Introduction
Method
Protocol and registration
Eligibility criteria
Information sources and search
Study selection and data collection process
Data items
Risk of bias in individual studies
Summary measures and synthesis of results
Results
Study selection and study characteristics (Fig. 1)
Author | Country | Publication date | Study design | Cohort Size, N | Follow-up timing | Age | Male, % (N) | Comorbidities, % (N) | Initial COVID-19 Symptoms, % (N) | Symptoms at follow-up, % (N) | Severe cases, % (N) | Non-severe cases, % (N) |
---|---|---|---|---|---|---|---|---|---|---|---|---|
You [17] | China | 6/5/20 | Retrospective | 18 | 38 ± 13.4 days after discharge | 50.7 ± 12.1 | 55.6% (10) | Hypertension 16.7% (3) Diabetes mellitus 5.6% (1) Hypothyroidism 5.6% (1) | NA | NA | 33.3% (6) | 66.7% (12) |
Huang [18] | China | 6/29/20 | Retrospective | 57 | 30 days after discharge | 46.7 ± 13.8 | 45.6% (26) | Hypertension 19.3% (11) Diabetes mellitus 7.0% (4) Cardiovascular disease 5.3% (3) Malignancy 5.3% (3) | NA | Cough 10.5% (6) Dyspnea 7% (4) Occasional wheezing 5.3% (3) | 29.8% (17) | 70.2% (40) |
Liu [19] | China | 7/21/20 | Retrospective | 51 | Initial CT: median 10 days (range 7–16) after discharge Llatest CT: median 31 days (range 20–37) after initial CT | 46.6 ± 13.9 | 41.2% (21) | Hypertension 13.7% (7) Diabetes mellitus 7.8% (4) Coronary heart disease 2% (1) | NA | Cough 15.7% (8) Sputum 3.9% (2) Throat discomfort 5.9% (3) | NA | NA |
Zhao [20] | China | 8/25/20 | Retrospective | 55 | 64–93 days after discharge | 47.7 ± 15.5 | 58.2% (32) | Hypertension 10.9% (6) Diabetes mellitus 3.6% (2) Cardiovascular disease 3.6% (2) | Fever 67.3% (37) Cough 54.5% (30) Fatigue 32.7% (18) | GI symptoms 30.9% (17) Headache 18.2% (10) Fatigue 16.4% (9) Exertional dyspnea 14.6% (8) Cough and sputum 1.8% (1) | 7.3% (4) | 92.7% (51) |
Zhong [21] | China | 10/14/20 | Retrospective | 52 | 39.6 ± 5.96 days after symptom onset 19.71 ± 4.08 days after discharge | 45.5 ± 13.7 | 55.8% (29) | Hypertension 23.1% (12) Diabetes mellitus 9.6% (5) Cardiac disease 5.8% (3) Cerebrovascular disease 1.9% (1) | Fever 100% (52) Cough 48.1% (25) Fatigue 28.8% (15) Headache 7.7% (4) Vomiting 1.9% (1) Abdominal pain3.8% (2) Diarrhea 1.9% (1) | NA | 36.5% (19) | 63.5% (33) |
Liang [22] | China | 10/26/20 | Prospective | 76 | 3 months after discharge | 41.3 ± 13.8 | 28% (21) | Hypertension 6.6% (5) Cardiovascular disease 1.3% (1) Diabetes mellitus 3.9% (3) Thyroid disease 2.6% (2) Pulmonary tuberculosis 6.6% (5) Chronic bronchitis 3.9% (3) Asthma 2.6% (2) | NA | NA | 9.2% (7) | 90.8% (69) |
Tabatabaei [23] | Iran | 11/9/20 | Retrospective | 52 | 91 ± 15.5 days after initial CT | 50.2 ± 13.1 | 61.5% (32) | Cardiac disease 11.5% (6) Diabetes mellitus 7.7% (4) Hypertension 3.8% (2) Pulmonary disease 3.8% (2) | Fever 88.4% (46) Fatigue 53.8% (28) Dyspnea 40.4% (21) | Mild chest pain or discomfort 28.8% (15) Dyspnea on exertion 11.5% (6) Cough 1.9% (1) | NA | NA |
van den Borst [24] | The Netherlands | 11/21/20 | Prospective | 124 | 13.0 ± 2.2 weeks after symptom onset 9.1 ± 1.6 weeks after discharge | 59 ± 14 | 60% (74) | Cardiovascular disease 24% (30) Asthma 10% (12) COPD 6% (7) Hypertension 28% (34) Diabetes mellitus 14% (17) Chronic kidney disease 8% (10) Malignancy 20% (25) Immunocompromised status 15% (18) | NA | NA | 37.1% (46) | 62.9% (78) |
Smet [25] | Belgium | 11/30/20 | Retrospective | 220 | 74 ± 12 days after diagnosis | 53 ± 13 | 61.4% (135) | Hypertension 34.1% (75) Diabetes mellitus 17.7% (39) | NA | Fatigue 40.9% (90) Dyspnea 29.5% (65) | 100% (220) | 0% (0) |
Shah [26] | Canada | 12/3/20 | Prospective | 60 | 12 weeks after symptom onset | 67 [54, 74] | 68.3% (41) | Hypertension 35% (21) Diabetes 22% (13) Chronic pulmonary disease 13% (8) Coronary artery disease 10% (6) Malignancy 10% (6) Chronic Kidney Disease 7% (4) | NA | Dyspnea 20% (12) Cough 20% (12) | 76.7% (46) | 23.3% (14) |
Lerum [27] | Norway | 12/10/20 | Prospective | 103 | 83 [73, 90] days after hospital admission | 59 [49, 72] | 52% (54) | Hypertension 34.0% (35) Diabetes Mellitus 7.8% (8) | NA | NA | 14.6% (15) | 85.4% (88) |
Bellan [28] | Italy | 1/4/21 | Prospective | 238 | 4 months after after discharge | 61 [50, 71] | 59.7% (142) | Hypertension 41.2% (98) Diabetes Mellitus 15.1% (36) Dyslipidemia 8.4% (20) COPD 5.8% (14) Inflammatory bowel disease 1.7% (4) Chronic liver disease 2.9% (7) Autoimmune disease 2.1% (5) Hematological disease 6.3% (15) Chronic kidney disease 6.3% (15) | Fever 90.3% (215) Cough 55.5% (132) Dyspnea 54.2% (129) Ageusia 29.4% (70) Anosmia 26.5% (63) Diarrhea 22.7% (54) Arthralgia 19.3% (46) Myalgia 18.9% (45) Chest pain 0.8% (2) Sore throat 0.4% (1) Headache 0.4% (1) | Cough 2.5% (6) Dyspnea 5.5% (13) Ageusia 5.0% (12) Anosmia 4.6% (11) Diarrhea 1.3% (3) Arthralgia 5.9% (14) Myalgia 5.9% (14) Chest pain 0.4% (1) | 29.4% (70) | 70.6% (168) |
Huang [29] | China | 1/8/21 | Ambi-directional | 1733 | 186 [175, 199] days after symptom onset | 57 (47, 65) | 52% (897) | Hypertension 29.1% (505) Diabetes Mellitus 11.9% (207) Cardiovascular disease 7.4% (128) Cerebrovascular disease 2.7% (47) Malignancy 2.5% (44) COPD 1.8% (31) Chronic Kidney Disease 1.6% (27) | NA | Fatigue 62.7% (1038) Sleep difficulties 26.4% (437) Hair loss 21.7% (359) Smell disorder 10.6% (176) Palpitations 9.3% (165) Arthralgia 9.3% (165) Decreased appetite 8.3% (138) Taste disorder 7.3% (120) Dizziness 6.1% (101) Diarrhea or vomiting 4.8% (80) Chest pain 4.5% (75) Sore throat 4.2% (69) Skin rash 2.8% (47) Myalgia 2.4% (39) Headache 2.0% (33) | 7.0% (122) | 93.0% (1611) |
Guler [30] | Switzerland | 1/8/21 | Prospective | 113 | 128 [108, 144] days after symptom onset | 57.2 ± 12.1 | 59.3% (67) | Hypertension 35.4% (40) Diabetes Mellitus 20.4% (23) Interstitial lung disease 4.4% (5) COPD 8.0% (9) Asthma 13.3% (15) GERD 9.7% (11) Sleep apnea 10.6% (12) Chronic heart failure 9.7% (11) Chronic Kidney Disease 11.5% (13) Malignancy 5.3% (6) | NA | NA | 58.4% (66) | 41.6% (47) |
Han [31] | China | 1/26/21 | Prospective | 114 | 175 ± 20 days after symptom onset | 54 ± 12 | 70.2% (80) | Hypertension 28.1% (32) Diabetes Mellitus 11.4% (13) Chronic pulmonary disease 14.0% (16) | NA | Cough 6.1% (7) Sputum 10.0% (11) Exertional Dyspnea 14.0% (16) | NA | NA |
Baseline characteristics of individual studies (Table 1)
Follow-up CT results after discharge (Table 2)
Author | Follow-up timing of latest tests | Cohort Size, N | Residual CT abnormalities % (N) | Parenchymal band or fibrous stripe % (N) | GGO % (N) | Consolidation % (N) | Interstitial thickening or interlobular septal thickening % (N) | Bronchovascular bundle distortion or bronchiectasis % (N) | Thickening of adjacent pleura % (N) | Pleural effusion % (N) | Crazy paving % (N) |
---|---|---|---|---|---|---|---|---|---|---|---|
You [17] | PFT Non-severe cases: 40 ± 11.6 days Severe cases: 34.7 ± 16.5 days CT was taken closest to the date of PFT | 18 | 83% (15) | NA | 61.1% (11) | NA | NA | NA | NA | NA | NA |
Huang [18] | 30 days after discharge | 57 | 54.4% (31) | NA | NA | NA | NA | NA | NA | NA | NA |
Liu [19] | 31 (20–37) days after discharge | 51 | 35.3% (18) | NA | 33.3% (17) | 2.0% (1) | 35.3% (18) | 3.9% (2) | 23.5% (12) | NA | NA |
Zhao [20] | 64–93 days after discharge | 55 | 70.9% (39) | NA | 12.7% (7) | NA | 27.3% (15) | NA | 41.8% (23) | 1.8% (1) | 5.5% (3) |
Zhong [21] | 39.6 ± 6.0 days after symptom onset 19.7 ± 4.1 days after discharge | 52 | 69.2% (36) | 36.5% (19) | 63.5% (33) | 9.6% (5) | 5.8% (3) | 7.7% (4) | NA | NA | NA |
Liang [22] | 3 months after discharge | 21 | 23.8% (5) | NA | 23.8% (5) | NA | NA | NA | NA | NA | NA |
Tabatabaei [23] | 91 ± 15.5 days after initial CT | 52 | 42.3% (22) | 19.2% (10) | 36.5% (19) | NA | NA | NA | NA | NA | NA |
van den Borst [24] | 13.0 ± 2.2 weeks after symptom onset 9.1 ± 1.6 weeks after discharge | 84 | 90.5% (76) | 64.3% (54) | 86.9% (73) | NA | NA | 60.7% (51) | NA | NA | NA |
Smet [25] | 74 ± 12 days after diagnosis | 220 | 26.4% (58) | NA | 25.0% (55) | 3.6% (8) | NA | NA | NA | NA | 40.9% (90) |
Lerum [27] | 83 [73, 90] days after hospital admission | 103 | NA | 18.4% (19) | 23.3% (24) | NA | NA | NA | NA | NA | NA |
Huang [29] | 186 [175, 199] days after symptom onset | 353 | 52.7% (186) | 15.9% (56) | 44.8% (158) | 1.1% (4) | 0.8% (3) | NA | 4.2% (15) | NA | NA |
Guler [30] | 128 [108, 144] days after symptom onset | 52 | NA | 51.9% (27) | 57.7%(30) | 28.8% (15) | 1.9% (1) | 38.5% (20) | 1.9% (1) | NA | NA |
Han [31] | 175 ± 20 days after symptom onset | 114 | 62.3% (71) | NA | 62.3% (71) | 23.7% (27) | NA | 10.5% (12) | 35.1% (40) | 8.8% (10) | NA |
Follow-up pulmonary function test after discharge (Table 3)
Author | Follow-up timing after discharge | Cohort Size, N | PFT abnormalities at follow-up, % (N) | Restrictive pattern % (N) VCmax % predicted < 80% or VCmax < LLN OR FVC % predicted < 80% or FVC < LLN OR TLC z-score < − 1.64 or TLC % predicted < 80% | Obstructive pattern % (N) FEV1/FVC < 70% OR FEV1/VCmax < LLN % | Diffusion Impairment % (N) DLCO < 80% predicted OR DLCO < LLN |
---|---|---|---|---|---|---|
You [17] | 38 ± 13.4 days after discharge | 18 | 38.9% (7) | 16.7% (3) | 16.7% (3) | NA |
Huang [18] | 30 days after discharge | 57 | NA | 10.5% (6) | 1.8% (1) | 52.6% (30) |
Zhao [20] | 64–93 days after discharge | 55 | 25.5% (14) | 10.9% (6) | 9.1% (5) | 16.4% (9) |
Liang [22] | 3 months after discharge | 76 | 42.1% (32) | NA | 6.6% (5) | 19.7% (15) |
van den Borst [24] | 13.0 ± 2.2 weeks after symptom onset 9.1 ± 1.6 weeks after discharge | 84 | NA | 9.5% (8) | 15.5% (13) | 48.8% (41) |
Smet [25] | 74 ± 12 days after diagnosis | 220 | 54.1% (119) | 38.2% (84) | NA | 21.8% (48) |
Shah [26] | 12 weeks after symptom onset | 60 | 58.3% (35) | 23.3% (14) | 11.7% (7) | 51.7% (31) |
Lerum [27] | 83 [73, 90] days after hospital admission | 1032 | NA | 6.8% (7) | NA | 23.3% (24) |
Bellan [28] | 4 months after after discharge | 224 | NA | NA | NA | 50.4% (113) |
Huang [29] | 186 [175, 199] days after symptom onset | 349 | NA | 16.0% (56) | 6.3% (22) | 32.7% (114) |