Introduction: Long-COVID-19 impacts health-related quality of life (HR-QoL) but data is scarce. The aim of this study was to describe and prospectively assess the prevalence and risk factors for long-COVID-19 after hospital discharge, and to evaluate its impact on patient HR-QoL.Material and Methods: Single-centre longitudinal study including all COVID-19 patients discharged between December 2020 and February 2021. Patients were contacted remotely at three, six and nine months. Data were collected as follows: 1) Long-COVID-19 symptoms were self-reported; 2) HRQoL were assessed using the 3-level EuroQoL-5D (EQ-5D-3L) questionnaire. Pregnant women, demented, bedridden, and non-Portuguese-speaking patients were excluded.Results: The three-, six- and nine-month assessments were completed by 152, 117 and 110 patients (median age: 61 years; male sex: 56.6%). Long-COVID-19 (≥ 1 symptom) was reported by 66.5%, 62.4% and 53.6% of patients and HR-QoL assessment showed impairment of at least some domain in 65.8%, 69.2% and 55.4% of patients at three, six and nine months, respectively. Fatigue was the most common long-COVID-19 symptom. Anxiety/depression domain was the most frequently affected in all three time-points, peaking at six months (39%), followed by pain/discomfort and mobility domains. Long-COVID-19 was associated with the impairment of all EQ-5D-3L domains except for self-care domain at each time-point. Neither intensive care unit admission nor disease severity were associated with long-COVID-19 nor with impairment of any EQ-5D-3L domain. After adjusting for sex, age, frailty status, and comorbid conditions, long-COVID-19 remained significantly associated with HR-QoL impairment at three (OR 4.27, 95% CI 1.92 – 9.52, p < 0.001), six (OR 3.46, 95% CI 1.40 – 8.57, p = 0.007) and nine months (OR 4.13, 95% CI 1.62 – 10.55, p = 0.003) after hospital discharge. In alongitudinal analysis, patients reporting long-COVID-19 at three months had an EQ-5D-3L index value decreased by 0.14 per visit (p < 0.001) compared to those without long-COVID-19 and both groups had a non-significant change in mean EQ-5D-3L index over the nine-month period (time-point assessment, Z = 0.91, p = 0.364).Conclusion: Clinical sequelae associated with long-COVID-19 can persist for at least nine months after hospital discharge in most patients and can impair long-term HR-QoL in more than half of patients regardless of disease severity, and clinicodemographic characteristics.
Objectives To characterize a LN cohort over 40 years, assessing its evolution, analysing two major outcomes: the development of end-stage renal disease and mortality rates in the first 5 years after LN diagnosis. Methods An observational retrospective study of patients with LN, followed up from 1975 at University College Hospital. Patients were divided into four groups, depending on the decade of LN diagnosis: 1975–1985 (D1), 1986–1995 (D2), 1996–2005 (D3) and 2006–2015 (D4). Comparison between groups was performed with respect to demographic, clinical, serological and histological characteristics and outcome. Results Two hundred and nineteen patients with LN were studied. There was a change in ethnic distribution, with a decreasing proportion of Caucasians (58.6% in D1 to 31.3% in D4, P = 0.018) and increase in African-ancestry (17.2% in D1 to 39.6% in D4, P = 0.040). Serological and histological patterns changed throughout time, with a reduction in class IV nephritis (51.7% in D1 to 27.1% in D4, P = 0.035), and increase in class II nephritis (10% in D2 to 18.8% in D4, P = 0.01) and anti-extractable nuclear antigen antibody positivity (17.2% in D1 to 83.3% in D4, P = 0.0001). The 5-year mortality rates decreased from D1 (24.1%) to D2 (4%), stabilizing for the next 30 years. The 5-year progression to end-stage renal disease remained stable over the decades. Conclusion Despite the changes in treatment of LN in the past 20 years, we have reached a plateau in 5-year mortality and progression to end-stage renal disease rates, suggesting that new therapeutic and management approaches, and strategies to enhance adherence, are needed to improve outcomes further in LN patients.
was measured with both the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and Physician Global Assessment (PGA). Treatment was recorded at every visit.Results aCL IgG >40 and aCL IgA were not associated with disease activity. Hydroxychloroquine reduced the levels of all antibodies, except for IgA aCL. Prednisone reduced aCL IgG but not aCL IgM, aCL IgA >40 or dRVVT (seconds prolongation). Conclusion High titer aCL were not affected by disease activity. Thus these patients are more like 'primary' antiphospholipid patients. Hydroxychloroquine use was associated with reduced lupus anticoagulant (by seconds of prolongation) and reduced titers for most of the isotypes of anticardiolipin. Prednisone did not reduce the seconds of dRVVT prolongation. Anticardiolipin IgA seemed the most resistant to therapy.
Objective To identify clinical and serological features that distinguish patients with systemic lupus erythematosus (SLE) who require single as opposed to repeated rituximab (RTX) cycles. Methods All 175 SLE patients followed-up at University College hospital from 2000 onwards were retrospectively reviewed. They were divided into a one RTX cycle and multiple-cycle groups (2 or more). Patients included had a follow-up of at least 3 years after their first RTX cycle, unless they needed a second infusion sooner. Results 131 patients were included; 44 (33.6%) received one cycle of RTX and 87 (66.4%) received two or more. The former were older at diagnosis (31.4 vs 21 years, p< 0.001) and at first RTX infusion (39.9 vs 29 years, p< 0.001). This group of patients had more organs/systems involved (p= 0.044), more leukopenia, lymphopenia and thrombocytopenia (p= 0.001, <0.0001 and 0.003 respectively) and lower C3 levels (p= 0.035). They also had fewer immunosuppressive (IS) drugs before RTX therapy compared with those who required multiple RTX cycles (p= 0.003). There was no statistical difference in the clinical and serological response after the first RTX cycle between both groups. Furthermore, patients who had received more IS treatments were more likely to require more than one cycle of RTX infusions (p= 0.007). Conclusions RTX is an effective option for SLE patients with severe flares. Patients who received more immunosuppressive drugs are more likely to receive more than one set of RTX infusions. This suggests that RTX is best used for SLE patients with no history of refractory disease.
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