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

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.

Complications Linked to Acute COVID-19 Phase during its Second Wave Era

“…Pneumonia was also the most prevalent organic complication resulting from SARS-CoV-2 infection among acute COVID-19 cases in a recent research study. Data from a systematic review and meta-analysis of COVID-19 complications showed that pulmonary complications, particularly pneumonia, were the most commonly reported organic complications in both 74 case reports/series and 15 observational studies, thereby providing strong support for the current study's findings [10].…”

“…Moreover, the present study reported less common acute COVID-19 complications, including hearing impairment (8.1%), acute respiratory failure (5.6%), acute cardiac injury (3.8%), thrombotic lesions (1.9%), and vision impairment (1.9%). Numerous studies have reported these complications, exhibiting similar or divergent frequencies and rates [4,10,[31][32][33]. For instance, Kluge et al reported that 5% of COVID-19 patients experienced devastating acute respiratory failure due to the development of severe acute respiratory distress syndrome (ARDS) [32].…”

“…In another study by Alonge et al, it was revealed that 1.7% of SARS-CoV-2 patients suffered from acute myopericarditis, and a similar rate was observed for atrial arrhythmias. Additionally, around 2% of these patients were affected by deep venous thrombosis [10]. Furthermore, Italian study reported that 7.7% of hospitalized COVID-19 patients were complicated by thromboembolic lesions at least one time during the disease course [33].…”

“…It was reported that COVID-19 complications are multi-systemic including pulmonary (pneumonia, acute respiratory distress syndrome (ARDS) and acute respiratory failure. ), cardiovascular (acute myocardial injury, myocarditis, cardiac arrhythmias, endothelial dysfunction, dysautonomia and thrombotic events), neurological (ischemic stroke, Seizures, hemorrhagic stroke and Hypoxic ischemic brain injury), gastrointestinal (liver injury, gastrointestinal bleeding, acute pancreatitis), renal (acute renal injury), endocrine (diabetic ketoacidosis, thyroiditis), haematological complications (deep venous thrombosis, bleeding events and disseminated intravascular coagulation), dermatological (herpes zoster) and others (Multiple organ dysfunction syndrome, Sepsis, shock) [10][11][12][13]. Pulmonary complications are the most common reported sequelae and acute respiratory failure is the primary cause of COVID-19 mortality [8,10].…”

Co-Occurring Hemolysis and Methemoglobinemia After COVID-19 Infection in Patient With G6PD Deficiency

“…The global pandemic of COVID-19, with more than 600 million confirmed cases worldwide, is associated with varying severity of presentation and complications. Understanding of the nature of COVID-19 disease is still evolving [7][8][9][10]. There are a few reported cases of COVID-19 with G6PD deficiency who were found to have simultaneous hemolytic anemia and methemoglobinemia.…”