A Prospective Study of Neurologic Disorders in Hospitalized Patients With COVID-19 in New York City
A Prospective Study of Neurologic Disorders in Hospitalized Patients With COVID-19 in New York City
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DOI：
10.1212/wnl.0000000000010979
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发表时间：
2021-01-26
期刊：
影响因子：
9.9
通讯作者：
Galetta, Steven
中科院分区：
文献类型：
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作者：
Frontera, Jennifer A.;Sabadia, Sakinah;Galetta, Steven
目的确定2019年冠状病毒病患者中明确神经系统诊断的患病率和相关死亡率（COVID-19），我们前瞻性地随访了住院的严重急性呼吸综合征冠状病毒2型（SARS 2）（SARS-CoV-2）阳性患者，并记录新的神经系统疾病和医院结局。对纽约市大都会区实验室确诊的SARS-CoV-2感染的连续住院成人进行观察性研究。新的神经系统疾病的患病率（由神经科医生诊断）被记录，住院死亡率和出院处置之间的COVID-19患者和无神经系统疾病进行了比较。结果4,491例COVID-19住院患者在研究时间范围内，606（13.5%）开发一个新的神经系统疾病的中位数为2天，从COVID-19症状发作。最常见的诊断是中毒/代谢性脑病（6.8%）、癫痫发作（1.6%）、卒中（1.9%）和缺氧/缺血性损伤（1.4%）。没有患者患有能够感染SARS-CoV-2的脑膜炎/脑炎或脊髓病/脊髓炎，18/18份CSF标本的SARS-CoV-2逆转录酶PCR阴性。患有神经系统疾病的患者更常见于老年、男性、白色、高血压、糖尿病、插管，并且具有较高的序贯器官衰竭评估（SOFA）评分（所有p < 0.05）。在调整年龄、性别、SOFA评分、插管、病史、医疗并发症、药物和舒适护理状态后，患有神经系统疾病的COVID-19患者的住院死亡风险增加（风险比[HR] 1.38，95%置信区间[CI] 1.17-1.62，p < 0.001）和出院回家的可能性降低（HR 0.72，95%CI 0.63-0.85，p < 0.001）.结论在13.5%的COVID-19患者中检测到神经系统疾病，并与院内死亡风险增加和出院回家可能性降低相关。许多观察到的神经系统疾病可能是严重全身性疾病的后遗症。
ObjectiveTo determine the prevalence and associated mortality of well-defined neurologic diagnoses among patients with coronavirus disease 2019 (COVID-19), we prospectively followed hospitalized severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive patients and recorded new neurologic disorders and hospital outcomes.MethodsWe conducted a prospective, multicenter, observational study of consecutive hospitalized adults in the New York City metropolitan area with laboratory-confirmed SARS-CoV-2 infection. The prevalence of new neurologic disorders (as diagnosed by a neurologist) was recorded and in-hospital mortality and discharge disposition were compared between patients with COVID-19 with and without neurologic disorders.ResultsOf 4,491 patients with COVID-19 hospitalized during the study timeframe, 606 (13.5%) developed a new neurologic disorder in a median of 2 days from COVID-19 symptom onset. The most common diagnoses were toxic/metabolic encephalopathy (6.8%), seizure (1.6%), stroke (1.9%), and hypoxic/ischemic injury (1.4%). No patient had meningitis/encephalitis or myelopathy/myelitis referable to SARS-CoV-2 infection and 18/18 CSF specimens were reverse transcriptase PCR negative for SARS-CoV-2. Patients with neurologic disorders were more often older, male, white, hypertensive, diabetic, intubated, and had higher sequential organ failure assessment (SOFA) scores (all p < 0.05). After adjusting for age, sex, SOFA scores, intubation, history, medical complications, medications, and comfort care status, patients with COVID-19 with neurologic disorders had increased risk of in-hospital mortality (hazard ratio [HR] 1.38, 95% confidence interval [CI] 1.17-1.62, p < 0.001) and decreased likelihood of discharge home (HR 0.72, 95% CI 0.63-0.85, p < 0.001).ConclusionsNeurologic disorders were detected in 13.5% of patients with COVID-19 and were associated with increased risk of in-hospital mortality and decreased likelihood of discharge home. Many observed neurologic disorders may be sequelae of severe systemic illness.