Cognitive concerns are a risk factor for mortality in people with HIV and coronavirus disease 2019.
Cognitive concerns are a risk factor for mortality in people with HIV and coronavirus disease 2019.
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DOI：
10.1097/qad.0000000000003595
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发表时间：
2023-08-01
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影响因子：
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中科院分区：
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支持痴呆症作为COVID-19死亡率风险因素的数据依赖于ICD-10编码，但近40%的可能患有痴呆症的个体缺乏正式诊断。艾滋病毒感染者（PWH）的痴呆症编码尚未建立，其依赖性可能会影响风险评估。这项对SARS-CoV-2聚合酶链反应阳性的PWH的回顾性队列分析包括与非HIV感染者（PWoH）的比较，按年龄、性别、种族和邮政编码匹配。主要暴露是痴呆诊断（按ICD-10编码）和认知问题（定义为在对电子健康记录的记录进行临床审查后，在COVID-19诊断前12个月内可能出现认知障碍）。Logistic回归模型评估了痴呆和认知问题对死亡几率的影响（OR [95%置信区间]）;模型根据VACS指数2.0进行了调整。在14，129名SARS-CoV-2感染患者中确定了64名PWH，并与463名PWO H相匹配。与PWoH相比，PWH的痴呆患病率（15.6% vs. 6%，p=0.01）和认知问题患病率（21.9% vs. 15.8%，p=0.04）更高。PWH组死亡率明显高于PWH组（P<0.01）。校正VACS指数2.0后，痴呆（2.4 [1.0-5.8]，p=0.05）和认知问题（2.4 [1.1-5.3]，p=0.03）与死亡几率增加相关。在PWH中，认知问题与死亡之间的相关性趋于统计学显著性（3.92 [0.81-20.19]，p=0.09）;与痴呆无关。认知状态评估对于COVID-19的护理非常重要，尤其是在PWH中。更大规模的研究应该验证研究结果，并确定具有既存认知缺陷的PWH的长期COVID-19后果。认知问题、痴呆和VACS指数2.0评分导致COVID-19死亡风险增加。PWH的死亡率更高，死于COVID-19的年龄比没有艾滋病毒的患者更小，即使调整了年龄，性别和邮政编码。
Data supporting dementia as a risk factor for COVID-19 mortality relied on ICD-10 codes, yet nearly 40% of individuals with probable dementia lack a formal diagnosis. Dementia coding is not well-established for people with HIV (PWH), and its reliance may affect risk assessment. This retrospective cohort analysis of PWH with SARS-CoV-2 polymerase chain reaction positivity includes comparisons to people without HIV (PWoH), matched by age, sex, race, and zipcode. Primary exposures were dementia diagnosis, by ICD-10 codes, and cognitive concerns, defined as possible cognitive impairment up to 12 months before COVID-19 diagnosis after clinical review of notes from the electronic health record. Logistic regression models assessed the effect of dementia and cognitive concerns on odds of death (OR [95% confidence interval]); models adjusted for VACS Index 2.0. Sixty-four PWH were identified out of 14,129 patients with SARS-CoV-2 infection and matched to 463 PWoH. Compared to PWoH, PWH had a higher prevalence of dementia (15.6% vs. 6%, p=0.01) and cognitive concerns (21.9% vs. 15.8%, p=0.04). Death was more frequent in PWH (p<0.01). Adjusted for VACS Index 2.0, dementia (2.4 [1.0–5.8], p=0.05) and cognitive concerns (2.4 [1.1–5.3], p=0.03) were associated with increased odds of death. In PWH, the association between cognitive concern and death trended towards statistical significance (3.92 [0.81–20.19], p=0.09); there was no association with dementia. Cognitive status assessments are important for care in COVID-19, especially among PWH. Larger studies should validate findings and determine long-term COVID-19 consequences in PWH with pre-existing cognitive deficits. Cognitive concerns, dementia, and VACS Index 2.0 score contribute to increase risk of mortality from COVID-19. PWH have higher mortality rates and die at a younger age from COVID-19 than patients without HIV, even when adjusting for age, sex, and zip code.
DOI：
10.1093/infdis/jiaa663
发表时间：
2021-01-04
期刊：
The Journal of infectious diseases
影响因子：
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作者：
Sun H;Jain A;Leone MJ;Alabsi HS;Brenner LN;Ye E;Ge W;Shao YP;Boutros CL;Wang R;Tesh RA;Magdamo C;Collens SI;Ganglberger W;Bassett IV;Meigs JB;Kalpathy-Cramer J;Li MD;Chu JT;Dougan ML;Stratton LW;Rosand J;Fischl B;Das S;Mukerji SS;Robbins GK;Westover MB
通讯作者：
Westover MB