Preprint Prevalence of CFS and its related factors in covid- 19 patients discharged from at northwest of Iran hospitals in 2022, 2024, Arman Alizadeh et al

[Mij]

Abstract
Introduction:
The COVID-19 pandemic has been a tragedy. It has devastated the health and financial well-being of many people around the world. Fatigue is one of the common symptoms and complications of covid-19, which can continue in patients for a long time after infection. The present study was also conducted with the aim of determining the prevalence of chronic fatigue syndrome and associated risk factors in covid-19 patients discharged from at northwest of Iran hospitals in 2022

Methods
This cross-sectional study was performed between May 2021 and January 2022 at northwest of Iran. 422 patients who had been discharged from hospital with COVID-19 were enrolled in our study. Chalder fatigue Assessment Scale (FAS) was used to measure post-COVID-19 chronic fatigue syndrome. Central and dispersion indicators were used to describe clinical and sociodemographic characteristics of patients. The chi-square test and person correlation were used to examine the statistical association between the CFS score and other clinical and sociodemographic factors.

Results
in overall, 72% of patients were female. The mean ± SD of the CFS score was 21.2 ± 9.0. The prevalence of post-COVID-19 CFS among our studied sample was %12.64. The findings showed that the prevalence of chronic fatigue and fatigue scores were higher in women (%13) than in men (%12.3) and this difference was statistically significant (P < 0.04). The findings showed that the prevalence of chronic fatigue with history of previous disease (P = 0.04), history of drug use (P = 0.01), history of smoking (P = 0.04), history of mechanical ventilation (P = 0.05) and age (P = 0.001) has a significant relationship.

Conclusion
Post-COVID-19 fatigue is a major issue following the initial acute illness with COVID-19, with a prevalence of %12.64. Therefore, the implementation of standardized measures for the screening of chronic fatigue after covid-19 and planning by the health staff in order to help these patients especially among female patients Seems necessary.
LINK

 

[Hutan]

Peng Fei Sun set al.'s meta-analysis analysis showed that in 10 articles studied among 50,466 patients with Covid-19, the incidence rate of fever was 89.1%, cough was 72.2%, and muscle pain or fatigue was 42.5%

This is a pre-print, with some issues with the English. I thought you might enjoy this typo that is probably the result of an over-zealous spell checker app.

Chronic fatigue is a debilitating chronic disease with a global prevalence of 0.3 to 0.8% (13). The effects of this syndrome on work are costly and cause a decrease in production, efficiency, motivation and increase in absenteeism and unemployment(14).

There's an issue here with confusing the symptom of chronic fatigue with chronic fatigue syndrome. Reference 13 with the global prevalence is actually to Jason LA, Sunnquist M, Brown A, Reed J. Defining essential features of myalgic encephalomyelitis and chronic fatigue syndrome.
Reference 14 is Nacul LC, Lacerda EM, Pheby D, Campion P, Molokhia M, Fayyaz S, et al. Prevalence of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) in three regions of England: a repeated cross-sectional study in primary care. I don't know if that reference says there is a deficit of motivation in people with ME/CFS - I'd be surprised if it does. In any case, I don't believe there is any good evidence to support it.

Koenig et al. (2023) in their study on general practitioner referrals, stated that 35% of patients suspected of covid-19 and 13% of patients not suspected of covid-19 had symptoms of persistent fatigue, and the prognostic factors of persistent fatigue included low education., the absence of a life partner, low flexibility, depression, history of drug use, and threatening experiences in the past (15, 16).

I think it's a shame to refer to this problematic article suggesting associations they found are prognostic factors.

The important point is that chronic fatigue with changes in mental health can affect the activity and function of the immune system of people with this disease and make them susceptible to other diseases. Paying attention to effective factors and treatments can play an important role in improving the health of people with chronic fatigue syndrome (11).

Reference 11 is Salari N, Khodayari Y, Hosseinian-Far A, Zarei H, Rasoulpoor S, Akbari H, et al. Global prevalence of chronic fatigue syndrome among long COVID-19 patients: A systematic review and meta-analysis. Biopsychosoc Med. 2022;16(1):21. Of course in Biopsychosocial Medicine. It's an odd statement that seems to be heading towards 'these people need to be got moving'.

and more:

It appears that the current coronavirus pandemic could trigger a global spike in CFS/ME within 6 to 18 months of discharge. Preventing the continuation of chronic fatigue and controlling its adverse consequences can be achieved by examining and intervening in the factors that determine the occurrence of this syndrome and the effective factors in reducing the quality of life of these patients (17, 18).

There's an ongoing sloppiness with the naming of the syndrome, and a strange over concern about the adverse consequences of allowing "CFS/ME" to continue, rather than being concerned about the awfulness of the illness itself. And there seems to be a misplaced certainty that the factors causing the syndrome can be both known and fixed.

 

[Hutan]

Methods

The inclusion criteria include covid-19 patients admitted to Ardabil hospitals in the northwest of Iran 2022 with a definite diagnosis (definite diagnosis of covid-19 disease by a specialist doctor and PCR + test), willingness to cooperate, at least 3 months and a maximum of 9 months have passed since at the time of discharge, the patients were alert, able to understand Farsi language, and completed the research ethics form. The exclusion criteria were the death of the patient, lack of access, diagnosis of physical and mental diseases that justify chronic fatigue in patients (infectious diseases, thyroid, depression, psychosis, etc.).

80% response rate; 340 patients

Demographic information questionnaire: consisting of 25 questions such as gender, age, weight, height, level of education, occupation, marriage, number of family members, way of life, economic status of the family, history of chronic illness, history of drug use, history of smoking, history of drug and psychoactive use, History of alcohol consumption, hospitalization history, duration of hospitalization, blood oxygen saturation level, examination of symptoms of shortness of breath, pain, fatigue, memory and concentration disorders.

"Chalder Chronic Fatigue Questionnaire"
14 question, 0 to 3 Likart, range 0 to 42

CFS is a reliable and valid tool that can be used in different populations to assess fatigue (internal consistency α = 0.863 and test-retest reliability ICC = 0.76) (20). Validity and reliability of the instrument have been confirmed in the study of the instrument designer (19). This tool has been psychometrically evaluated in Iran by Rahimian and internal consistency has been reported with Cronbach's alpha of 0.91(21).

Yeah right - check out commentary elsewhere on the forum if you aren't sure why I am so dismissive of the Chalder Fatigue Questionnaire.

 

[Hutan]

Results

Among the 422 cases of patients who were randomly selected, 340 people agreed to cooperate (RR = 80.56). The results showed that 51.8% of the examined patients were female and 36.5% of them were illiterate. Of them, 6.5% had a history of smoking and 80.6% had a history of chronic disease. The mean age of patients was 60.18 ± 19.5 years and the mean length of hospital stay was 6.70 ± 2.59 days.

Not quite sure how George Monbiot and his ilk have managed to spread the meme of Long Covid to these people...

Although that easy jibe aside, surely most of these people don't have ME/CFS, or CFS/ME? Average age 60 years, 84% from an "unfavourable" economic situation, 81% with an existing chronic disease, and 100% had been hospitalised with the chronic infection. The collection of symptoms 3 months following hospitalisation does not seem to ask for new symptoms. For example over 99% of the sample had chronic pain, but what percentage of them had chronic pain before hospitalisation for Covid-19? And how many of them had obvious tissue damage as a result of their Covid illness (over 14% had mechanical ventilation)?

They report that 13% of the respondents scored below the cutoff score on the Chalder Fatigue Questionnaire. (This survey did ask if people were more fatigued than before). I'm surprised it was not more.

The prevalence of chronic fatigue was higher in women (%13) than in men (%12.3) and this difference was statistically significant (P < 0.04).

This finding, which was reported in the abstract, is what motivated me to read this paper. It's ridiculous to make a big deal of that difference. A P of 0.04 is barely significant, and 13% and 12.3% are really not very different.
What's worse, it's not even clear if the percentage was higher in men or women. Look at Table 5!



Table 5 suggests that the incidence of chronic fatigue was marginally higher in males, not females. Argh.

The abstract says '72% of the patients were female'. I have no idea how they got that figure or what 'patients' means here (respondents to the survey? respondents who met the CFQ criteria for chronic fatigue?). I haven't looked hard, but none of the numbers obviously result in 72% female.

 

[Hutan]

Ok, the discussion

Regarding the signs and symptoms of covid-19 in our study, the most common symptom was chronic pain and about 54% of the participants reported shortness of breath.

They say that this is different to another study that found fatigue was the most reported symptom. But, as I noted, this is ridiculous, because there was no accounting for pre-Covid symptoms, and no effort made to separate out people who had obviously been damaged by their severe Covid-19 infection.

This study found that 12.64% of patients experienced various fatigue levels. • Although the global prevalence (CFS/ME) is reported to be 1 to 2% (24). Contrary to the findings of our study, other studies have reported a prevalence of 43–45% (CFS/ME) in patients with covid-19(11, 25).

But earlier in the paper they said

Chronic fatigue is a debilitating chronic disease with a global prevalence of 0.3 to 0.8% (13).

That makes no sense at all. And that's just the start of the problems with those sentences. CFS/ME is not the same as people scoring less than 22 on the Chalder Fatigue Questionnaire. The authors seem to have no understanding that ME/CFS or CFS/ME is not a synonym for chronic fatigue.

The results of this study showed that history of previous disease (P = 0.04), history of drug use (P = 0.01), history of smoking (P = 0.04), history of mechanical ventilation (P = 0.05) and Age (P = 0.001) is a risk factor associated with chronic fatigue.

Well yes, but... Take smoking. 6 smokers had chronic fatigue, 27% of the smokers. 37 non-smokers had chronic fatigue, 12% of the non-smokers. And the P was barely significant. The sample is too small to say reliably. And this tells us nothing about risk factors for ME/CFS.

The prevalence of chronic fatigue and fatigue scores were higher in women than in men. Contrary to the findings of our study, in different studies gender (female gender) was associated with an increased risk of CFS/ME (26, 30, 33). CFS/ME is approximately 1.5 to 2 times more common in women than in men (36).

How muddled is that? The prevalence of chronic fatigue that they found was about the same in males and females. And yet they start out with a sentence suggesting that they found a higher prevalence in women. And then in the second sentence they say that their study had a different result to studies that found being female was a risk factor for CFS/ME. And in teh third sentence they say unequivocally and with no discussion of why they found otherwise, that CFS/ME is more common in women than men. and that is all they say about sex differences in the Discussion. But, in the abstract, they say

Therefore, the implementation of standardized measures for the screening of chronic fatigue after covid-19 and planning by the health staff in order to help these patients especially among female patients Seems necessary.

 

[Hutan]

Conclusion

The results showed that some patients with Covid-19 suffer from chronic fatigue after being discharged from the hospital. Therefore, considering the significant negative consequences caused by this syndrome, it is recommended that health policy makers take measures to reduce the adverse effects of this syndrome by creating programs to support long-term Covid-19 patients.

Heaven help the people of Northwest Iran if this paper is an indication of the quality of thinking that will go into the creation of programs to support long-term Covid-19 patients. I'm sorry to be so blunt, but the paper is terrible. I appreciate the concern for patients that does come through in this paper, but the authors desperately need more information about ME/CFS before they attempt to treat people with chronic fatigue.

 

[Hutan]

I sincerely do not understand how people, who come across as well-meaning, can produce such a problematic paper with so many errors in internal inconsistencies.

 

[hotblack]

Peng Fei Sun set al.'s meta-analysis analysis

Its analysis all the way down…

 

[hotblack]

It’s not all bad…

The exclusion criteria were the death of the patient,

More seriously, it does seem very muddled on what the conditions it’s trying to discuss are. I appreciated your commentary though @Hutan