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6-month neurological and psychiatric outcomes in 236 379 survivors of COVID-19: a retrospective cohort study..., 2021, Taquet et al

Discussion in 'Long Covid research' started by Andy, Apr 7, 2021.

  1. Andy

    Andy Committee Member

    Messages:
    21,803
    Location:
    Hampshire, UK
    Full title: 6-month neurological and psychiatric outcomes in 236 379 survivors of COVID-19: a retrospective cohort study using electronic health records

    Background
    Neurological and psychiatric sequelae of COVID-19 have been reported, but more data are needed to adequately assess the effects of COVID-19 on brain health. We aimed to provide robust estimates of incidence rates and relative risks of neurological and psychiatric diagnoses in patients in the 6 months following a COVID-19 diagnosis.

    Methods
    For this retrospective cohort study and time-to-event analysis, we used data obtained from the TriNetX electronic health records network (with over 81 million patients). Our primary cohort comprised patients who had a COVID-19 diagnosis; one matched control cohort included patients diagnosed with influenza, and the other matched control cohort included patients diagnosed with any respiratory tract infection including influenza in the same period. Patients with a diagnosis of COVID-19 or a positive test for SARS-CoV-2 were excluded from the control cohorts. All cohorts included patients older than 10 years who had an index event on or after Jan 20, 2020, and who were still alive on Dec 13, 2020. We estimated the incidence of 14 neurological and psychiatric outcomes in the 6 months after a confirmed diagnosis of COVID-19: intracranial haemorrhage; ischaemic stroke; parkinsonism; Guillain-Barré syndrome; nerve, nerve root, and plexus disorders; myoneural junction and muscle disease; encephalitis; dementia; psychotic, mood, and anxiety disorders (grouped and separately); substance use disorder; and insomnia. Using a Cox model, we compared incidences with those in propensity score-matched cohorts of patients with influenza or other respiratory tract infections. We investigated how these estimates were affected by COVID-19 severity, as proxied by hospitalisation, intensive therapy unit (ITU) admission, and encephalopathy (delirium and related disorders). We assessed the robustness of the differences in outcomes between cohorts by repeating the analysis in different scenarios. To provide benchmarking for the incidence and risk of neurological and psychiatric sequelae, we compared our primary cohort with four cohorts of patients diagnosed in the same period with additional index events: skin infection, urolithiasis, fracture of a large bone, and pulmonary embolism.

    Findings
    Among 236 379 patients diagnosed with COVID-19, the estimated incidence of a neurological or psychiatric diagnosis in the following 6 months was 33·62% (95% CI 33·17–34·07), with 12·84% (12·36–13·33) receiving their first such diagnosis. For patients who had been admitted to an ITU, the estimated incidence of a diagnosis was 46·42% (44·78–48·09) and for a first diagnosis was 25·79% (23·50–28·25). Regarding individual diagnoses of the study outcomes, the whole COVID-19 cohort had estimated incidences of 0·56% (0·50–0·63) for intracranial haemorrhage, 2·10% (1·97–2·23) for ischaemic stroke, 0·11% (0·08–0·14) for parkinsonism, 0·67% (0·59–0·75) for dementia, 17·39% (17·04–17·74) for anxiety disorder, and 1·40% (1·30–1·51) for psychotic disorder, among others. In the group with ITU admission, estimated incidences were 2·66% (2·24–3·16) for intracranial haemorrhage, 6·92% (6·17–7·76) for ischaemic stroke, 0·26% (0·15–0·45) for parkinsonism, 1·74% (1·31–2·30) for dementia, 19·15% (17·90–20·48) for anxiety disorder, and 2·77% (2·31–3·33) for psychotic disorder. Most diagnostic categories were more common in patients who had COVID-19 than in those who had influenza (hazard ratio [HR] 1·44, 95% CI 1·40–1·47, for any diagnosis; 1·78, 1·68–1·89, for any first diagnosis) and those who had other respiratory tract infections (1·16, 1·14–1·17, for any diagnosis; 1·32, 1·27–1·36, for any first diagnosis). As with incidences, HRs were higher in patients who had more severe COVID-19 (eg, those admitted to ITU compared with those who were not: 1·58, 1·50–1·67, for any diagnosis; 2·87, 2·45–3·35, for any first diagnosis). Results were robust to various sensitivity analyses and benchmarking against the four additional index health events.

    Interpretation
    Our study provides evidence for substantial neurological and psychiatric morbidity in the 6 months after COVID-19 infection. Risks were greatest in, but not limited to, patients who had severe COVID-19. This information could help in service planning and identification of research priorities. Complementary study designs, including prospective cohorts, are needed to corroborate and explain these findings.

    Open access, https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(21)00084-5/fulltext
     
    Peter Trewhitt and Simon M like this.
  2. MEMarge

    MEMarge Senior Member (Voting Rights)

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    Location:
    UK
    Four out of five are based in Psychiatry Depts in Oxford.
     
    Wyva, Hutan, Trish and 2 others like this.
  3. NelliePledge

    NelliePledge Moderator Staff Member

    Messages:
    13,140
    Location:
    UK West Midlands
    Why are neurological and psychiatric lumped together?
     
    Peter Trewhitt, MEMarge, Wyva and 2 others like this.
  4. rvallee

    rvallee Senior Member (Voting Rights)

    Messages:
    12,290
    Location:
    Canada
    It's boom time in "liaison psychiatry", aka psychosomatics with a new label.

    Reading comments from long haulers, so many report the exact same formula that applied to us: many things missing from their medical records, especially neurological symptoms, while additional mental health things, denied or never discussed, are there instead. This isn't just GIGO, it's manufactured GIGO, medicine's own fault for mislabeling or dismissing real things as something else.

    This is indicative of something real but the data are so unreliable as to be useless. Questions unasked always go unanswered.
     
    Peter Trewhitt likes this.
  5. Shinygleamy

    Shinygleamy Senior Member (Voting Rights)

    Messages:
    150
    On instagram

    Quote from wessely. Getting his oar in.
    Ps I'm an independent expert too. My speciality is 'getting irritated by self declared experts.'
     
    Last edited by a moderator: Apr 8, 2021
    Wyva, MeSci, Andy and 3 others like this.

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