Clinical features and cognitive sequelae in COVID-19: a retrospective study on N=152 patients.
Clinical features and cognitive sequelae in COVID-19: a retrospective study on N=152 patients.
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DOI：
10.1007/s10072-021-05744-8
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发表时间：
2022-01
期刊：
影响因子：
--
通讯作者：
Pistarini C
中科院分区：
文献类型：
--
作者：
Manera MR;Fiabane E;Pain D;Aiello EN;Radici A;Ottonello M;Padovani M;Wilson BA;Fish J;Pistarini C
新型人类冠状病毒（SARS-CoV-2）表现出嗜神经性，并系统性影响中枢神经系统（CNS）。认知缺陷确实被报道为SARS-CoV-2感染的短期和长期后遗症。然而，这些障碍与背景/疾病相关的临床特征之间的联系仍然难以捉摸。这项工作旨在通过控制发病前/当前认知缺陷的危险因素，探索感染后认知状态与临床/治疗结果的关系。回顾性评估N=152例COVID-19患者的认知测量（迷你精神状态检查，MMSE）与疾病严重程度、重症监护病房（ICU）入院、类固醇治疗和其他病毒/细菌感染发生的关系，通过控制认知缺陷的远程/近期/COVID-19相关危险因素（危险与非危险：神经+与神经-）。描述性地说，MMSE表现受损在轻至中度患者中非常普遍（26.3%）。在分离危险因素和年龄时，icu住院患者在MMSE上的错误率低于未住院患者（p= 0.021），后者对表现有负面影响。当仅针对神经患者时，类固醇治疗似乎可以改善其他感染患者的MMSE评分（p= 0.025）。COVID-19的认知后遗症可能是背景/临床发病前特征与疾病相关/介入性程序和结果之间复杂的相互作用造成的。需要辅助通气但未入住ICU的轻度至中度患者更有可能患有认知障碍，尽管其病因尚不明确。
The novel human coronavirus (SARS-CoV-2) shows neurotropism and systemically affects the central nervous system (CNS). Cognitive deficits have been indeed reported as both short- and long-term sequelae of SARS-CoV-2 infection. However, the association between these disturbances and background/disease-related clinical features remains elusive. This work aimed at exploring how post-infective cognitive status relates to clinical/treatment outcomes by controlling for premorbid/current risk factors for cognitive deficits. Cognitive measures (Mini-Mental State Examination, MMSE) of N=152 COVID-19 patient were retrospectively assessed in relation to disease severity, intensive care unit (ICU) admission, steroidal treatment, and occurrence of other viral/bacterial infections by controlling for remote/recent/COVID-19-related risk factors for cognitive deficits (at-risk vs. not-at-risk: Neuro+ vs. Neuro−). Descriptively, impaired MMSE performances were highly prevalent in mild-to-moderate patients (26.3%). ICU-admitted patients made less errors (p=.021) on the MMSE than those not admitted when partialling out risk factors and age—the latter negatively influencing performances. When addressing Neuro− patients only, steroidal treatment appears to improve MMSE scores among those suffering from other infections (p=.025). Cognitive sequelae of COVID-19 are likely to arise from a complex interplay between background/clinical premorbid features and disease-related/interventional procedures and outcomes. Mild-to-moderate patients requiring assistive ventilation who however are not admitted to an ICU are more likely to suffer from cognitive deficits—despite their etiology remaining elusive.
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