Long-term clinical outcomes in survivors of severe acute respiratory syndrome and Middle East respiratory syndrome coronavirus outbreaks after hospitalisation or ICU admission: A systematic review and meta-analysis

J Rehabil Med. 2020 May 31;52(5):jrm00063. doi: 10.2340/16501977-2694.


Objective: To determine long-term clinical outcomes in survivors of severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) coronavirus infections after hospitalization or intensive care unit admission.

Data sources: Ovid MEDLINE, EMBASE, CINAHL Plus, and PsycINFO were searched.

Study selection: Original studies reporting clinical outcomes of adult SARS and MERS survivors 3 months after admission or 2 months after discharge were included.

Data extraction: Studies were graded using the Oxford Centre for Evidence-Based Medicine 2009 Level of Evidence Tool. Meta-analysis was used to derive pooled estimates for prevalence/severity of outcomes up to 6 months after hospital discharge, and beyond 6 months after discharge.

Data synthesis: Of 1,169 identified studies, 28 were included in the analysis. Pooled analysis revealed that common complications up to 6 months after discharge were: impaired diffusing capacity for carbon monoxide (prevalence 27%, 95% confidence interval (CI) 15–45%); and reduced exercise capacity (mean 6-min walking distance 461 m, CI 450–473 m). The prevalences of post-traumatic stress disorder (39%, 95% CI 31–47%), depression (33%, 95% CI 20–50%) and anxiety (30%, 95% CI 10–61) beyond 6 months after discharge were considerable. Low scores on Short-Form 36 were identified beyond 6 months after discharge.

Conclusion: Lung function abnormalities, psychological impairment and reduced exercise capacity were common in SARS and MERS survivors. Clinicians should anticipate and investigate similar long-term outcomes in COVID-19 survivors.

Keywords: COVID-19; MERS, ARDS; SARS; anxiety; depression; exercise tolerance; fatigue; follow-up; follow-up studies; lung function; post-traumatic stress disorder; prevalence; quality of life; coronavirus infection.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Adult
  • Anxiety / etiology
  • Betacoronavirus
  • COVID-19
  • Coronavirus Infections / physiopathology
  • Coronavirus Infections / psychology*
  • Depression / etiology
  • Exercise Test
  • Exercise Tolerance
  • Hospitalization
  • Humans
  • Intensive Care Units
  • Middle East Respiratory Syndrome Coronavirus*
  • Pandemics
  • Patient Discharge
  • Pneumonia, Viral
  • Respiratory Function Tests
  • SARS-CoV-2
  • Severe Acute Respiratory Syndrome / physiopathology
  • Severe Acute Respiratory Syndrome / psychology*
  • Stress Disorders, Post-Traumatic / etiology
  • Survivors