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Long‐lasting clinical symptoms 6 months after COVID-19 infection in the French national cohort of patients on dialysis, 2022, Belkacemi et al

Discussion in 'Long Covid research' started by Andy, Mar 19, 2022.

  1. Andy

    Andy Committee Member

    Messages:
    21,810
    Location:
    Hampshire, UK
    Abstract

    Background
    Systematic reviews have shown a high prevalence of long-term persistent sequelae after COVID-19. The aim of this study was to describe the prevalence and risk factors associated with long‐lasting clinical symptoms (LLCS) in survivors on chronic dialysis at 6 months after the onset of acute COVID-19 infection in the pre-vaccination period.

    Methods
    This national cohort study included all French patients on dialysis who had SARS-Cov-2 infection between March and December 2020 and who were alive and still on dialysis 6 months after infection. A form was filled in at 6 months concerning the presence of the following persistent symptoms: extreme fatigue, headache, muscle or weight loss of > 5%, respiratory sequelae, tachycardia, chest pain, joint or muscle pain, persistent anosmia or ageusia, diarrhea, sensory disorders, neuro-cognitive disorders, post-traumatic stress syndrome, depression, and anxiety.

    Results
    Complete survey results were available for 1217 patients (25.2% of those included); 216 (17.7%) had some LLCS. Probability of 6-month LLCS was higher in patients who were hospitalized in a medical or intensive care unit: OR 1.64 (95% CI 1.16–2.33) and 5.03 (2.94–8.61), respectively. Younger patients had a lower probability of LLCS. Each year on dialysis, as well as diabetes, overweight or obesity were associated with a higher probability of LLCS by 1.03 (1.01–1.06), 1.53 (1.08–2.17), 1.96 (1.10–3.52) and 2.35 (1.30–4.26), respectively.

    Conclusions
    This national study shows that at least one in six patients on dialysis who have COVID-19 will have LLCS. Systematic screening in dialysis patients would allow us to identify those who need more careful prevention and long-term care and to address them towards a rehabilitation pathway.

    Open access, https://link.springer.com/article/10.1007/s40620-022-01295-z
     
    DokaGirl likes this.
  2. shak8

    shak8 Senior Member (Voting Rights)

    Messages:
    2,203
    Location:
    California
    How I love the discussion section:

    "...However, our results should be interpreted with caution since, first of all, defining symptoms as sequelae 6 months after infection should be done with great caution. Some symptoms are frequent in the dialysis population and could be part of the natural disease evolution. Moreover, patients may have changed their treatment unit, so assessing a change, or lack thereof in comparison to the previous 6 months is difficult. Second, given the number of surveys that were returned, we cannot exclude some selection bias..."

    Bolding mine. My 20 yrs of experience with dialysis patients gave me this doubt because these patients have so many symptoms normally (exhaustion, cardiovascular disease, diabetes, immune suppression), are frequently short of breath due to build up of fluids (which dialysis removes, sometimes in an emergency situation.)
     
    Last edited: Mar 19, 2022
  3. Hutan

    Hutan Moderator Staff Member

    Messages:
    26,530
    Location:
    Aotearoa New Zealand
    So many issues with these Long Covid prevalence papers - I'm going to make a checklist, feel free to copy and paste for later papers, and add things I have forgotten:

    Size - 1217 patients, not bad except,
    Selection - :emoji_warning: Selection bias likely. Surveys were completed for only 1217 patients out of 4826 potentially available (25%). Possibly not as biased as when patients can choose to answer; in this case forms were filled out by medical staff.

    Accuracy of Covid-19 infection status - seems good e.g. 82% had a positive PCR.

    Accuracy of symptom reporting - :emoji_warning: They say "the clinical research assistant of the registry in close collaboration with the nephrologists filled in a form for each survivor". It's not clear what role the patients played in this form filling, in which case, it's hard to know how the form fillers would know how to answer for the patient. That might explain why 'weight loss' was the symptom most often reported.

    Accounting for pre-existing symptoms :emoji_warning: a particularly bad problem in this paper as the population have end-stage kidney disease, and so probably weren't feeling too flash before getting Covid-19. The incidence of depression and/or anxiety was only 13%, which seems remarkably low considering the considerable disease burden many of the patients were carrying (e.g. in addition to the severe kidney disease, there was cancer, stroke, paraplegia...)

    Accounting for frequency/severity/impact of symptoms, just absence or presence :emoji_warning: Just absence or presence. How diagnostic of anything is a question 'do you have headaches?' going to be?

    Separate reporting of symptoms likely to have very different causes :emoji_warning: Although percentages by symptom are reported, there is quite a bit of reporting and analysis of odds ratios that lump things like depression, anxiety, post-traumatic distress syndrome, respiratory symptoms, lack of smell and the things we would associate with ME/CFS such as fatigue, joint/muscle pain and neurological-cognitive disorders together.
    e.g. "In this study, persistent symptoms were more frequent in older patients and in those with more comorbidities."


    Assessment of PEM :emoji_warning: no, no mention


    Psychosomatic inference ? a bit. The references given for medical interventions to correct post-Covid symptoms look suspicious.
    Ref 13. Sandler CX, Wyller VBB, Moss-Morris R, Buchwald D, Crawley E, Hautvast J, et al. Long COVID and Post-infective Fatigue Syndrome: A Review. Open Forum Infect Dis. 2021 Oct

    Ref 14. Yong SJ, Liu S (2021) Proposed subtypes of post-COVID-19 syndrome (or long-COVID) and their respective potential therapies. Rev Med Virol e2315

    Ref 15. Vance H, Maslach A, Stoneman E, Harmes K, Ransom A, Seagly K et al (2021) Addressing post-COVID symptoms: a guide for primary care physicians. J Am Board Fam Med JABFM 34(6):1229–1242


    Length of time - ok, 6 months


    All in all, I don't think this study tells us much at all. I can't see anywhere to post a comment on the study.
     
    Last edited: Mar 20, 2022
    shak8, alktipping, Ariel and 2 others like this.
  4. NelliePledge

    NelliePledge Moderator Staff Member

    Messages:
    13,145
    Location:
    UK West Midlands
    Love your use of the signs :emoji_warning: @Hutan
     
    Hutan, bobbler, Trish and 1 other person like this.

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