COVID-19 related neuroimaging findings: A signal of thromboembolic complications and a strong prognostic marker of poor patient outcome
COVID-19 related neuroimaging findings: A signal of thromboembolic complications and a strong prognostic marker of poor patient outcome
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DOI：
10.1016/j.jns.2020.116923
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发表时间：
2020-07-15
影响因子：
4.4
通讯作者：
Horwtiz, Leora
中科院分区：
文献类型：
--
作者：
Jain, Rajan;Young, Matthew;Horwtiz, Leora
目的：调查纽约市住院的 COVID-19 患者的神经影像学结果的发生率和范围及其对预后的作用。方法：这是一项回顾性队列研究，对象为 2020 年 3 月 1 日至 2020 年 4 月 13 日期间纽约市一家主要医疗系统（三家医院）收治的 3218 名 COVID-19 确诊患者。临床数据从电子病历中提取，特别是从影像报告中提取所有神经系统症状的数据。四位神经放射科医生评估了所有神经影像学研究中与 COVID-19 相关的急性神经影像学结果。结果：14.1% 的入院 COVID-19 患者进行了神经影像学检查，但这仅占影像学研究总数的 5.5%。急性中风是神经影像学最常见的发现，92.5% 的神经影像学研究呈阳性的患者中出现急性中风，1.1% 的住院 COVID-19 患者中出现急性中风。与未接受神经影像检查的 COVID-19 患者相比，急性大面积缺血性和出血性中风患者的死亡风险（根据年龄、BMI 和高血压进行调整）要高得多。 （LR 的比值比为 6.02；CRR 的风险比为 2.28）。结论：我们的研究表明，急性卒中是住院 COVID-19 患者中最常见的神经影像学表现。检测到急性中风是预后不良的一个强有力的预后标志。我们的研究还强调了这样一个事实：由于多种后勤限制，神经影像学在这些患者中的使用有限。
Objective: To investigate the incidence and spectrum of neuroimaging findings and their prognostic role in hospitalized COVID-19 patients in New York City.Methods: This is a retrospective cohort study of 3218 COVID-19 confirmed patients admitted to a major healthcare system (three hospitals) in New York City between March 1, 2020 and April 13, 2020. Clinical data were extracted from electronic medical records, and particularly data of all neurological symptoms were extracted from the imaging reports. Four neuroradiologists evaluated all neuroimaging studies for acute neuroimaging findings related to COVID-19.Results: 14.1% of admitted COVID-19 patients had neuroimaging and this accounted for only 5.5% of the total imaging studies. Acute stroke was the most common finding on neuro-imaging, seen in 92.5% of patients with positive neuro-imaging studies, and present in 1.1% of hospitalized COVID-19 patients. Patients with acute large ischemic and hemorrhagic stroke had much higher mortality risk adjusted for age, BMI and hypertension compared to those COVID-19 patients without neuroimaging. (Odds Ratio 6.02 by LR; Hazard Ratio 2.28 by CRR).Conclusions: Our study demonstrates acute stroke is the most common neuroimaging finding among hospitalized COVID-19 patients. Detection of an acute stroke is a strong prognostic marker of poor outcome. Our study also highlights the fact there is limited use of neuroimaging in these patients due to multiple logistical constraints.