Frequent neurologic manifestations and encephalopathy-associated morbidity in Covid-19 patients.
Frequent neurologic manifestations and encephalopathy-associated morbidity in Covid-19 patients.
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DOI：
10.1002/acn3.51210
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发表时间：
2020-11
影响因子：
5.3
通讯作者：
Koralnik IJ
中科院分区：
文献类型：
--
作者：
Liotta EM;Batra A;Clark JR;Shlobin NA;Hoffman SC;Orban ZS;Koralnik IJ
COVID-19可能涉及包括神经系统在内的多个器官。我们试图描述新冠肺炎住院患者的神经系统表现、其风险因素和相关结局。我们检查了伊利诺伊州芝加哥一家医院网络内确诊的509名连续患者的神经系统表现。我们比较了有和没有神经系统表现的患者的Covid-19严重程度和结局。我们还使用二元逻辑回归确定了任何神经系统表现、脑病和功能结局的独立预测因子。215例（42.2%）患者在新冠肺炎发病时、319例（62.7%）患者住院时以及419例（82.3%）患者在病程中的任何时间均存在神经系统表现。最常见的神经系统表现为肌痛（44.8%）、头痛（37.7%）、脑病（31.8%）、头晕（29.7%）、味觉障碍（15.9%）和嗅觉丧失（11.4%）。卒中、运动障碍、运动和感觉缺陷、共济失调和癫痫发作不常见（各占患者的0.2%至1.4%）。134例患者（26.3%）发生了需要机械通气的严重呼吸系统疾病。发生任何神经系统表现的独立风险因素是严重的Covid-19（OR 4.02; 95% CI 2.04-8.89; P < 0.001）和年轻（OR 0.982; 95% CI 0.968-0.996; P = 0.014）。在所有患者中，362例（71.1%）出院时功能结局良好（改良兰金量表0-2）。然而，脑病与更差的功能结局（OR 0.22; 95% CI 0.11-0.42; P < 0.001）和住院30天内更高的死亡率（35例[21.7%] vs. 11例[3.2%]; P < 0.001）独立相关。神经系统表现发生在大多数住院的Covid-19患者中。脑病与发病率和死亡率增加相关，与呼吸道疾病的严重程度无关。
Covid‐19 can involve multiple organs including the nervous system. We sought to characterize the neurologic manifestations, their risk factors, and associated outcomes in hospitalized patients with Covid‐19. We examined neurologic manifestations in 509 consecutive patients admitted with confirmed Covid‐19 within a hospital network in Chicago, Illinois. We compared the severity of Covid‐19 and outcomes in patients with and without neurologic manifestations. We also identified independent predictors of any neurologic manifestations, encephalopathy, and functional outcome using binary logistic regression. Neurologic manifestations were present at Covid‐19 onset in 215 (42.2%), at hospitalization in 319 (62.7%), and at any time during the disease course in 419 patients (82.3%). The most frequent neurologic manifestations were myalgias (44.8%), headaches (37.7%), encephalopathy (31.8%), dizziness (29.7%), dysgeusia (15.9%), and anosmia (11.4%). Strokes, movement disorders, motor and sensory deficits, ataxia, and seizures were uncommon (0.2 to 1.4% of patients each). Severe respiratory disease requiring mechanical ventilation occurred in 134 patients (26.3%). Independent risk factors for developing any neurologic manifestation were severe Covid‐19 (OR 4.02; 95% CI 2.04–8.89; P < 0.001) and younger age (OR 0.982; 95% CI 0.968–0.996; P = 0.014). Of all patients, 362 (71.1%) had a favorable functional outcome at discharge (modified Rankin Scale 0–2). However, encephalopathy was independently associated with worse functional outcome (OR 0.22; 95% CI 0.11–0.42; P < 0.001) and higher mortality within 30 days of hospitalization (35 [21.7%] vs. 11 [3.2%] patients; P < 0.001). Neurologic manifestations occur in most hospitalized Covid‐19 patients. Encephalopathy was associated with increased morbidity and mortality, independent of respiratory disease severity.
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DOI：
10.1056/nejmoa1301372
发表时间：
2013-10-03
期刊：
The New England journal of medicine
影响因子：
--
作者：
Pandharipande PP;Girard TD;Jackson JC;Morandi A;Thompson JL;Pun BT;Brummel NE;Hughes CG;Vasilevskis EE;Shintani AK;Moons KG;Geevarghese SK;Canonico A;Hopkins RO;Bernard GR;Dittus RS;Ely EW;BRAIN-ICU Study Investigators
通讯作者：
BRAIN-ICU Study Investigators
影响因子：
9.9
作者：
Romero-Sanchez, Carlos Manuel;Diaz-Maroto, Inmaculada;Segura, Tomas
通讯作者：
Segura, Tomas
影响因子：
8.8
作者：
Devlin, John W.;Skrobik, Yoanna;Alhazzani, Waleed
通讯作者：
Alhazzani, Waleed
影响因子：
39
作者：
Gupta, Shruti;Hayek, Salim S.;Leaf, David E.
通讯作者：
Leaf, David E.
影响因子：
15.9
作者：
Bekerman, Elena;Neveu, Gregory;Einav, Shirit
通讯作者：
Einav, Shirit