Encephalopathy at admission predicts adverse outcomes in patients with SARS-CoV-2 infection.
Encephalopathy at admission predicts adverse outcomes in patients with SARS-CoV-2 infection.
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DOI：
10.1111/cns.13687
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发表时间：
2021-10
影响因子：
5.5
通讯作者：
Yang L
中科院分区：
文献类型：
--
作者：
Tang L;Liu S;Xiao Y;Tran TML;Choi JW;Wu J;Halsey K;Huang RY;Boxerman J;Patel SH;Kung D;Liu R;Feldman MD;Danoski DD;Liao WH;Kasner SE;Liu T;Xiao B;Zhang PJ;Reznik M;Bai HX;Yang L
确定入院时的神经系统症状是否可以预测严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) 患者的不良后果。回顾性分析了美国一家大型医疗中心 1053 例实验室确诊感染 SARS-CoV-2 的连续住院患者的电子病历。通过计算曲线下面积 (AUC) 和一致性指数 (C-index) 进行单变量和多变量 Cox 回归分析。根据生存统计数据，根据脑病的存在及其严重程度将患者分为亚组。在敏感性分析中，分别考虑轻度/中度和重度脑病（定义为昏迷）的患者。在 1053 名患者中（平均年龄 52.4 岁，48.0% 为男性 [n = 505]），35.1% (n = 370) 入院时出现神经系统表现，其中 10.3% (n = 108) 患有脑病。在多变量 Cox 回归中，脑病是死亡的独立预测因素（风险比 [HR] 2.617，95% 置信区间 [CI] 1.481–4.625）。将脑病添加到包含其他不良结果预测因子的多变量模型中，增加了 AUC（死亡率：0.84-0.86，通气/重症监护病房 [ICU]：0.76-0.78）和 C 指数（死亡率：0.78 至 0.81，通气/ICU：0.85-0.86）。在敏感性分析中，根据入院时严重脑病 (n = 15) 与轻度/中度脑病 (n = 93) 与无脑病 (n = 945) 的死亡率和通气/ICU 风险分层生存曲线具有区分性 (p < 0.001)。入院时的脑病预示着 SARS-CoV-2 感染后期进展至死亡，这可能对临床实践中的风险分层具有重要意义。严重急性呼吸综合征冠状病毒2感染患者的神经系统表现的患病率很高，包括头痛、脑病、头晕、味觉和嗅觉障碍。入院时患有脑病的患者可预测 SARS-CoV-2 感染后期进展至死亡和机械通气/入住 ICU，这可能对临床实践中的风险分层具有重要意义。
To determine if neurologic symptoms at admission can predict adverse outcomes in patients with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). Electronic medical records of 1053 consecutively hospitalized patients with laboratory‐confirmed infection of SARS‐CoV‐2 from one large medical center in the USA were retrospectively analyzed. Univariable and multivariable Cox regression analyses were performed with the calculation of areas under the curve (AUC) and concordance index (C‐index). Patients were stratified into subgroups based on the presence of encephalopathy and its severity using survival statistics. In sensitivity analyses, patients with mild/moderate and severe encephalopathy (defined as coma) were separately considered. Of 1053 patients (mean age 52.4 years, 48.0% men [n = 505]), 35.1% (n = 370) had neurologic manifestations at admission, including 10.3% (n = 108) with encephalopathy. Encephalopathy was an independent predictor for death (hazard ratio [HR] 2.617, 95% confidence interval [CI] 1.481–4.625) in multivariable Cox regression. The addition of encephalopathy to multivariable models comprising other predictors for adverse outcomes increased AUCs (mortality: 0.84–0.86, ventilation/ intensive care unit [ICU]: 0.76–0.78) and C‐index (mortality: 0.78 to 0.81, ventilation/ICU: 0.85–0.86). In sensitivity analyses, risk stratification survival curves for mortality and ventilation/ICU based on severe encephalopathy (n = 15) versus mild/moderate encephalopathy (n = 93) versus no encephalopathy (n = 945) at admission were discriminative (p < 0.001). Encephalopathy at admission predicts later progression to death in SARS‐CoV‐2 infection, which may have important implications for risk stratification in clinical practice. Patients with severe acute respiratory syndrome coronavirus 2 infection have a high prevalence of neurologic manifestations, including headache, encephalopathy, dizziness, taste, and smell impairment. Patients with encephalopathy at admission predict later progression to death and mechanical ventilation/ICU admission in SARS‐CoV‐2 infection, which may have important implications for risk stratification in clinical practice.
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