A New England COVID-19 Registry of Patients With CNS Demyelinating Disease: A Pilot Analysis.
A New England COVID-19 Registry of Patients With CNS Demyelinating Disease: A Pilot Analysis.
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DOI：
10.1212/nxi.0000000000001046
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发表时间：
2021-09
期刊：
影响因子：
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通讯作者：
Sloane JA
中科院分区：
文献类型：
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作者：
Money KM;Mahatoo A;Samaan S;Anand P;Baber U;Bailey M;Bakshi R;Bouley A;Bower A;Cahill J;Houtchens M;Katz J;Lathi E;Levit E;Longbrake EE;McAdams M;Napoli S;Raibagkar P;Wade P;Sloane JA
我们试图确定患有CNS脱髓鞘疾病（如MS）的患者发生2019年严重冠状病毒病（COVID-19）感染需要住院的风险，以及增加严重感染风险的因素，以指导COVID-19大流行期间患者护理的决策。对来自美国东北部的91名确诊或疑似COVID-19感染患者的试点队列进行了分析，以表征患者风险因素和与COVID-19感染严重程度增加相关的因素。使用Mann-Whitney U检验或方差分析（连续变量）和χ2或Fisher精确检验（名义变量）进行单变量方差分析。单因素和逐步多因素logistic回归确定了与住院相关的临床特征或症状。我们的队列显示了27.5%的住院率和4.4%的病死率。COVID-19感染前计时25英尺步行的表现、年龄、合并症数量以及出现恶心/呕吐症状和神经系统症状（例如，感觉异常或虚弱）是住院的独立危险因素，而头痛预示着不住院的轻度病程。在COVID-19感染期间，住院患者的绝对淋巴细胞计数较低。使用疾病缓解治疗不会增加住院风险，但与呼吸支持需求增加相关。我们队列中的病死率和住院率与该地区MS和普通人群COVID-19队列中的病死率和住院率相似。住院与残疾、年龄和合并症的增加相关，但与疾病修饰治疗的使用无关。
We sought to define the risk of severe coronavirus disease 2019 (COVID-19) infection requiring hospitalization in patients with CNS demyelinating diseases such as MS and the factors that increase the risk for severe infection to guide decisions regarding patient care during the COVID-19 pandemic. A pilot cohort of 91 patients with confirmed or suspected COVID-19 infection from the Northeastern United States was analyzed to characterize patient risk factors and factors associated with an increased severity of COVID-19 infection. Univariate analysis of variance was performed using the Mann-Whitney U test or analysis of variance for continuous variables and the χ2 or Fisher exact test for nominal variables. Univariate and stepwise multivariate logistic regression identified clinical characteristics or symptoms associated with hospitalization. Our cohort demonstrated a 27.5% hospitalization rate and a 4.4% case fatality rate. Performance on Timed 25-Foot Walk before COVID-19 infection, age, number of comorbidities, and presenting symptoms of nausea/vomiting and neurologic symptoms (e.g., paresthesia or weakness) were independent risk factors for hospitalization, whereas headache predicted a milder course without hospitalization. An absolute lymphocyte count was lower in hospitalized patients during COVID-19 infection. Use of disease-modifying therapy did not increase the risk of hospitalization but was associated with an increased need for respiratory support. The case fatality and hospitalization rates in our cohort were similar to those found in MS and general population COVID-19 cohorts within the region. Hospitalization was associated with increased disability, age, and comorbidities but not disease-modifying therapy use.