Complications of Covid-19: A Systematic Review and Meta-Analysis

Year 2021, Volume: 11 Issue: 02, 45 - 57, 15.06.2021

Aishat Temitope Alonge Babatunde Isaac Ademusire Chinweoge Frances Epum Boluwatife Adeleye Adewale Opeoluwa Samuel Adefarati

https://doi.org/10.5799/jmid.951471

Cited By: 1

Abstract

Objectives: COVID-19, primarily a respiratory disease, can have complications that affect all organ systems of the body. There is a paucity of systematic reviews on all the complications. In this systematic review and meta-analysis, we set out to summarize the complications of COVID-19 in all body systems and their prevalence.
Methods: PubMed and Google Scholar were searched for eligible articles using predefined criteria. Database searching and extraction were performed by independent reviewers.
Results: We identified 74 case reports/series and 15 observational studies. In both the case reports/series and observational studies, pulmonary complications were the most commonly reported, particularly pneumonia, followed by neurological complications in case reports/case series and hematological complications in observational studies. Atrial arrhythmias (1.7%) and acute myopericarditis (1.7%), liver injury (3.3%), acute kidney injury (8.8%), deep venous thrombosis (2.2%), ischemic stroke (12.2%), herpes zoster (1.1%), and diabetic ketoacidosis (1.1%) were the most reported cardiovascular, gastrointestinal, renal, hematological, neurological, dermatological, and endocrine complications respectively in case reports/series. However, acute myocarditis (100%), hypoproteinemia (15.9-28.8%), transient acute renal failure (49.9-90.1%), acute coagulopathy (16.5-28.4%), and ischemic stroke (1.3-3.9%) had the highest pooled prevalence for cardiovascular, gastrointestinal, renal, hematological, and neurological complications respectively in observational studies.
Conclusion: The complications of COVID-19 are multi-systemic with pulmonary complications being the most commonly reported. Notwithstanding, healthcare professionals should be aware that COVID-19 is a differential diagnosis for even the rare but equally debilitating complications and should screen patients who develop these complications to rule out COVID-19 during the pandemic and beyond. J Microbiol Infect Dis 2021; 11(2): 45-57.

Keywords

Covid-19, Systematic review, SARS-CoV-2, Complications, Sequelae

References

• 1. Mao L, Wang M, Chen S, et al. Neurological Manifestations of Hospitalized Patients with COVID-19 in Wuhan, China: A Retrospective Case Series Study. https://www.medrxiv.org/content/10.1101/2020.02.22.20026500v1,
• 2. Culp WC. Coronavirus Disease 2019. A A Pract 2020; 14: e01218.
• 3. Pinna P, Grewal P, Hall JP, et al. Neurological manifestations and COVID-19: Experiences from a tertiary care center at the Frontline. J Neurol Sci. 2020; 415:116969.
• 4. Zeng J-H, Liu Y-X, Yuan J, et al. First case of COVID-19 complicated with fulminant myocarditis: a case report and insights. Infection 2020 Oct;48(5):773-777.
• 5. Gupta A, Madhavan M V., Sehgal K, et al. Extrapulmonary manifestations of COVID-19. Nat Med 2020; 26:1017–32.
• 6. Kohn MA, Senyak J. Sample Size Calculators [website]. UCSF CTSI. 29 April 2021. Available at https://www.sample-size.net/ [Accessed 10 June 2021]
• 7. Hamming I, Timens W, Bulthuis MLC, Lely AT, Navis GJ, van Goor H. Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step in understanding SARS pathogenesis. J Pathol 2004; 203:631–637.
• 8. World Health Organization. Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected. Interim guidance. Pediatr Med Rodz 2020, 16 (1): 9–26.
• 9. Ranieri VM, Rubenfeld GD, Thompson BT, et al. Acute respiratory distress syndrome: The Berlin definition. JAMA 2012; 307: 2526-2533.
• 10. Li X, Ma X. Acute respiratory failure in COVID-19: Is it “typical” ARDS? Crit Care 2020 May 6;24(1):198.
• 11. Helleberg M, Steensen M, Arendrup MC. Invasive aspergillosis in patients with severe COVID-19 pneumonia. Clin Microbiol Infect 2021; 27(1):147-148.
• 12. Fraser E. Long term respiratory complications of Covid-19. BMJ 2020; 370:m3001. https://doi.org/10.1136/bmj.m3001.
• 13. NHS. Aftercare needs of inpatients recovering from COVID-19. England: 2020. https://www.cambscommunityservices.nhs.uk/docs/default-source/luton-adults-general/c0388_after_care_needs_of_inpatients_recovering_from_covid-19_5_june_2020.pdf
• 14. Nishiga M, Wang DW, Han Y, Lewis DB, Wu JC. COVID-19 and cardiovascular disease: from basic mechanisms to clinical perspectives. Nat Rev Cardiol 2020; 17:543–58.
• 15. Long B, Brady WJ, Koyfman A, Gottlieb M. Cardiovascular complications in COVID-19. Am J Emerg Med 2020; 38:1504–1507.
• 16. Chen L, Li X, Chen M, Feng Y, Xiong C. The ACE2 expression in human heart indicates new potential mechanism of heart injury among patients infected with SARS-CoV-2. Cardiovasc Res 2020; 116:1097–1000.
• 17. Mercuro NJ, Yen CF, Shim DJ, et al. Risk of QT Interval Prolongation Associated with Use of Hydroxychloroquine with or without Concomitant Azithromycin among Hospitalized Patients Testing Positive for Coronavirus Disease 2019 (COVID-19). JAMA Cardiol 2020; 5: 1036-1041.
• 18. Fox S, Vashisht R, Siuba M, Dugar S. Evaluation and management of shock in patients with COVID-19. Cleve Clin J Med 2020. https://doi.org/10.3949/ccjm.87a.ccc052.
• 19. Hoffmann M, Kleine-Weber H, Krüger N, Müller M, Drosten C, Pöhlmann S. The novel coronavirus 2019 (2019-nCoV) uses the SARS-coronavirus receptor ACE2 and the cellular protease TMPRSS2 for entry into target cells. 2020. https://www.biorxiv.org/content/10.1101/2020.01.31.929042v1.
• 20. Musa S. Hepatic and gastrointestinal involvement in coronavirus disease 2019 (COVID-19): What do we know till now? Arab J Gastroenterol 2020; 21:3–8. https://doi.org/10.1016/j.ajg.2020.03.002.
• 21. Zhang H, Kang Z, Gong H, et al. The digestive system is a potential route of 2019-nCov infection: a bioinformatics analysis based on single-cell transcriptomes. 2020. https://www.biorxiv.org/content/10.1101/2020.01.30.927806v1
• 22. Yang F, Shi S, Zhu J, Shi J, Dai K, Chen X. Analysis of 92 deceased patients with COVID-19. J Med Virol 2020;92(11):2511-2515.
• 23. Kunutsor SK, Laukkanen JA. Renal complications in COVID-19: a systematic review and meta-analysis. Ann Med 2020; 52:1–9.
• 24. Connors JM, Levy JH. Thromboinflammation and the hypercoagulability of COVID-19. J Thromb Haemost 2020; 18:1559–61.
• 25. Chen X, Laurent S, Onur OA, et al. A systematic review of neurological symptoms and complications of COVID-19. J Neurol 2020; J Neurol 2021; 268(2):392-402.
• 26. Gavriatopoulou M, Korompoki E, Fotiou D, et al. Organ-specific manifestations of COVID-19 infection. Clin Exp Med 2020 20(4):493-506.
• 27. Elsaie ML, Nada HA. Herpes Zoster (shingles) complicating the course of COVID19 infection. J Dermatolog Treat 2020; 12;1-3.
• 28. Bellastella G, Maiorino MI, Esposito K. Endocrine complications of COVID-19: what happens to the thyroid and adrenal glands? J Endocrinol Invest 2020; 43:1169–70.
• 29. Ruggeri RM. Subacute thyroiditis in a patient infected with SARS-COV-2: an endocrine complication linked to the COVID-19 pandemic 2020:9-11.
• 30. Palermo NE, Sadhu AR, McDonnell ME. Diabetic Ketoacidosis in COVID-19: unique concerns and considerations. J Clin Endocrinol Metab 2020; 105 (8):dgaa360.
• 31. Kumar P, Kuchay MS, Mehta Y, Mishra KS. Diabetic ketoacidosis precipitated by COVID-19: A report of two cases and review of literature. Diabetes Metab Syndr 2020; 14(5): 1459-1462.
• 32. Robba C, Battaglini D, Pelosi P, Rocco PRM. Multiple organ dysfunction in SARS-CoV-2: MODS-CoV-2. Expert Rev Respir Med 2020:1–4. https://doi.org/10.1080/17476348.2020.1778470.
• 33. Lippi G, South AM, Henry BM. Electrolyte imbalances in patients with severe coronavirus disease 2019 (COVID-19). Ann Clin Biochem 2020; 57:262-265.