In patients with post-acute sequelae of COVID-19, the pooled global prevalence was 70.6% for orthostatic intolerance, 36.2% for postural orthostatic tachycardia syndrome, and 18.6% for orthostatic hypotension.
Meta-Analysis (n=2,916)
Autonomic dysfunction is highly prevalent in post-acute sequelae of COVID-19, with orthostatic intolerance affecting over 70% of patients, highlighting a significant public health burden.
Background: The COVID-19 pandemic has resulted in over 776 million confirmed cases worldwide, with post-acute sequelae of COVID-19 now recognized as a significant public health concern. Autonomic dysfunction-including orthostatic intolerance (OI), postural orthostatic tachycardia syndrome (POTS), and orthostatic hypotension (OH) -constitutes a major complication of post-acute sequelae of COVID-19. However, reliable epidemiological estimates remain scarce. As a result, we aim to provide the first global prevalence estimates of autonomic dysfunction in post-acute sequelae of COVID-19. Methods: This systematic review and meta-analysis adhered to PRISMA 2020 guidelines, including 21 observational studies. Random-effects models were utilized to estimate pooled prevalence, and sensitivity and meta-regression analyses were conducted to explore heterogeneity. GRADE assessments evaluated evidence certainty. Results: The pooled prevalence estimates demonstrated 70. 6% for OI, 36. 2% for POTS, and 18. 6% for OH. Advancing age exhibited a significant negative association with POTS and OH. In contrast, prolonged post-acute sequelae of COVID-19 duration and female sex showed no significant association with the incidence rates of these conditions. Subgroup analyses indicated higher POTS and OH incidence in mild vs. moderate or severe COVID-19 cases. Publication bias was minimal for OH but evident for POTS. Conclusion: This study provides the first global prevalence estimates of autonomic dysfunction in post-acute sequelae of COVID-19, highlighting its disproportionate burden among younger populations and non-linear temporal trends. The findings advance epidemiological understanding and inform evidence-based public health strategies to address post-COVID complications. Systematic Review Registration: https: //www. crd. york. ac. uk/PROSPERO/displayᵣecord. php? RecordID=556546, PROSPERO CRD42024556546.
Wang et al. (Thu,) conducted a meta-analysis in Post-acute sequelae of COVID-19 (PASC) (n=2,916). In patients with post-acute sequelae of COVID-19, the pooled global prevalence was 70.6% for orthostatic intolerance, 36.2% for postural orthostatic tachycardia syndrome, and 18.6% for orthostatic hypotension.