Registry reports in COVID-19 patients: juggling with big data, poor data, and no data
Authors: John Mackay Søfteland, Kristjan Karason, Jesper Magnusson, Andreas Schult, Marie Felldin, Vanda Friman, Mihai Oltean
Journal: Kidney International (2020)

We read with great interest the recent paper by Caillard et al.,1Caillard S. Anglicheau D. Matignon M. et al.An initial report from the French SOT COVID Registry suggests high mortality due to COVID-19 in recipients of kidney transplants.Kidney Int. 2020; 98: 1549-1558Abstract Full Text Full Text PDF PubMed Scopus (197) Google Scholar which is an interesting addition to the burgeoning coronavirus disease 2019 (COVID-19) literature.2Oltean M. Søfteland J.M. Bagge J. et al.Covid-19 in kidney transplant recipients: a systematic review of the case series available three months into the pandemic.Infect Dis (Lond). 2020; 52: 830-837Crossref PubMed Scopus (31) Google Scholar However, we noted a discrepancy between the 426 kidney transplant recipients reported to the registry and the 279 cases presented, which corresponds to one-third of all patients. These available but unreported cases may have significantly impacted the results, but the authors neither explain this omission nor acknowledge it as a limitation. In addition, the authors' choice of the term "severe" to collectively describe a broad group of patients requiring admission to the intensive care unit, patients requiring mechanical ventilation, as well as deceased patients would be considered a methodological error by intensivists. It would have been more appropriate to stratify the patients according to more detailed, objective criteria.3National Institutes of HealthClinical presentation of people with SARS-CoV-2 Infection.https://www.covid19treatmentguidelines.nih.gov/overview/management-of-covid-19/Google Scholar These flaws likely stem from the limitations of registries, which are often based on voluntary contributions and frequently lack auditing procedures and links to governmental, automatic databases. Although patient registries are essential instruments for medical community, their value during challenging times may be questionable as data are rapidly evolving, and individuals tasked with collecting and reporting data are overwhelmed by their daily clinical duties. In these rapidly shifting times, we urge the editors to weigh the temptation of registry studies against their relevance, completeness, and quality. Smaller single-center or multicenter studies with targeted data collection may be better suited to answer a specific research question and should not be undervalued because of their lower statistical power. An initial report from the French SOT COVID Registry suggests high mortality due to COVID-19 in recipients of kidney transplantsKidney InternationalVol. 98Issue 6PreviewNotwithstanding the ongoing coronavirus disease-2019 (Covid-19) pandemic, information on its clinical presentation and prognosis in recipients of a kidney transplant remain scanty. The aim of this registry-based observational study was to explore characteristics and clinical outcomes of recipients of kidney transplants included in the French nationwide Registry of Solid Organ Transplant Recipients with Covid-19. Covid-19 was diagnosed in symptomatic patients who had a positive PCR assay for SARS-CoV-2 or having typical lung lesions on imaging. Full-Text PDF The authors replyKidney InternationalVol. 98Issue 6PreviewWe thank Søfteland et al.1 for their interest in our registry based-study focusing on coronavirus disease 2019 (COVID-19) in kidney transplant recipients.2 They lament that a discrepancy exists between the number of patients reported in the introductory section (n = 426) and those included in the final analysis (n = 279). However, the 147 excluded patients had <30 days of follow-up at the time of the report (April 2020), and their data were incomplete. Their inclusion would have resulted in biased results, especially in terms of COVID-19–related mortality. Full-Text PDF