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The chronification of post-COVID condition associated with neurocognitive symptoms, functional impairment and (...), 2022, Nehme et al

Discussion in 'Long Covid research' started by Wyva, Aug 27, 2022.

  1. Wyva

    Wyva Senior Member (Voting Rights)

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    Full title:
    The chronification of post-COVID condition associated with neurocognitive symptoms, functional impairment and increased healthcare utilization

    Abstract

    Post-COVID condition is prevalent in 10–35% of cases in outpatient settings, however a stratification of the duration and severity of symptoms is still lacking, adding to the complexity and heterogeneity of the definition of post-COVID condition and its oucomes. In addition, the potential impacts of a longer duration of disease are not yet clear, along with which risk factors are associated with a chronification of symptoms beyond the initial 12 weeks.

    In this study, follow-up was conducted at 7 and 15 months after testing at the outpatient SARS-CoV-2 testing center of the Geneva University Hospitals. The chronification of symptoms was defined as the continuous presence of symptoms at each evaluation timepoint (7 and 15 months). Adjusted estimates of healthcare utilization, treatment, functional impairment and quality of life were calculated. Logistic regression models were used to evaluate the associations between the chronification of symptoms and predictors.

    Overall 1383 participants were included, with a mean age of 44.3 years, standard deviation (SD) 13.4 years, 61.4% were women and 54.5% did not have any comorbidities. Out of SARS-CoV-2 positive participants (n = 767), 37.0% still had symptoms 7 months after their test of which 47.9% had a resolution of symptoms at the second follow-up (15 months after the infection), and 52.1% had persistent symptoms and were considered to have a chronification of their post-COVID condition.

    Individuals with a chronification of symptoms had an increased utilization of healthcare resources, more recourse to treatment, more functional impairment, and a poorer quality of life. Having several symptoms at testing and difficulty concentrating at 7 months were associated with a chronification of symptoms. COVID-19 patients develop post-COVID condition to varying degrees and duration. Individuals with a chronification of symptoms experience a long-term impact on their health status, functional capacity and quality of life, requiring a special attention, more involved care and early on identification considering the associated predictors.

    Open access: https://www.nature.com/articles/s41598-022-18673-z
     
    Andy, shak8, Snow Leopard and 2 others like this.
  2. Wyva

    Wyva Senior Member (Voting Rights)

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    1,368
    Location:
    Budapest, Hungary
    "Risk factors for the chronification of symptoms may include having several symptoms at time of testing and the presence of cognitive symptoms evidenced by a difficulty concentrating. A recent study described the longitudinal evolution of symptoms over 12 months and suggested neurologic symptoms such as paresthesia might increase with time16. This is in line with our hypothesis that the chronification of symptoms may be driven by a neurological process. In comparison, risk factors for other chronic conditions similar to post-COVID have been reported such as age, sex, education levels, depression or anxiety found to be associated with an increased risk of chronic fatigue syndrome33,34,35,38.

    However, these studies have shown contradictory results showing an association with lower income34, but also with middle-high income leading to more diagnosis38. Studies also showed an association of chronic fatigue syndrome with younger33, and older age35. These factors were not associated with a chronification of symptoms in our study. Also comparatively, patients with post-COVID condition after hospitalization might exhibit more respiratory symptoms6, which was not as evident in our study. To date, the definition of post-COVID condition includes both outpatient and inpatient settings however the manifestation of disease might be different and so could the predicting factors.

    The underlying mechanisms of post-COVID are not yet understood. Four hypotheses remain at the forefront of explanations of post-COVID condition including viral persistence, dysbiosis39, an autoimmune response40 or a dysregulated inflammatory response39,41. Studies have shown that inflammatory markers are elevated in post-COVID individuals42, autoantibodies during the acute phase could be correlated with long-term symptoms, and smaller studies have detected persistent viral particles on gastrointestinal biopsies43,44.

    In addition to learning about the mechanisms of post-COVID condition, it is paramount to understand the mechanisms leading to a chronification of symptoms. Comparatively, the chronification of symptoms in chronic fatigue syndrome shows that immune dysregulation or a low-level chronic inflammation might be potential contributors45."
     
    Andy, DokaGirl, CRG and 4 others like this.
  3. chrisb

    chrisb Senior Member (Voting Rights)

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    I suspect that "chronification" is a word which will lead to many misconceptions and false inferences.

    "Chronification" is all in the head. The head of the person who uses the word.
     
    Milo, Forbin, DokaGirl and 5 others like this.
  4. Peter Trewhitt

    Peter Trewhitt Senior Member (Voting Rights)

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    I am still unsure what ‘chronification’ means, does it mean ‘ongoing’ or ‘continuous’ as opposed to temporary or episodic?
     
    DokaGirl and chrisb like this.
  5. Trish

    Trish Moderator Staff Member

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    UK
    I looked it up. As far as I can see it simply means a symptom that started off as acute becoming chronic.
     
    Last edited: Aug 27, 2022
    Mithriel, Andy, Milo and 6 others like this.
  6. rvallee

    rvallee Senior Member (Voting Rights)

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    In other words: illness is associated with symptoms and chronic illness is associated with chronic symptoms. Also: illness is limiting and generally sucks.

    Glad we made all that progress in 2.5 years. You can really feel the complete lack of urgency and interest behind it. You can also feel the expertise behind it, so heavy and thick and moving slower than dry molasses.
     
    Forbin, DokaGirl, alktipping and 3 others like this.
  7. chrisb

    chrisb Senior Member (Voting Rights)

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    One might reasonably expect that chronification could have three potential uses:

    by analogy with "magnification", the degree or state of chronicity,

    or, the process of becoming chronic,

    or, the process of being made chronic.

    Perhaps there are more. The process of becoming chronic is merely that of failure to recover.
     
  8. DokaGirl

    DokaGirl Senior Member (Voting Rights)

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    I think the BPS Movement might use chronification to mean the volitional act of thinking oneself chronically ill.
     
    chrisb, Forbin and Peter Trewhitt like this.
  9. DokaGirl

    DokaGirl Senior Member (Voting Rights)

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    It's good these researchers are comparing risk factors in diseases similar to Long COVID, and finding glaring discrepancies.
     
    shak8 and Peter Trewhitt like this.
  10. Forbin

    Forbin Senior Member (Voting Rights)

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    Adding "-fication" to a verb of action ending in "-fy" is a way of turning the verb into a noun, as when "magnify" is turned into "magnification."

    The problem seems to be that almost no one uses the word "chronify," although it is a word meaning "to become chronic." I suppose a doctor might say, "We must not let his condition chronify," but I wonder just how often that is used.

    "Chronification" sounds more like the dubious changing of a label from something that isn't chronic to something that is. In that regard, it sounds a lot like "medicalization," the transforming of something other than medical into something medical.
     
    Last edited: Aug 28, 2022
    DokaGirl, chrisb, alktipping and 2 others like this.
  11. NelliePledge

    NelliePledge Moderator Staff Member

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    As it is a Swiss team quite likely they don’t have English as their first language and the term chronification arises from translation from another language.
     
    DokaGirl, TigerLilea, Andy and 7 others like this.
  12. chrisb

    chrisb Senior Member (Voting Rights)

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    This. "Chronification" is merely a change of category, or classification. As such it is purely down to the classifier.

    Earlier chronification was established by changing the definition from six months to three months, or whatever it now is.

    People using this term are likely to be asking the wrong questions.
     
    Mithriel, DokaGirl and Peter Trewhitt like this.

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