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. 2022 Oct 21;26:322. doi: 10.1186/s13054-022-04203-w

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© The Author(s) 2022

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

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Fig. 3 — A To validate the findings the same analysis was performed in the Biobanque Québécoise de la COVID-19 (BQC19) (A). Out of a total of 3768 included patients, 1637 had plasma urea analyzed at some point during their ICU stay and could be used to analyze the aestivation response through estimated osmolality (eOSM). Out of these 872 patients filled out questionnaires on remaining symptoms. B, C The validation cohort recapitulates the aestivation response for the ionic osmolytes (B), and the organic osmolytes (C). Pearson regression line with p value and R² for the correlation. D,E,F: As in the Pronmed cohort maximum dehydration was higher in more severely ill COVID-19 patients for the outcomes acute kidney injury (AKI, D), need for invasive mechanical ventilation (IMV, E), and hospital mortality (F). Student’s T-test was used to test for chance difference. G, H, I Finally, the association of maximal dehydration with physical symptoms after 3–6 months was reproduced (G). In addition, an association was seen for mental long-COVID in the BQC19 cohort (H). Student’s T-test was used to test for chance difference. The analysis adjusted for sex, age and disease severity using ICU-admission reproduces the substantially greater effect eOSM has on physical long-COVID than on mental long-COVID, although both show significant effect (I)