Post-acute COVID-19 symptom risk in hospitalized and non-hospitalized COVID-19 survivors: A systematic review and meta-analysis

Abstract

Background: Post-acute coronavirus disease 2019 (COVID-19) symptoms occurred in most of the COVID-19 survivors. However, few studies have examined the issue of whether hospitalization results in different post-acute COVID-19 symptom risks. This study aimed to compare potential COVID-19 long-term effects in hospitalized and non-hospitalized COVID-19 survivors.

Methods: This study is designed as a systematic review and meta-analysis of observational studies. A systematic search of six databases was performed for identifying articles published from inception until April 20th, 2022, which compared post-acute COVID-19 symptom risk in hospitalized and non-hospitalized COVID-19 survivors using a predesigned search strategy included terms for SARS-CoV-2 (eg, COVID, coronavirus, and 2019-nCoV), post-acute COVID-19 Syndrome (eg, post-COVID, post COVID conditions, chronic COVID symptom, long COVID, long COVID symptom, long-haul COVID, COVID sequelae, convalescence, and persistent COVID symptom), and hospitalization (hospitalized, in hospital, and home-isolated). The present meta-analysis was conducted according to The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement using R software 4.1.3 to create forest plots. Q statistics and the I ² index were used to evaluate heterogeneity in this meta-analysis.

Results: Six observational studies conducted in Spain, Austria, Switzerland, Canada, and the USA involving 419 hospitalized and 742 non-hospitalized COVID-19 survivors were included. The number of COVID-19 survivors in included studies ranged from 63 to 431, and follow-up data were collected through visits in four studies and another two used an electronic questionnaire, visit and telephone, respectively. Significant increase in the risks of long dyspnea (OR = 3.18, 95% CI = 1.90-5.32), anxiety (OR = 3.09, 95% CI = 1.47-6.47), myalgia (OR = 2.33, 95% CI = 1.02-5.33), and hair loss (OR = 2.76, 95% CI = 1.07-7.12) risk were found in hospitalized COVID-19 survivors compared with outpatients. Conversely, persisting ageusia risk was significantly reduced in hospitalized COVID-19 survivors than in non-hospitalized patients.

Conclusion: The findings suggested that special attention and patient-centered rehabilitation service based on a needs survey should be provided for hospitalized COVID-19 survivors who experienced high post-acute COVID-19 symptoms risk.

Keywords: COVID-19 survivor; hospitalized; long-COVID; meta-analysis; non-hospitalized; post-acute COVID-19 symptom.

Figure 1

Flowchart of the database search and study selection.

Figure 2

Forest plot for meta-analysis of any persistent symptom risk among Hospitalized vs. non-hospitalized COVID-19 survivors.

Figure 3

Forest plot for meta-analysis of general symptom risk among Hospitalized vs. non-hospitalized COVID-19 survivors.

Figure 4

Forest plot for meta-analysis of respiratory symptoms risk among Hospitalized vs. non-hospitalized COVID-19 survivors. (A) Dyspnea risk; (B) Cough risk; (C) Chest pain risk.

Figure 5

Forest plot for meta-analysis of neurological symptoms risk among Hospitalized vs. non-hospitalized COVID-19 survivors. (A) Headache risk; (B) Sleep disorder risk; (C) Ageusia risk; (D) Anosmia risk; (E) Anxiety risk; (F) Depression risk.

Figure 6

Forest plot for meta-analysis of other symptoms risk among Hospitalized vs. non-hospitalized COVID-19 survivors. (A) Myalgia risk; (B) Hair loss risk.