Post-COVID syndrome: prevalence, organ pathogenesis and routes of correction. A systematic review

Background. The ongoing COVID-19 pandemic is building up a population of previous SARS-CoV-2 patients with non-transient multiorgan failures having diverse stable symptoms and/or delayed complications. Proper measures should be defined in public healthcare to tackle patients’ diagnosis, treatment and rehabilitation.

Objectives. A systematic review of recent evidence in epidemiology and pathophysiology of organ-specific COVID-19 aftereffects and their routes of correction.

Methods. Sources were mined in eLibrary and Medline/PubMed using the keywords “post-covid syndrome” [постковидный синдром], COVID-19, SARS-CoV-2, “organ lesions”, pathogenesis, treatment; the article type were “Clinical Trial”, “Meta-Analysis”, Review and “Systematic Review” published in English or Russian during 01 January 2020–10 July 2021. All study designs considered reflected the current understanding of epidemiology, pathogenesis, late manifestations and complications of old systemic and organ COVID-19, as well as their correction measures. Full-text peer-reviewed high-impact journal articles had preference.

Results. A screening of 1,163 sources selected 480 most relevant full-text articles for analysis, with 131 included in the final review. A number of 2020–2021 studies reported persistent COVID-19 representations, including pulmonary, cardiovascular, renal complications, haematological disorders, neuropsychiatric and endocrine aftereffects. Gastrointestinal, hepatobiliary and dermatological complications of SARS-CoV-2 are less elaborated. Insights are emerging into the pathogenesis of weeks-to-months persisting post-acute COVID-19 organ and systemic lesions. Understanding their pathophysiology will enable targeting measures towards a comprehensive treatment of post-COVID syndrome. Clinical trials are currently underway that will evidence-ground the prevention and therapy of COVID-19 complications in discharged patients.

Conclusion. COVID-19 patients should be managed beyond hospital discharge, as many of them require comprehensive inter-specialty medical care in outpatient follow-up. A rapid enrichment of databases and professional evidence for post-COVID syndrome lays the grounds for successful treatment and rehabilitation of patients who had coped with this disease.