Archives of Academic Emergency Medicine. 2021; 9(1): e14 https://doi.org/10.22037/aaem.v9i1.1058 REV I EW ART I C L E Late Complications of COVID-19; a Systematic Review of Current Evidence SeyedAhmad SeyedAlinaghi1, Amir Masoud Afsahi2, Mehrzad MohsseniPour1, Farzane Behnezhad3, Mohammad Amin Salehi1, Alireza Barzegary4, Pegah Mirzapour1, Esmaeil Mehraeen5∗, Omid Dadras6 1. Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran. 2. Department of Radiology, School of Medicine, University of California, San Diego (UCSD), California, USA. 3. Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. 4. School of medicine, Islamic Azad University, Tehran, Iran. 5. Department of Health Information Technology, Khalkhal University of Medical Sciences, Khalkhal, Iran. 6. Department of Global Health and Socioepidemiology, Graduate School of Medicine, Kyoto University, Kyoto. Japan. Received: December 2021; Accepted: December 2021; Published online: 20 January 2021 Abstract: Introduction: COVID-19 is a new rapidly spreading epidemic. The symptoms of this disease could be diverse as the virus can affect any organ in the body of an infected person. This study aimed to investigate the available evidence for long-term complications of COVID-19. Methods: This study was a systematic review of current evidence conducted in November 2020 to investigate probable late and long-term complications of COVID-19. We performed a systematic search, using the keywords, in online databases including PubMed, Scopus, Science Direct, Up to Date, and Web of Science, to find papers published from December 2019 to October 2020. Peer- reviewed original papers published in English, which met the eligibility criteria were included in the final report. Addressing non-human studies, unavailability of the full-text document, and duplicated results in databases, were characteristics that led to exclusion of the papers from review. Results: The full-texts of 65 articles have been reviewed. We identified 10 potential late complications of COVID-19. A review of studies showed that lung injuries (n=31), venous/arterial thrombosis (n=28), heart injuries (n=26), cardiac/brain stroke (n=23), and neurological injuries (n=20) are the most frequent late complications of COVID-19. Conclusion: Since we are still at the early stages of the COVID-19 epidemic, it is too soon to predict what long-term complications are likely to appear in the survivors of the disease in years after recovery. Furthermore, the complexity of COVID-19 behaviors and targets in the human body creates uncertainty in anticipating long-term complications. Keywords: Long Term Adverse Effects; Late Onset Disorders; COVID-19; SARS-CoV-2; post-acute COVID-19 syndrome Cite this article as: SeyedAlinaghi SA, Afsahi A M, MohsseniPour M, Behnezhad F, Salehi M A, Barzegary A, Mirzapour P, Mehraeen E, Dadras O. Late Complications of COVID-19; a Systematic Review of Current Evidence. Arch Acad Emerg Med. 2021; 9(1): e14. 1. Introduction Coronavirus disease 2019 (COVID-19) is an extremely conta- gious infectious disease caused by SARS-CoV-2 (1). COVID- 19 infection was first reported in Wuhan, China, and spread quickly and turned into an unprecedented global pandemic (2-5). The novel coronavirus affects not only the respiratory ∗Corresponding Author: Esmaeil Mehraeen, Department of Health Infor- mation Technology, Khalkhal University of Medical Sciences, Khalkhal, Iran. Postal Code: 1419733141. Tel: +98-21-66581583, Fax: +98-21-66947984, E- mail: es.mehraeen@gmail.com. tract, but also other organs in the human body. COVID-19 could cause injuries in the lungs, liver, kidney, heart, vessels, and other organs (6). Respiratory failure and acute respira- tory distress syndrome (ARDS) are the most common com- plications of severe COVID-19 infection; the majority of hos- pitalized COVID-19 patients suffer from severe lung injuries and fatal multi-organ failure as well as hemolytic anemia. However; super infection, acute liver, kidney, and cardiac in- juries, shock, and hypoxic encephalopathy are less common symptoms (7-9). Some COVID-19 patients may also present signs of tissue damage including rhabdomyolysis or hemop- tysis, which lead to cellular injury, release of heme proteins, This open-access article distributed under the terms of the Creative Commons Attribution NonCommercial 3.0 License (CC BY-NC 3.0). Downloaded from: http://journals.sbmu.ac.ir/aaem SA. SeyedAlinaghi et al. 2 and collection of heme in body tissues (10). SARS-CoV-2 usually affects the respiratory system (11), nervous system involvement has also been reported in some recent studies among patients with COVID-19 (12). Coronaviruses can at- tack the neural tissue including microglia, astrocytes, and macrophages, and cause nerve injury through direct nerve infection (13). The nervous system injuries could manifest as headache, dizziness, seizure, impaired consciousness, acute cerebrovascular disease, and ataxia. The virus could also af- fect the peripheral nervous system (PNS) and cause olfac- tory dysfunction, dysgeusia, vision impairment, and neuro- pathic pain (12, 13). COVID-19 could also cause cardiac in- juries such as cardiomyopathy and conduction system mal- function. Studies suggest the direct involvement of car- diac muscles in some patients (4, 14, 15). Generally, infec- tious myocarditis is the most common cardiac complication of COVID-19 infection. SARS-CoV-2 uses the angiotensin- converting enzyme 2 (ACE2) receptors to infect host cells, through which it can cause pneumonia and myocardial in- juries. High expression of ACE2 receptors in the lungs and heart could increase the risk of myocardial injuries in COVID- 19 patients (14). ACE2 is also expressed in the intravas- cular endothelium, intestinal epithelium, and the kidneys; therefore, these organs could be a target for SARS-CoV-2 in- fection. Tachyarrhythmia is also a common cardiovascu- lar complication in COVID-19 patients. Electrocardiogra- phy and echocardiography could be used in diagnosing and predicting the prognosis in COVID-19 patients (16). Some COVID-19 patients could suffer from earache that may be a sign of sub-acute thyroiditis. Studies have shown that a few weeks after upper respiratory tract involvement, suba- cute thyroiditis may occur and it might be a late compli- cation in patients with COVID-19 infection. Therefore, thy- roid functions should be checked after discharge in patients with COVID-19 (17, 18). In addition, there is an abnormal rise in various biochemical parameters such as erythrocyte sedimentation rate (ESR), albumin levels, serum ferritin lev- els, lactate dehydrogenase (LDH) levels, and C-reactive pro- tein (CRP) levels in the infected patients; on the other hand, the hemoglobin levels and lymphocyte count could reduce in these patients. These complications could lead to cytokine storm, causing multiple organ dysfunction (19, 20). The coronavirus pandemic showed that COVID-19 could affect many organs besides the lungs, like heart and brain, which increases the risk of long-term health problems. There are several ways that the infection can affect someone’s health. Much is still unknown about how COVID-19 will affect peo- ple over time. While most patients infected with COVID-19 recover quickly, the potential long-lasting problems caused by COVID-19 make it necessary to look for and study its late complications. This review aims to present a systematic re- view of late complications of COVID-19 and identify how prevalent these symptoms are and who is most likely to be affected by them. 2. Methods 2.1. Study design and setting This study was a systematic review of current evidence conducted in October 2020 and subsequently updated on November 4, 2020. The Preferred Reporting Items for Sys- tematic Reviews and Meta-Analyses (PRISMA) checklist was employed. 2.2. Data sources We performed a systematic search using the keywords in the online databases including PubMed, Scopus, Science Direct, Up to Date, and Web of Science. All the related papers and reports published in English from December 2019 through October 2020 were retrieved and then up- dated in November 2020. Our search strategy in each of the above-mentioned databases included several combinations of keywords in the following orders: A. “Coronavirus” OR “COVID-19”OR“SARS-CoV-2” OR “Novel Coronavirus” OR “2019-nCoV" [Title/Abstract] B. "Clinical characteristics” OR “clinical feature” OR “clinical manifestation" [Title/Abstract] C. "Consequences” OR “Chronic complications” OR“ Late complications” OR “Long-term effects" [Title/Abstract] D. [A] AND [B] AND [C] 2.3. Study selection The most relevant studies based on titles and abstracts were retrieved by three independent investigators. The full con- tents of the retrieved papers were reviewed, and the most relevant papers were selected based on the eligibility crite- ria. The relevant data were extracted and organized in tables. The peer-reviewed original papers published in English that met the eligibility criteria were included in the final report. The exclusion criteria were as follows: – Papers addressing non-human studies including in vitro investigations or pub- lications concentrating on animal experiments, or discussing COVID-19 in general, without reference to the keywords of this study. – Unavailability of the full-text document. – Du- plicated results in databases. 2.4. Data extraction We used the data extraction sheet (Table 2) to summarize the information of the authors, type of article (e.g., case series), country of origin, study population, and clinical symptoms (late complications in this study). Two independent investi- gators gathered this information and further organized them in the Tables. All the selected articles were cross-checked by other authors to ensure no duplications or overlap exists in the content. This open-access article distributed under the terms of the Creative Commons Attribution NonCommercial 3.0 License (CC BY-NC 3.0). Downloaded from: http://journals.sbmu.ac.ir/aaem 3 Archives of Academic Emergency Medicine. 2021; 9(1): e14 2.5. Quality assessment For bias risk assessment, two independent reviewers rated the quality of included studies by applying the National In- stitute of Health (NIH) Quality Assessment Tools for Case Se- ries Studies. For this purpose, we have designed a table and evaluated the studies according to NIH questionnaire (Table 1). A third independent investigator was consulted to resolve probable difference of opinions in any case. The full text of select articles was fully read and the key findings were ex- tracted. The final report including the key findings is sum- marized in Table 2. 3. Results We retrieved 1325 documents using a systematic search strat- egy. After an initial review of retrieved articles, 542 dupli- cates were removed, and the titles and abstracts of the re- maining 783 articles were reviewed. Applying the selection criteria, 718 articles were excluded, and only 65 articles met the inclusion criteria and were included in the final review (Figure 1). We identified 10 potential late complications of COVID-19 including neurological injuries, lung, liver, kidney, and heart injuries, thromboembolism, cardiac/brain stroke, encephalopathy, and psychological distress. Furthermore, some studies have pointed out other complications such as hypoproteinemia, septic shock, and multiple organ dysfunc- tion syndromes (Table 1). Review of studies showed that lung injuries (n=31), venous/arterial thrombosis (n=28), heart in- juries (n=26), cardiac/brain stroke (n=23), and neurological injuries (n=20) were the most frequent late complications of COVID-19. Frequencies of identified late complications of COVID-19 are demonstrated in Figure 2. 4. Discussion One of the most important unknown features of COVID-19 is the duration of symptoms. In the early stages of the disease, the experts believed that the recovery time for mild cases of COVID-19 is 1-2 weeks (21). However, later in many patients, the symptoms lasted for 8 to 10 weeks or even longer, and in some cases, the initial symptoms were replaced by long-term complications such as lung or cardiac injuries (22). Since COVID-19 is a novel virus, there are limited studies about its late complications; it is just a few months since the recovery of the first patients in China. However, the available evidence suggests that the coronavirus can cause long-term compli- cations in an infected person as it may cause major injuries to the heart, kidneys, brain, and even blood vessels (6, 10, 23, 24). The available evidence indicates the recurrence of symptoms in some patients who presented with severe ini- tial symptoms (2, 25, 26). The key question is “what causes the recurrence of symptoms?”. It may be caused by the re- currence or persistence of the primary COVID-19 infection or super infection with another virus or even bacteria due to the compromised immune system (27). In addition, the systemic and multiorgan involvement in advanced phases of COVID-19 pneumonia can cause renal failure, liver dys- function, thrombocytopenia, and coagulation disorders (28). Therefore, the survivors may present a variety of long-term complications in different organs, including a post-recovery syndrome that doctors call "post-COVID lung disease" (29). By looking at the organs affected during an infection, one can imagine what organs are likely to be affected by long- term complications of COVID-19 infection (30). The most common long-term complication of COVID-19 is lung dis- ease (8, 29, 31). Most of the COVID-19 patients could be recovered completely except for some minor complications such as cough and shortness of breath. However, a cer- tain proportion of patients have excessive lung damage, and some of them develop pulmonary fibrosis (32). Autopsy stud- ies demonstrated the predominance of microvascular throm- bosis in the lungs, coincident with markers of inflamma- tion, which is a hallmark of prolonged infection and sepsis (33). Severe lung involvement in COVID-19 patients could in- crease the likelihood of progression to chronic lung disease and lead to long-term complications (8, 33). COVID-19 pa- tients may experience both venous and arterial thrombosis due to severe inflammation and hypoxia, long immobiliza- tion, and diffuse intravascular coagulation (27, 28). Klok et al. reported the incidence rate of thrombotic complications to be 31% among ICU patients with severe COVID-19 infection (27). The results of another study reported the high number of arterial and, in particular, venous thrombo-embolic late complications (34). Poggiali et al. described two patients with COVID-19 pneumonia who developed venous throm- boembolism and reported hypoxia and sepsis as the poten- tial risk factors for vein thromboembolism (VTE)(35). Recent studies reported an increased risk of heart failure in COVID- 19 patients (26, 28, 30). Moreover, episodes of clinical my- ocarditis have been observed (15). Heart injuries related to COVID-19 may occur over the course of the disease(36). Late involvement of cardiac muscle has been documented in a study by Puntmannet al. In this study, the researchers inves- tigated the cardiac complications in 100 recovered patients; 78% of patients had cardiac involvement in cardiac mag- netic resonance imaging (MRI), 76% had detectable high- sensitivity troponin, and 60% had abnormal native T1 and T2, which indicates the presence of active myocardial (37). Compared to the control group with similar preexisting con- ditions, left ventricle ejection fraction was lower and the ven- tricular size was higher in COVID-19 patients. In addition, 32% of patients had late gadolinium enhancement and 22% of them had pericardial involvement (36, 37). COVID-19 can cause damage to the central nervous system, with po- This open-access article distributed under the terms of the Creative Commons Attribution NonCommercial 3.0 License (CC BY-NC 3.0). Downloaded from: http://journals.sbmu.ac.ir/aaem SA. SeyedAlinaghi et al. 4 tentially long-term consequences (38-41). Late neurological complications of COVID-19, whether caused by the virus or by the triggered inflammation, include decreased awareness and absorption, disturbed memory, and dysfunction of the peripheral nervous system (42). In one study from China, more than a third of hospitalized patients with confirmed COVID-19 had neurological symptoms, including dizziness, headaches, impaired consciousness, vision, taste/smell im- pairment, and nerve pain. These symptoms were more com- mon in patients with severe disease, where the incidence in- creased to almost 47 percent (43). Another study in France found neurologic features in 58 of 64 critically ill COVID-19 patients (25). 5. Conclusion Since we are still at the early stages of the COVID-19 epi- demic, it is too soon to predict what long-term complications are likely to appear in the survivors of the disease in years af- ter recovery. Furthermore, the complexity of COVID-19 be- haviors and variety of its targets in the human body create uncertainty in anticipating long-term complications. How- ever, several ongoing studies are set up to examine the physi- cal, psychological, and socio-economic consequences of the COVID-19. 6. Declarations 6.1. Acknowledgment The present study was conducted in collaboration with Khalkhal University of Medical Sciences, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, and Department of Global Health and So- cioepidemiology, Kyoto University. 6.2. Author contributions (1) The conception and design of the study: Esmaeil Mehraeen, SeyedAhmad SeyedAlinaghi (2) Acquisition of data: Amir Masoud Afsahi, Mehrzad MohsseniPour (3) Analysis and interpretation of data: Farzane Behnezhad, Mohammad Amin Salehi, Alireza Barzegary (4) Drafting the article: Pegah Mirzapour, Esmaeil Mehraeen (5) Revising it critically for important intellectual content: SeyedAhmad SeyedAlinaghi, Omid Dadras (6) Final approval of the version to be submitted: Esmaeil Mehraeen, Omid Dadras 6.3. Ethics approval and consent to participate The present study was extracted from the research project with code IR.KHALUMS.REC.1399.001 entitled "Investiga- tion of effective drugs for people affected by Coronavirus dis- ease 2019 (COVID-19) in selected hospitals in Ardabil" con- ducted at Khalkhal University of Medical Sciences in 2020. 6.4. Funding This research did not receive any grant from funding agencies in the public, commercial, or not-for-profit sectors. 6.5. Consent to publication Not applicable 6.6. Availability of data and material The authors stated that all information provided in this arti- cle are available. 6.7. Competing interests The authors declare that there is no conflict of interest re- garding the publication of this manuscript. References 1. Orlandi M, Lepri G, Bruni C, Wang Y, Bartoloni A, Za- mmarchi L, et al. The systemic sclerosis patient in the COVID-19 era: the challenging crossroad between im- munosuppression, differential diagnosis and long-term psychological distress. Clinical Rheumatology. 2020:1. 2. Heneka MT, Golenbock D, Latz E, Morgan D, Brown R. Immediate and long-term consequences of COVID-19 infections for the development of neurological disease. Alzheimer’s research & therapy. 2020;12(1):69. 3. Mehraeen E, Behnezhad F, Salehi MA, Noori T, Harandi H, SeyedAlinaghi S. Olfactory and gustatory dysfunctions due to the coronavirus disease (COVID-19): a review of current evidence. European Archives of Oto-Rhino- Laryngology. 2020:1-6. 4. Mehraeen E, Hayati B, Saeidi S, Heydari M, Seyed Alinaghi S. Self-Care Instructions for People Not Re- quiring Hospitalization for Coronavirus Disease 2019 (COVID-19). Archives of Clinical Infectious Diseases. 2020;15(COVID-19). 5. SeyedAlinaghi S, Ghadimi M, Hajiabdolbaghi M, Ra- soolinejad M, Abbasian L, Nezhad MH, et al. Prevalence of COVID-19-like symptoms among people living with HIV, and using antiretroviral therapy for prevention and treatment. Current HIV Research. 2020. 6. Wang X, Fang X, Cai Z, Wu X, Gao X, Min J, et al. Comorbid Chronic Diseases and Acute Organ In- juries Are Strongly Correlated with Disease Severity and Mortality among COVID-19 Patients: A Systemic Re- view and Meta-Analysis. Research (Washington, DC). 2020;2020:2402961. This open-access article distributed under the terms of the Creative Commons Attribution NonCommercial 3.0 License (CC BY-NC 3.0). Downloaded from: http://journals.sbmu.ac.ir/aaem 5 Archives of Academic Emergency Medicine. 2021; 9(1): e14 7. Consoli L, Bendotti V, Cicchinelli S, Gaioni F, Prandolini P, Bettonagli M, et al. 2019 novel coronavirus (COVID-19) pneumonia complications: the importance of lung ultra- sound. Journal of ultrasound. 2020:1-4. 8. Asadollahi-Amin A, Hasibi M, Ghadimi F, Rezaei H, SeyedAlinaghi S. Lung involvement found on chest ct scan in a pre-symptomatic person with SARS-CoV-2 in- fection: a case report. Tropical medicine and infectious disease. 2020;5(2):56. 9. Ghiasvand F, Miandoab SZ, Harandi H, Golestan FS, Ali- naghi SAS. A patient with COVID-19 disease in a Referral Hospital in Iran: a typical case. Infectious disorders drug targets. 2020. 10. Wagener F, Pickkers P, Peterson SJ, Immenschuh S, Abra- ham NG. Targeting the Heme-Heme Oxygenase System to Prevent Severe Complications Following COVID-19 In- fections. Antioxidants (Basel, Switzerland). 2020;9(6). 11. Montalvan V, Lee J, Bueso T, De Toledo J, Rivas K. Neu- rological manifestations of COVID-19 and other coron- avirus infections: A systematic review. Clinical Neurology and Neurosurgery. 2020;194:105921. 12. Heneka MT, Golenbock D, Latz E, Morgan D, Brown R. Immediate and long-term consequences of COVID-19 infections for the development of neurological disease. Alzheimer’s Research & Therapy. 2020;12:1-3. 13. Beghi E, Feigin V, Caso V, Santalucia P, Logroscino G. COVID-19 Infection and Neurological Compli- cations: Present Findings and Future Predictions. Neuroepidemiology.54(4):1-6. 14. Aghagoli G, Gallo Marin B, Soliman LB, Sellke FW. Car- diac involvement in COVID-19 patients: Risk factors, predictors, and complications: A review. Journal of Car- diac Surgery. 2020. 15. Inciardi RM, Lupi L, Zaccone G, Italia L, Raffo M, Toma- soni D, et al. Cardiac involvement in a patient with coro- navirus disease 2019 (COVID-19). JAMA cardiology. 2020. 16. Bandyopadhyay D, Akhtar T, Hajra A, Gupta M, Das A, Chakraborty S, et al. COVID-19 pandemic: Cardiovas- cular complications and future implications. American Journal of Cardiovascular Drugs. 2020:1-14. 17. Bellastella G, Maiorino M, Esposito K. Endocrine compli- cations of COVID-19: what happens to the thyroid and adrenal glands? Journal of Endocrinological Investiga- tion. 2020:1. 18. Docherty AB, Harrison EM, Green CA, Hardwick HE, Pius R, Norman L, et al. Features of 16,749 hospitalised UK patients with COVID-19 using the ISARIC WHO Clinical Characterisation Protocol. medRxiv. 2020. 19. Singh Y, Gupta G, Kazmi I, Al-Abbasi FA, Negi P, Chellap- pan D, et al. SARS CoV-2 aggravates cellular metabolism mediated complications in COVID-19 infection. Derma- tologic therapy. 2020. 20. Coperchini F, Chiovato L, Croce L, Magri F, Rotondi M. The cytokine storm in COVID-19: an overview of the involvement of the chemokine/chemokine-receptor sys- tem. Cytokine & Growth Factor Reviews. 2020. 21. Sepehrinezhad A, Shahbazi A, Negah SS. COVID-19 virus may have neuroinvasive potential and cause neurologi- cal complications: a perspective review. Journal of neu- rovirology. 2020;26(3):324-9. 22. Filatov A, Sharma P, Hindi F, Espinosa PS. Neurological complications of coronavirus disease (COVID-19): en- cephalopathy. Cureus. 2020;12(3). 23. Singh Y, Gupta G, Kazmi I, Al-Abbasi FA, Negi P, Chellap- pan DK, et al. SARS CoV-2 aggravates cellular metabolism mediated complications in COVID-19 infection. Derma- tologic therapy. 2020:e13871. 24. Varatharajah N, Rajah S. Microthrombotic Complica- tions of COVID-19 Are Likely Due to Embolism of Circulating Endothelial Derived Ultralarge Von Wille- brand Factor (eULVWF) Decorated-Platelet Strings. Fed- eral practitioner : for the health care professionals of the VA, DoD, and PHS. 2020;37(6):e1-e2. 25. Helms J, Kremer S, Merdji H, Clere-Jehl R, Schenck M, Kummerlen C, et al. Neurologic features in severe SARS- CoV-2 infection. New England Journal of Medicine. 2020. 26. Kochi AN, Tagliari AP, Forleo GB, Fassini GM, Tondo C. Cardiac and arrhythmic complications in patients with COVID-19. Journal of cardiovascular electrophysiology. 2020;31(5):1003-8. 27. Klok FA, Kruip M, van der Meer NJM, Arbous MS, Gom- mers D, Kant KM, et al. Incidence of thrombotic com- plications in critically ill ICU patients with COVID-19. Thrombosis research. 2020;191:145-7. 28. Landi A, De Servi S. The burden of thrombotic complica- tions in critically ill patients with COVID-19: charting the uncharted. Internal and emergency medicine. 2020:1-3. 29. Nogueira MS. Optical theranostics and treatment dosimetry for COVID-19 lung complications: towards increasing the survival rate of vulnerable popula- tions. Photodiagnosis and photodynamic therapy. 2020;31:101892. 30. Klok FA, Kruip M, van der Meer NJM, Arbous MS, Gom- mers D, Kant KM, et al. Confirmation of the high cumu- lative incidence of thrombotic complications in critically ill ICU patients with COVID-19: An updated analysis. Thrombosis research. 2020;191:148-50. 31. Consoli L, Bendotti V, Cicchinelli S, Gaioni F, Prandolini P, Bettonagli M, et al. 2019 novel coronavirus (COVID-19) pneumonia complications: the importance of lung ultra- sound. Journal of ultrasound. 2020:1-4. 32. Lifelong Lung Damage: The Serious COVID- 19 Complication That Can Hit People in Their 20s [Internet]. Healthline. 2020. Available from: This open-access article distributed under the terms of the Creative Commons Attribution NonCommercial 3.0 License (CC BY-NC 3.0). Downloaded from: http://journals.sbmu.ac.ir/aaem SA. SeyedAlinaghi et al. 6 https://www.healthline.com/health-news/lifelong- lung-damage-the-serious-covid-19-complication-that- can-hit-people-in-their-20s. 33. Orsi FA, De Paula EV, Santos FO, Teruchkin MM, Campêlo DHC, Mello TT, et al. Guidance on diagnosis, preven- tion and treatment of thromboembolic complications in COVID-19: a position paper of the Brazilian Society of Thrombosis and Hemostasis and the Thrombosis and Hemostasis Committee of the Brazilian Association of Hematology, Hemotherapy and Cellular Therapy. Hema- tology, transfusion and cell therapy. 2020. 34. Lodigiani C, Iapichino G, Carenzo L, Cecconi M, Ferrazzi P, Sebastian T, et al. Venous and arterial thromboem- bolic complications in COVID-19 patients admitted to an academic hospital in Milan, Italy. Thrombosis research. 2020;191:9-14. 35. Poggiali E, Bastoni D, Ioannilli E, Vercelli A, Magnacav- allo A. Deep Vein Thrombosis and Pulmonary Em- bolism: Two Complications of COVID-19 Pneumonia? European journal of case reports in internal medicine. 2020;7(5):001646. 36. Yancy CW, Fonarow GC. Coronavirus Disease 2019 (COVID-19) and the Heart—Is Heart Failure the Next Chapter? JAMA cardiology. 37. Puntmann VO, Carerj ML, Wieters I, Fahim M, Arendt C, Hoffmann J, et al. Outcomes of Cardiovascular Magnetic Resonance Imaging in Patients Recently Recovered From Coronavirus Disease 2019 (COVID-19). JAMA cardiology. 38. Pryce-Roberts A, Talaei M, Robertson NP. Neurological complications of COVID-19: a preliminary review. Jour- nal of neurology. 2020;267(6):1870-3. 39. Sheraton M, Deo N, Kashyap R, Surani S. A Review of Neurological Complications of COVID-19. Cureus. 2020;12(5):e8192. 40. Strafella C, Caputo V, Termine A, Barati S, Gambardella S, Borgiani P, et al. Analysis of ACE2 Genetic Variabil- ity among Populations Highlights a Possible Link with COVID-19-Related Neurological Complications. Genes. 2020;11(7). 41. Varatharaj A, Thomas N, Ellul MA, Davies NWS, Pollak TA, Tenorio EL, et al. Neurological and neuropsychiatric complications of COVID-19 in 153 patients: a UK-wide surveillance study. The lancet Psychiatry. 2020. 42. Paybast S, Emami A, Koosha M, Baghalha F. Novel Coro- navirus Disease (COVID-19) and Central Nervous System Complications: What Neurologist Need to Know. Acta neurologica Taiwanica. 2020;29(1):24-31. 43. Mao L, Jin H, Wang M, Hu Y, Chen S, He Q, et al. Neuro- logic manifestations of hospitalized patients with coro- navirus disease 2019 in Wuhan, China. JAMA neurology. 2020;77(6):683-90. 44. Kunutsor SK, Laukkanen JA. Hepatic manifestations and complications of COVID-19: A systematic review and meta-analysis. The Journal of infection. 2020. 45. Lazar HL. Commentary: Compliance with the Ameri- can Association for Thoracic Surgery guidelines will pre- vent sternal wound infections and minimize postopera- tive complications in cardiac surgery patients during the COVID-19 pandemic. The Journal of thoracic and cardio- vascular surgery. 2020;160(2):e44-8. 46. Lee M, Chen CS, Ovbiagele B. Covert COVID-19 compli- cations: Continuing the use of evidence-based drugs to minimize potentially lethal indirect effects of the pan- demic in stroke patients. Journal of the neurological sci- ences. 2020;414:116883. 47. Liabeuf S, Moragny J, Bennis Y, Batteux B, Brochot E, Schmit JL, et al. Association between renin-angiotensin system inhibitors and COVID-19 complications. Euro- pean heart journal Cardiovascular pharmacotherapy. 2020. 48. Liu B, Qi Z. Authors’ Reply to: Tocilizumab, Adipokines and Severe Complications of COVID-19. Clinical drug in- vestigation. 2020:1-3. 49. Lorenzo-Villalba N, Maouche Y, Syrovatkova A, Pham F, Chahbazian JB, Pertoldi P, et al. Cutaneous Com- plications Secondary to Haemostasis Abnormalities in COVID-19 Infection. European journal of case reports in internal medicine. 2020;7(7):001769. 50. Loungani RS, Rehorn MR, Newby LK, Katz JN, Klem I, Mentz RJ, et al. A care pathway for the cardiovascular complications of COVID-19: Insights from an institu- tional response. American heart journal. 2020;225:3-9. 51. Long B, Brady WJ, Koyfman A, Gottlieb M. Cardiovascu- lar complications in COVID-19. The American journal of emergency medicine. 2020;38(7):1504-7. 52. Lopez M, Bell K, Annaswamy T, Juengst S, Ifejika N. COVID-19 Guide for the Rehabilitation Clinician: A Re- view of Nonpulmonary Manifestations and Complica- tions. American journal of physical medicine & rehabil- itation. 2020;99(8):669-73. 53. Ma J, Xia P, Zhou Y, Liu Z, Zhou X, Wang J, et al. Potential effect of blood purification therapy in reducing cytokine storm as a late complication of critically ill COVID-19. Clinical Immunology (Orlando, Fla). 2020;214:108408. 54. Ma L, Song K, Huang Y. Coronavirus Disease-2019 (COVID-19) and Cardiovascular Complications. Journal of cardiothoracic and vascular anesthesia. 2020. 55. Mauro V, Lorenzo M, Paolo C, Sergio H. Treat all COVID 19-positive patients, but do not forget those negative with chronic diseases. Internal and emergency medicine. 2020:1-4. 56. Mendoza-Pinto C, Escárcega RO, García-Carrasco M, Bai- ley DJO, Gálvez-Romero JL, Cervera R. Viral infections and their relationship with catastrophic antiphospho- This open-access article distributed under the terms of the Creative Commons Attribution NonCommercial 3.0 License (CC BY-NC 3.0). Downloaded from: http://journals.sbmu.ac.ir/aaem 7 Archives of Academic Emergency Medicine. 2021; 9(1): e14 lipid syndrome: a possible pathogenic mechanism of se- vere COVID-19 thrombotic complications. Journal of in- ternal medicine. 2020. 57. Nobile B, Durand M, Olié E, Guillaume S, Molès JP, Haf- fen E, et al. Clomipramine Could Be Useful in Prevent- ing Neurological Complications of SARS-CoV-2 Infec- tion. Journal of neuroimmune pharmacology : the offi- cial journal of the Society on NeuroImmune Pharmacol- ogy. 2020:1-2. 58. Oudkerk M, Büller HR, Kuijpers D, van Es N, Oudkerk SF, McLoud TC, et al. Diagnosis, Prevention, and Treatment of Thromboembolic Complications in COVID-19: Report of the National Institute for Public Health of the Nether- lands. Radiology. 2020:201629. 59. Palmer K, Monaco A, Kivipelto M, Onder G, Maggi S, Michel JP, et al. The potential long-term impact of the COVID-19 outbreak on patients with non- communicable diseases in Europe: consequences for healthy ageing. Aging clinical and experimental research. 2020;32(7):1189-94. 60. Parry AH, Wani AH, Yaseen M, Dar MI. Demystifying pulmonary vascular complications in severe coronavirus disease-19 pneumonia (COVID-19) in the light of clinico- radiologic-pathologic correlation. Thrombosis research. 2020. 61. Patel VG, Zhong X, Liaw B, Tremblay D, Tsao CK, Gal- sky MD, et al. Does androgen deprivation therapy pro- tect against severe complications from COVID-19? An- nals of oncology : official journal of the European Society for Medical Oncology. 2020. 62. Paul P. Cardiac Troponin-I may be a predictor of com- plications and mortality in COVID-19 patients. Current medicine research and practice. 2020;10(3):130-1. 63. Rey JR, Caro-Codón J, Poveda Pineda D, Merino JL, Ini- esta Á M, López-Sendón JL. Arterial thrombotic compli- cations in hospitalized patients with COVID-19. Revista espanola de cardiologia (English ed). 2020. 64. Roche JA, Roche R. A hypothesized role for dysregulated bradykinin signaling in COVID-19 respiratory complica- tions. FASEB journal : official publication of the Fed- eration of American Societies for Experimental Biology. 2020;34(6):7265-9. 65. Rosen RJ. Thrombotic complications in critically ill pa- tients with COVID 19. Thrombosis research. 2020;191:56. 66. Saban-Ruiz J, Ly-Pen D. COVID-19: A Personalized Car- diometabolic Approach for Reducing Complications and Costs. The Role of Aging Beyond Topics. The Journal of Nutrition, Health & Aging. 2020:1. 67. Siguret V, Voicu S, Neuwirth M, Delrue M, Gayat E, Stépa- nian A, et al. Are antiphospholipid antibodies associated with thrombotic complications in critically ill COVID-19 patients? Thrombosis Research. 2020. 68. Silingardi R, Gennai S, Migliari M, Covic T, Leone N. Acute limb ischemia in COVID-19 patients: Could Aortic Floating Thrombus be the source of embolic complica- tions? Journal of vascular surgery. 2020. 69. Silverman DA, Lin C, Tamaki A, Puram SV, Carrau RL, Seim NB, et al. Respiratory and pulmonary compli- cations in head and neck cancer patients: Evidence- based review for the COVID-19 era. Head & Neck. 2020;42(6):1218-26. 70. Stevens DV, Tran AQ, Kim E. Complications of Orbital Emphysema in a COVID-19 Patient. Ophthalmology. 2020. 71. Tian D, Ye Q. Hepatic complications of COVID-19 and its treatment. Journal of medical virology. 2020. 72. Thomas W, Varley J, Johnston A, Symington E, Robinson M, Sheares K, et al. Thrombotic complications of patients admitted to intensive care with COVID-19 at a teaching hospital in the United Kingdom. Thrombosis Research. 2020;191:76-7. 73. Terpos E, Ntanasis-Stathopoulos I, Elalamy I, Kastritis E, Sergentanis TN, Politou M, et al. Hematological find- ings and complications of COVID-19. American journal of hematology. 2020. 74. Zhu H, Rhee J-W, Cheng P, Waliany S, Chang A, Witteles RM, et al. Cardiovascular complications in patients with COVID-19: consequences of viral toxicities and host im- mune response. Current cardiology reports. 2020;22:1-9. 75. Abboud H, Abboud FZ, Kharbouch H, Arkha Y, El Abbadi N, El Ouahabi A. COVID-19 and SARS-Cov-2 Infection: Pathophysiology and Clinical Effects on the Nervous Sys- tem. World Neurosurg. 2020;140:49-53. 76. Ahmed SI, Khan S. Coagulopathy and Plausible Benefits of Anticoagulation Among COVID-19 Patients. Curr Probl Cardiol. 2020;45(9):100648. 77. Khandait H, Gandotra G, Sachdeva S, Kramer CA, Nye D, Golamari R, et al. COVID-19 and Hematology-What Do We Know So Far? SN Compr Clin Med. 2020:1-6. 78. Msigwa SS, Wang Y, Li Y, Cheng X. The neurological in- sights of the emerging coronaviruses. J Clin Neurosci. 2020;78:1-7. 79. Sheikh AB, Shekhar R, Javed N, Upadhyay S. Inferior Wall Myocardial Infarction in Severe COVID-19 Infection: A Case Report. Am J Case Rep. 2020;21:e926101. 80. Siripanthong B, Nazarian S, Muser D, Deo R, Santangeli P, Khanji MY, et al. Recognizing COVID-19-related my- ocarditis: The possible pathophysiology and proposed guideline for diagnosis and management. Heart Rhythm. 2020;17(9):1463-71. 81. Vonck K, Garrez I, De Herdt V, Hemelsoet D, Laureys G, Raedt R, et al. Neurological manifestations and neuro- invasive mechanisms of the severe acute respiratory syn- drome coronavirus type 2. Eur J Neurol. 2020;27(8):1578- This open-access article distributed under the terms of the Creative Commons Attribution NonCommercial 3.0 License (CC BY-NC 3.0). Downloaded from: http://journals.sbmu.ac.ir/aaem SA. SeyedAlinaghi et al. 8 87. 82. Wijeratne T, Sales C, Karimi L, Crewther SG. Acute Is- chemic Stroke in COVID-19: A Case-Based Systematic Review. Front Neurol. 2020;11:1031. 83. Yachou Y, El Idrissi A, Belapasov V, Ait Benali S. Neuroin- vasion, neurotropic, and neuroinflammatory events of SARS-CoV-2: understanding the neurological manifesta- tions in COVID-19 patients. Neurol Sci. 2020;41(10):2657- 69. 84. Zaim S, Chong JH, Sankaranarayanan V, Harky A. COVID-19 and Multiorgan Response. Curr Probl Cardiol. 2020;45(8):100618. This open-access article distributed under the terms of the Creative Commons Attribution NonCommercial 3.0 License (CC BY-NC 3.0). Downloaded from: http://journals.sbmu.ac.ir/aaem 9 Archives of Academic Emergency Medicine. 2021; 9(1): e14 Table 1: Quality ratings of included studies based on NIH quality assessment (QA) tool for case series studies First Author *Question Rating 1 2 3 4 5 6 7 8 9 # 1 # 2 Ali Sepehrinezhad (21) Yes Yes CD CD NA Yes CD NA Yes Fair Fair Filatov A (22) Yes Yes CD CD NA Yes CD Yes Yes Fair Fair Helms J (25) Yes Yes NA CD NA Yes CD Yes Yes Fair Fair Heneka MT (2) Yes Yes CD CD NA Yes CD Yes Yes Fair Fair Kochi AN (26) Yes Yes CD CD NA Yes CD NA Yes Fair Fair Klok FA (27) Yes Yes NA CD NA Yes CD NA Yes Fair Fair Klok FA (30) Yes Yes NR NA NA Yes CD Yes Yes Fair Fair Klok FA(30) Yes Yes CD CD NA Yes CD NA Yes Fair Fair Kunutsor SK(44) Yes Yes CD NA NA Yes CD Yes Yes Fair Fair Landi A (28) Yes Yes CD NA NA Yes CD Yes Yes Fair Fair Lazar HL (45) Yes Yes CD NA NA Yes CD Yes Yes Fair Fair Lee M (46) Yes Yes NA CD NA Yes CD Yes Yes Fair Fair Liabeuf S(47) Yes Yes CD CD NA Yes CD Yes Yes Fair Fair Liu B (48) Yes Yes NA CD NA Yes CD Yes Yes Fair Fair Lorenzo-Villalba N(49) Yes Yes NR CD NA Yes CD Yes Yes Fair Fair Loungani RS(50) Yes Yes NR CD NA Yes CD Yes Yes Fair Fair Lodigiani C(34) Yes Yes CD CD NA Yes CD Yes Yes Fair Fair Long B (51) Yes Yes CD CD NA Yes CD Yes Yes Fair Fair Lopez M (52) Yes Yes CD CD NA Yes CD Yes Yes Fair Fair Ma J (53) Yes Yes CD NA NA Yes CD Yes Yes Fair Fair Ma L (54) Yes Yes CD NA NA Yes CD NA Yes Fair Fair Mao L(43) Yes Yes CD NA NA Yes CD NA Yes Fair Fair Mauro V(55) Yes Yes NA CD NA Yes CD Yes Yes Fair Fair Mendoza-Pinto C(56) Yes Yes NR CD NA Yes CD Yes Yes Fair Fair Nobile B (57) Yes Yes CD CD NA Yes CD Yes Yes Fair Fair Nogueira MS (29) Yes Yes CD CD NA Yes CD Yes Yes Fair Fair Orsi FA(33) Yes Yes NA CD NA Yes CD Yes Yes Fair Fair Oudkerk M(58) Yes Yes NA NA NA Yes CD Yes Yes Fair Fair Palmer K (59) Yes Yes NA NA NA Yes CD Yes Yes Fair Fair Poggiali E (35) Yes Yes NA CD NA Yes CD Yes Yes Fair Fair Parry AH (60) Yes Yes NA CD NA Yes CD Yes Yes Fair Fair Patel VG (61) Yes Yes NA NA NA Yes CD NA Yes Fair Fair Paul P (62) Yes Yes CD NA NA Yes CD Yes Yes Fair Fair Paybast S (42) Yes Yes CD NA NA Yes CD Yes Yes Fair Fair Pryce-Roberts A(38) Yes Yes NA CD NA Yes CD Yes Yes Fai Fair Puntmann VO(37) Yes Yes NA CD NA Yes CD Yes Yes Fair Fair Rey JR (63) Yes Yes NA CD NA Yes CD Yes Yes Fair Fair Roche JA(64) Yes Yes CD CD NA Yes CD Yes Yes Fair Fair Rosen RJ(65) Yes Yes NA NA NA Yes CD Yes Yes Fair Fair Saban-Ruiz J (66) Yes Yes NR CD NA Yes CD Yes Yes Fair Fair Sheraton M (39) Yes Yes CD CD NA Yes CD Yes Yes Fair Fair Siguret V (67) Yes Yes CD CD NA Yes CD Yes Yes Fair Fair Silingardi R (68) Yes Yes CD CD NA Yes CD Yes Yes Fair Fair Silverman – Chen Lin DA (69) Yes Yes CD NA NA Yes CD Yes Yes Fair Fair NA: not applicable; NIH: National Institutes of Health; NR: not reported; CD: cannot determine *The NIH Quality Assessment Tool for Case Series Studies contains nine questions: 1 = Was the study question or objective clearly stated?, 2 = Was the study population clearly and fully described, including a case definition?, 3 = Were the cases consecutive?, 4 = Were the subjects comparable?, 5 = Was the intervention clearly described?, 6 = Were the outcome measures clearly defined, 7 = Was the length of follow-up adequate?, 8 = Were the statistical methods well-described?, 9 = Were the results well-described? This open-access article distributed under the terms of the Creative Commons Attribution NonCommercial 3.0 License (CC BY-NC 3.0). Downloaded from: http://journals.sbmu.ac.ir/aaem SA. SeyedAlinaghi et al. 10 Table 1: Quality ratings of included studies based on NIH quality assessment (QA) tool for case series studies First Author *Question Rating 1 2 3 4 5 6 7 8 9 # 1 # 2 Singh Y (23) Yes Yes NA NA NA Yes CD Yes Yes Fair Fair Stevens DV (70) Yes Yes NA NA NA Yes CD Yes Yes Fair Fair Strafella C (40) Yes Yes NA NA NA Yes CD Yes Yes Fair Fair Tian D (71) Yes Yes NA NA NA Yes CD Yes Yes Fair Fair Thomas W (72) Yes Yes CD CD NA Yes CD Yes Yes Fair Fair Terpos E (73) Yes Yes NR CD NA Yes CD Yes Yes Fair Fair Varatharaj A (41) Yes Yes NA CD NA Yes CD Yes Yes Fair Fair Varatharajah N (24) Yes Yes NA CD NA Yes CD Yes Yes Fair Fair Wagener F (10) Yes Yes CD CD NA Yes CD NA Yes Fair Fair Wang X (6) Yes Yes NA NA NA Yes CD Yes Yes Fair Fair Zhu H (74) Yes Yes CD NA NA Yes CD Yes Yes Fair Fair Abboud H (75) Yes Yes CD CD NA Yes CD Yes Yes Fair Fair Khan S (76) Yes Yes CD CD NA Yes CD Yes Yes Fair Fair Khandait H (77) Yes Yes CD CD NA Yes CD Yes Yes Fair Fair Msigwa S S(78) Yes Yes NA CD NA Yes CD Yes Yes Fair Fair Sheikh A B (79) Yes Yes NA CD NA Yes CD Yes Yes Fair Fair Siripanthong B (80) Yes Yes NA NA NA Yes CD Yes Yes Fair Fair Vonck K (81) Yes Yes CD NA NA Yes CD Yes Yes Fair Fair Wijeratne T (82) Yes Yes NA NA NA Yes CD Yes Yes Fair Fair Yachou Y (83) Yes Yes CD NA NA Yes CD Yes Yes Fair Fair Zaim S (84) Yes Yes NA CD NA Yes CD Yes Yes Fair Fair NA: not applicable; NIH: National Institutes of Health; NR: not reported; CD: cannot determine *The NIH Quality Assessment Tool for Case Series Studies contains nine questions: 1 = Was the study question or objective clearly stated?, 2 = Was the study population clearly and fully described, including a case definition?, 3 = Were the cases consecutive?, 4 = Were the subjects comparable?, 5 = Was the intervention clearly described?, 6 = Were the outcome measures clearly defined, 7 = Was the length of follow-up adequate?, 8 = Were the statistical methods well-described?, 9 = Were the results well-described? This open-access article distributed under the terms of the Creative Commons Attribution NonCommercial 3.0 License (CC BY-NC 3.0). Downloaded from: http://journals.sbmu.ac.ir/aaem 11 Archives of Academic Emergency Medicine. 2021; 9(1): e14 Figure 1: Flow diagram of the selection process of articles identified. This open-access article distributed under the terms of the Creative Commons Attribution NonCommercial 3.0 License (CC BY-NC 3.0). Downloaded from: http://journals.sbmu.ac.ir/aaem SA. SeyedAlinaghi et al. 12 Figure 2: Frequency of identified late complications of COVID-19. This open-access article distributed under the terms of the Creative Commons Attribution NonCommercial 3.0 License (CC BY-NC 3.0). Downloaded from: http://journals.sbmu.ac.ir/aaem 13 Archives of Academic Emergency Medicine. 2021; 9(1): e14 Table 2: Identified late complications of COVID-19 ID First author Study type Country Study Population Late complications Neurologic Lung disease Liver diseases Heart damage Thrombosis Kidneydisease Stroke 1 Ali Sepehrinezhad (21) Perspective Review Iran Patients with neurological complications p × × × × × × – 2 Filatov A (22) Case Report USA 74-year-old male p × × × × × × Encephalopathy 3 Helms J (25) Editorial France COVID19 patients p × × × × × p – 4 Heneka MT (2) Review Germany COVID19 patients p × × × × × × – 5 Kochi AN (26) Review Italy COVID19 patients × p × p × × p – 6 Klok FA (27) Case- control Netherlands COVID19 patients × × × × p × × – 7 Klok FA (30) Case- Control Netherlands COVID19 patients × × × p p × p Symptomatic acute pulmonary embolism (PE), myocardial infarction or systemic arterial embolism 8 Klok FA(30) Case- Control Netherlands COVID19 patients admitted to the ICU × × × p p × p Pulmonary embolism, DVT, Ischemic, systemic arterial embolism 9 Kunutsor SK(44) Letter to Editor UK COVID 19 patients × × p × × × × Hypoproteinemia 10 Landi A (28) Letter to Editor Italy COVID-19 patients admitted to ICU × p × p p × p – 11 Lazar HL (45) Commentary USA COVID19 patients admitted to the ICU × p × × × × × – 12 Lee M (46) Letter to Editor China COVID 19 patients with a history of cardiovascular diseases × × × p × × × – 13 Liabeuf S(47) Cohort France hospitalized patients with laboratory- confirmed COVID-19 × p × × × p × GI damage, septic shock 14 Liu B (48) Authors Reply China COVID19 Patients × p × × p × × – 15 Lorenzo- Villalba N(49) Case Report France a patient hospitalized for COVID-19 × p × × p × × Parotiditis, cutaneous complications such as hemorrhagic bullae with intra-bullae blood clots and dissecting hematomas, Isolated herpetiform lesions, petechial rash 16 Loungani RS(50) Review USA COVID 19 Patients × × × p × × p 17 Lodigiani C(34) Cohort Italy COVID19 patients admitted to hospital × × × p p × p Acute coronary syndrome (ACS)/myocardial infarction (MI),overt disseminated intravascular coagulation (DIC) 18 Long B (51) Cohort USA COVID19 patients × p × p p × × Systematic inflammation, myocardial injury, acute myocardial infarction, dysrhythmias, 19 Lopez M (52) Review USA COVID19 patients p p p p p × p Psychological distress 20 Ma J (53) Letter to Editor China three critically ill patients with coronavirus disease 2019 (COVID-19) p × × × p p p Multiple organ dysfunction syndrome, dry gangrene, multiple cerebral infarction, refractory disseminated intravascular coagulation (DIC) and pneumothorax 21 Ma L (54) Review China COVID19 patients × p × p × × p Pneumonia, persistent hypotension 22 Mao L(43) Research article China Hospitalized Patients With Coronavirus Disease 2019 p p × × × × × – 23 Mauro V(55) Point of view Italy COVID19 patients × × p × × × × – DVT: Deep vein thrombosis; GI: gastrointestinal; PTE: pulmonary thromboembolism; DIC: disseminated intravascular coagulation. This open-access article distributed under the terms of the Creative Commons Attribution NonCommercial 3.0 License (CC BY-NC 3.0). Downloaded from: http://journals.sbmu.ac.ir/aaem SA. SeyedAlinaghi et al. 14 Table 2: Identified late complications of COVID-19 ID First author Study type Country Study Population Late complications Neurologic Lung disease Liver diseases Heart damage Thrombosis Kidneydisease Stroke 24 Mendoza- Pinto C(56) Letter to Editor Mexico COVID19 patients × × × p p p × Elevated D-dimer, and coagulation abnormalities, catastrophic antiphospholipid syndrome (CAPS), multiple small vessel occlusions, multiorgan system failure 25 Nobile B (57) Letter to Editor France COVID19 patients using Cloripramine p p × × × × p Psychological distress, ischemic attacks, leading to brain inflammation and lesions 26 Nogueira MS (29) Review Ireland COVID19 patients × p × × × × × Pneumonia, acute respiratory distress syndrome (ARDS) and lymphadenopathy 27 Orsi FA(33) Review Brazil HospitalizedCOVID- 19 patients × p × × p × × Septic shock or multiple organ dysfunction, ARDS, Hypercoagulability 28 Oudkerk M(58) Special Report Netherlands COVID-19 patients × p × p p p × GI damage, vascular endothelial damage 29 Palmer K (59) Review Italy COVID-19 patients with non- communicable disease (NCD) × p × p p × p Psychological distress, exacerbated chronic NCD conditions (e.g., asthma, chronic obstructive, congestive cardiac failure) 30 Poggiali E (35) Case Reports Italy An 82-year-old woman, A 64-year-old man × p × × p × × Venous thromboembolism, Deep Pulmonary Embolism 31 Parry AH (60) Letter to Editor India COVID-19 patients with pneumonia × p × × p × × Diffuse alveolar damage, acute respiratory distress syndrome, pulmonary vascular damage, PTE 32 Patel VG (61) Letter to Editor- Cohort USA COVID-19 patients with prostate cancer × p × × × × × – 33 Paul P (62) Letter to Editor India COVID-19 patients × p × p × × × ARDS, pneumonia, multiple organ failure, infective myocarditis 34 Paybast S (42) Review Iran COVID-19 patients p p × × × p p GI disease, Intracranial hemorrhage, hyposmia and hypogeusia, disorientation, third nerve palsy 35 Pryce-Roberts A(38) Review UK COVID-19 patients p × × × × × p Dysgeusia, hyposmia, disorientation, encephalitis, meningoencephalitis, and encephalopathy 36 Puntmann VO(37) Clinical trial Germany Patients Recently Recovered From COVID-19 × × × p × × × – 37 Rey JR (63) Letter to editor Spain patients attended due to COVID-19 × p × p p × p Acute coronary syndrome 38 Roche JA(64) Hypothesis USA COVID 19 patients with deregulated BK signaling × p × × × × × – 39 Rosen RJ(65) Letter to editor USA × × × × p × p – 40 Saban-Ruiz J (66) Review Spain Cardiometabolic health/medicine × × × p × × p – 41 Sheraton M (39) Review USA Patients with neurological complications p × × × × × × Guillain-Barre syndrome 42 Siguret V (67) Letter to the editor France Thrombotic complications in critically ill COVID-19 × × × × p × p – 43 Silingardi R (68) Letter to the editor Italy Acute limb ischemia in COVID-19 patients × × × × p × × Acute limb ischemia-Pulmonary Embolism-Aortic floating thrombus 44 Silverman – Chen Lin DA (69) Review USA COVID-19 patients × p × × × × × – DVT: Deep vein thrombosis; GI: gastrointestinal; PTE: pulmonary thromboembolism; DIC: disseminated intravascular coagulation. This open-access article distributed under the terms of the Creative Commons Attribution NonCommercial 3.0 License (CC BY-NC 3.0). Downloaded from: http://journals.sbmu.ac.ir/aaem 15 Archives of Academic Emergency Medicine. 2021; 9(1): e14 Table 2: Identified late complications of COVID-19 ID First author Study type Country Study Population Late complications Neurologic Lung disease Liver diseases Heart damage Thrombosis Kidneydisease Stroke 45 Singh Y (23) Letter to the editor India Cellular metabolism mediated complications in COVID-19 infection p p × p × p p Cell death triggered by ferroptotic stress 46 Stevens DV (70) Case-Study USA Complications of Orbital Emphysema in a COVID-19 Patient × p × × p × × – 47 Strafella C (40) Analytic Italy Analysis of ACE2 Genetic Variability Among Populations p p × p × p × Sepsis 48 Tian D (71) Review China COVID-19 patients × × p × × × × – 49 Thomas W (72) Letter to the editor United Kingdom Thrombotic complication of a patient with COVID-19 × × × × p × p – 50 Terpos E (73) Review Greece Hematologic complications in COVID-19 patients × × × p p × × – 51 Varatharaj A (41) Case- control UK COVID-19 patients p × × × × × p Thrombotic complication of a patient with COVID-19 52 Varatharajah N (24) Letter to the editor USA Microthrombotic complications of patients with COVID-19 × p × × p × × Hematologic complications in COVID-19 patients 53 Wagener F (10) Viewpoint Netherlands Critically ill COVID-19 patients × p × × × × × Coagulation abnormality 54 Wang X (6) Research article China Chronic diseases among patients with COVID-19 × × p p p p × – 55 Zhu H (74) Review USA patients with COVID-19 × p × p × × × Coagulopathy-DIC 56 Abboud H (75) Review Morocco patients with COVID-19 p × × × × × × – 57 Khan S (76) Review Malaysia patients with COVID-19 × × × × p × × – 58 Khandait H (77) Research article India patients with COVID-19 × p × p p × p Coagulopathy-DIC-Pulmonary Embolism-Deep vein thrombosis 59 Msigwa S S(78) Review China patients with COVID-19 p × × × × × × – 60 Sheikh A B (79) Case-report USA 56-year-old man with COVID-19 × × × p p × × – 61 Siripanthong B (80) Review UK patients with COVID-19 × × × p × × × Myocarditis 62 Vonck K (81) Review Belgium patients with COVID-19 p × × × × × × central nervous system (CNS) manifestations [dizziness, headache, impaired, consciousness, acute cerebrovascular disease (CVD), ataxia and seizure], cranial and peripheral nervous system manifestations (taste impairment, smell impairment, vision impairment and neuropathy), and skeletal muscular injury manifestations 63 Wijeratne T (82) Review Australia patients with COVID-19 p × × × × × p Acute ischemic stroke 64 Yachou Y (83) Review Russia patients with COVID-19 p × × × × × × – 65 Zaim S (84) Review UK patients with COVID-19 p p p p × p × DIC DVT: Deep vein thrombosis; GI: gastrointestinal; PTE: pulmonary thromboembolism; DIC: disseminated intravascular coagulation. This open-access article distributed under the terms of the Creative Commons Attribution NonCommercial 3.0 License (CC BY-NC 3.0). Downloaded from: http://journals.sbmu.ac.ir/aaem Introduction Methods Results Discussion Conclusion Declarations References