Individual Participant Data Meta-Analysis (IPDMA) of long-term COVID-19 outcomes in a systematic review-informed, international, multidisciplinary database.

Authors

Myzoon Ali, Marian C Brady, Pauline Campbell, Scott Rooney, Linda Williams, Lorna Paul, Helen Mason, Sarkis Manoukian, Charlie Chung, Mark Barber, Claire McGoldrick, Andrew Smith, Neil Basu, Manish Patel, Kathryn VandenBerg, Aikaterini Papadopoulou, Azza Abdelaal, Samuel Jk Abraham, Alaa Abu Sayf, Jane Agergaard, Motaz Alawna, Sergiu Albu, Laurent Alric, Paulette Andino, Jakub Antczak, Alexander Arutyunov, Aylin Ayyıldız, Ellena Badrick, Pınar Yalcin Bahat, Tala Ballouz, Clara Balsano, Matteo Bassetti, Mariana Bendersky, Danilo Berton, Fausto Biancari, Bjorn Blomberg, Gianluca Em Boari, Silvia Bonetti, Mohammad Bosaeed, Benoit Bouteleux, Salvatore Brugaletta, Mikhail Bychinin, Ina Callebaut, Stephen J Carter, Michal Chudzik, Julien Coelho, Mario Cornejo-Giraldo, Stefania Costi, Gilles Darcis, David R Darley, Antonio Di Baigio, Arianna Di Stadio, Michael Dreher, Dmitry Enikeev, Rachael Evans, Luiz Fábio Magno Falcão, Clara Fehrmann, Stefania Fugazzaro, Lorenzo Gamberini, Fatma Ketenci Gencer, Carlos Alberto Gonzalez, Fergus Hamilton, Chelsea Harrison, Markus C Hayden, Haley Hedlin, Majanka Heijenbrok-Kal, Merel E Hellemons, Brynja Ingadottir, Prasanna Jagannathan, Roman Khokhlov, Leonid Khokhlov, Dacre Knight, Marc Kollum, Henrik Kolstad, Luciane Kopittke, Linda Ashman Kröönström, Nina Langeland, Christian Lawlor, Mark L Levitt, Fabio Santos Lira, Judith Loffler-Ragg, David Tw Lui, Reaz Mahmud, Łukasz Małek, Ili Margalit, Sergi Marti-Beltran, Adrian Martineau, Mar Masia, Paul Mathew, Gisela Mautner, Aurélien Mazeraud, Dominik Menges, Christian S Meyhoff, Alice Milne, Fatemeh Sadat Mirfazeli, Shima T Moein, Aliae Ar Mohamed-Hussein, Giovanni Monteleone, Igor H Murai, Andreas Steenholt Niklassen, Arvind Nune, Maria Natividad Seisdedos Nunez, Luis Ortega-Paz, Daniel Ouellette, Alna Carolina Mendes Paranhos, Esra Pehlivan, Giovanna Pelà, Filipe Alexandre Pereira, Hanna C Persson, Simone Piva, Terry F Plasse, Tamara Platteel, Simone Porcelli, Irene Prediletto, Gilead Raday, Kadalraja Raghavan, Kathrin Reetz, Damiano Rizzoni, Mauricio Salinas, Gillian Santorelli, H N Sarker, Sathyamurthy P, Islam Galal Sayed, Leo Sekine, Susan Shapiro, Samuel Katsuyuki Shinjo, Ventura Simonovich, Gaia Sinatti, Thomas Sonnweber, Vasileios T Stavrou, Björn Stessel, Katharina Stibrant Sunnerhagen, Julio Vallejos, Rita Jg van den Berg-Emons, Lavanya Visvabharathy, Yize I Wan, John Wilkinson, Clarissa Lin Yasuda, Zuobiao Yuan, Alexandre Prehn Zavascki, Maria Del Pilar Brito Zeron, Sigridur Zoëga, Cesar Zoni

Published in

Health and social care delivery research. Volume 14. Issue 29. Pages 1-160.

Abstract

Identifying and addressing long-term health and societal challenges after COVID-19 is a research priority.
To create an international, multidisciplinary COVID-19 database, and synthesise long-term outcomes, predictors and costs.
Systematic identification of COVID-19 data sets and meta-analysis of individual participant data on long-term outcomes after COVID-19.
Contributed data were collected in clinical, community and research settings.
Interventions from original studies were included as covariates in models.
MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE, Web of Science, PsycInfo^® (American Psychological Association, Washington, DC, USA), Cumulative Index to Nursing and Allied Health Literature, World Health Organization Global Index Medicus, Epistemonikos, LitCOVID; World Health Organization International Clinical Trials Registry Platform; ClinicalTrials.gov and supplementary searches for studies (November 2019-November 2021) were searched for studies on > 10 people from cohort, case-control, survey or randomised controlled trial studies, across any setting, describing validated assessment instruments, symptoms, hospitalisation, discharge destination or mortality beyond 28-days after COVID-19 onset. Data were extracted by two independent reviewers.
Principal investigators contributed fully anonymised individual participant data. Demography, equity and symptoms were described. Assessment instruments were mapped to the International Classification of Functioning, Disability and Health. Factors associated with outcomes at 3-6 months, 9-12 months and beyond 12 months of index infection, for n > 500 individual participant data and > 1 data set were described using ratio of difference, point estimates, odds ratio and 95% confidence interval, as appropriate. The Mixed Methods Appraisal Tool described study quality; models were appraised using a Grading of Recommendations Assessment, Development and Evaluation-informed approach; heterogeneity was described using I².
Included overall perception of health, multidomain cognitive function, anxiety, depression, stress, post-traumatic stress disorder, fatigue, strength, walking ability, mobility, coping with daily life, breathlessness, mortality, later hospitalisation and health-related quality of life.
PRECIOUS collated 116 data sets from 40 countries (individual participant data = 62,849), comprising 20 randomised controlled trials, 13 case-control, 60 cohort 2 longitudinal, 1 survey and 20 other study types. Participants' median age was 58 years interquartile range (45-68); 34,185 (54.4%) were female; 158 unique symptoms and 137 unique assessment instruments were captured, predominantly describing International Classification of Function, Disability and Health-body functions. Women had poorer outcomes across 30/37 models, compared with men. In 15/37 models, pre-existing lung disease and increasing age were associated with poorer outcomes; hospitalisation, diabetes and chronic kidney disease were each associated with poorer outcomes in 8/37 models. Initial hospitalisation resulted in lower health-related quality of life that did not recover for up to 2 years after initial infection. Heterogeneity was low in 34/37 models; 22/37 models were of moderate and 11/37 were of low quality.
Use of secondary data limits available covariates, outcomes and time points to those included in primary data sets; evidence was primarily based on high-income countries. There was a lack of data on longer-term healthcare resource use to estimate the costs to the healthcare system.
PRECIOUS contributes to the overall picture of long-term COVID-19 outcomes beyond the long-COVID condition and highlights poorer long-term outcomes in women and people with pre-existing comorbidities.
Evidence gaps included healthcare resource use, isolation, loneliness, societal participation and return to work outcomes. Data are needed on the role of health inequity on long-term outcomes.
This study is registered as PROSPERO (CRD42020224323, IRAS ID: 293578).
This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR132895) and is published in full in Health and Social Care Delivery Research; Vol. 14, No. 29. See the NIHR Funding and Awards website for further award information.

PMID:
42663308
Bibliographic data and abstract were imported from PubMed on 28 Aug 2026.

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