Neurological symptoms in Covid-19 patients in the emergency department.
Neurological symptoms in Covid-19 patients in the emergency department.
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DOI：
10.1002/brb3.2058
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发表时间：
2021-04
影响因子：
3.1
通讯作者：
Arenillas JF
中科院分区：
文献类型：
--
作者：
García-Azorín D;Trigo J;Martínez-Pías E;Hernández-Pérez I;Valle-Peñacoba G;Talavera B;Simón-Campo P;de Lera M;Chavarría-Miranda A;López-Sanz C;Gutiérrez-Sánchez M;Martínez-Velasco E;Pedraza M;Sierra Á;Gómez-Vicente B;Guerrero Á;Arenillas JF
2019冠状病毒病（Covid-19）可能会出现神经系统症状。我们的目的是评估他们在急诊科（艾德）就诊时的频率及其对预后的影响。回顾性队列研究，包括2020年3月8日至4月11日期间的所有连续住院病例。通过聚合酶链反应试验和/或血清学证实了Covid-19诊断。我们比较了入院时有和无神经系统症状的患者的人口统计学、临床表现、异常实验室检查值的频率和类型。我们通过考克斯回归对数秩检验分析了与院内全因死亡率相关的变量。我们纳入了576例住院患者，250例（43.3%）女性，年龄67.2岁。在艾德访视时，320例（55.6%）描述了神经系统症状，包括嗅觉丧失（146例，25.3%）、肌痛（139例，24.1%）、头痛（137例，23.8%）和精神状态改变（98例，17.0%）。198例（54.2%）患者在出现症状的第一天开始出现神经系统症状。有神经系统症状的患者迟至艾德就诊（7.9 vs. 6.6天，p = .019）。只有4例（0.6%）病例没有典型的COVID-19全身症状，只有6例（1.9%）实验室结果正常，灵敏度分别为98.7%（95%置信区间（CI）：96.6%-99.6%）和98.1%（95% CI：95.7%-99.2%）。在死亡率预测因子的多变量考克斯回归分析中，嗅觉丧失（HR：0.358，95%CI：0.140-0.916）和精神状态改变（HR：1.867，95%CI：1.162-3.001）具有显著性。神经系统症状是最常见的肺外症状。在艾德访视时，有一半的Covid-19患者存在这种情况。入院时嗅觉缺失是住院死亡率较低的独立预测因素，入院时精神状态改变可预测住院死亡率。半数新冠肺炎患者在出现艾德时描述了神经系统症状。艾德出现神经症状是死亡率的独立预测因素。精神状态改变的患者死亡率更高，死亡时间更早，嗅觉丧失的患者死亡风险更低。
Coronavirus disease 2019 (Covid‐19) might present neurological symptoms. We aimed to evaluate the frequency of them at the moment of emergency department (ED) visit and their impact in the prognosis. Retrospective cohort study including all consecutive hospitalized cases between March 8th and April 11th, 2020. Covid‐19 diagnosis was confirmed by polymerase chain reaction test and/or serology. We compared, in patients with and without neurological symptoms on admission, demographic, clinical presentation, and frequency and type of abnormal laboratory values. We analyzed the variables that were associated with in‐hospital all‐cause mortality by Cox‐regression log‐rank test. We included 576 hospitalized patients, 250 (43.3%) female, aged 67.2 years. At the moment of ED visit, 320 (55.6%) described neurological symptoms, including anosmia (146, 25.3%), myalgia (139, 24.1%), headache (137, 23.8%), and altered mental status (98, 17.0%). Neurological symptoms started the first symptomatic day in 198 (54.2%) cases. Patients with neurological symptoms presented later to the ED (7.9 versus. 6.6 days, p = .019). Only four (0.6%) cases had no typical Covid‐19 general symptoms, and only six (1.9%) had a normal laboratory results, for a sensitivity of 98.7% (95% confidence interval (CI): 96.6%–99.6%) and 98.1% (95% CI: 95.7%–99.2%), respectively. In the multivariate Cox‐regression of mortality predictors, anosmia (HR: 0.358, 95%CI: 0.140–0.916) and altered mental status (HR: 1.867, 95%CI: 1.162–3.001) were significant. Neurological symptoms were the most frequent extrapulmonary symptoms. They were present in half of the Covid‐19 patients at the time of the ED visit. Anosmia on admission was an independent predictor of lower in‐hospital mortality and altered mental status on admission predicted in‐hospital mortality. Half of the Covid‐19 patients described neurological symptoms at the moment of ED presentation. The presence of neurological symptoms at the moment of ED presentation was an independent predictor of mortality. Patients with altered mental status died more and earlier, and patients with anosmia had a lower risk of mortality.
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DOI：
10.15557/pimr.2020.0003
发表时间：
2020-01-01
影响因子：
3.6
作者：
通讯作者：
--
影响因子：
168.9
作者：
Huang, Chaolin;Wang, Yeming;Cao, Bin
通讯作者：
Cao, Bin
影响因子：
39
作者：
Wu, Chaomin;Chen, Xiaoyan;Song, Yuanlin
通讯作者：
Song, Yuanlin
影响因子：
7.4
作者：
Trigo, Javier;Garcia-Azorin, David;Guerrero, Angel L.
通讯作者：
Guerrero, Angel L.
影响因子：
5
作者：
Belvis, Robert
通讯作者：
Belvis, Robert