hassaan Ahmed, Kajal Patel, Darren C Greenwood, Stephen Halpin, Penny Lewthwaite, Abayomi Salawu, Lorna Eyre, Andrew Breen, Rory O'Connor, Anthony Jones, Manoj Sivan

Journal: Journal of rehabilitation medicine 2020;52(5):jrm00063

PMID: 32449782

Free Full Text on MJS Publishing View on PubMed

Plain Language Summary

Alongside acute challenges, the severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) outbreaks resulted in significant long-term clinical problems for survivors, with implications for rehabilitation services and healthcare utilization. The aim of this study was to determine the long-term clinical complications for survivors of SARS and MERS after hospitalization and intensive care unit admission. This study is a systemic review and meta-analysis which included a total of 28 studies in the systematic review and 23 in the meta-analysis. Results indicate that health-related quality of life, measured using SF-36, was considerably reduced in survivors at 6 months post-infection, and showed only slight improvement beyond 6 months. Health-related quality of life of survivors remained below that of the normal population and of those with chronic conditions. Authors conclude that clinicians should monitor the survivors of COVID-19 for the range of physical and mental health impairments in order to manage these patients appropriately.

Abstract

OBJECTIVE

To determine long-term clinical outcomes in survivors of severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) coronavirus infections after hospitalization or intensive care unit admission.

DATA SOURCES

Ovid MEDLINE, EMBASE, CINAHL Plus, and PsycINFO were searched.

STUDY SELECTION

Original studies reporting clinical outcomes of adult SARS and MERS survivors 3 months after admission or 2 months after discharge were included.

DATA EXTRACTION

Studies were graded using the Oxford Centre for Evidence-Based Medicine 2009 Level of Evidence Tool. Meta-analysis was used to derive pooled estimates for prevalence/severity of outcomes up to 6 months after hospital discharge, and beyond 6 months after discharge.

DATA SYNTHESIS

Of 1,169 identified studies, 28 were included in the analysis. Pooled analysis revealed that common complications up to 6 months after discharge were: impaired diffusing capacity for carbon monoxide (prevalence 27%, 95% confidence interval (CI) 15–45%); and reduced exercise capacity (mean 6-min walking distance 461 m, CI 450–473 m). The prevalences of post-traumatic stress disorder (39%, 95% CI 31–47%), depression (33%, 95% CI 20–50%) and anxiety (30%, 95% CI 10–61) beyond 6 months after discharge were considerable. Low scores on Short-Form 36 were identified beyond 6 months after discharge.

CONCLUSION

Lung function abnormalities, psychological impairment and reduced exercise capacity were common in SARS and MERS survivors. Clinicians should anticipate and investigate similar long-term outcomes in COVID-19 survivors.

Address: School of Medical Sciences, University of Manchester, UK.; School of Medicine and Leeds Institute for Data Analytics, University of Leeds, UK; Academic Department of Rehabilitation Medicine, University of Leeds and National Demonstration Centre of Rehabilitation Medicine, Leeds Teaching Hospitals NHS trust, UK; Department of Infectious Diseases, Leeds Teaching Hospitals NHS Trust, Leeds, UK; Department of Rehabilitation Medicine, Hull University Teaching Hospitals NHS Trust, Hull, UK; Intensive Care Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK; Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK

DOI: 10.2340/16501977-2694