Clinical characteristics and outcomes of inpatients with neurologic disease and COVID-19 in Brescia, Lombardy, Italy
Clinical characteristics and outcomes of inpatients with neurologic disease and COVID-19 in Brescia, Lombardy, Italy
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DOI：
10.1212/wnl.0000000000009848
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发表时间：
2020-08-18
期刊：
影响因子：
9.9
通讯作者：
Padovani, Alessandro
中科院分区：
文献类型：
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作者：
Benussi, Alberto;Pilotto, Andrea;Padovani, Alessandro
目的报告2019年因伴或不伴冠状病毒病的神经系统疾病住院患者的临床和实验室特征、治疗和临床结局在这项回顾性、单中心队列研究中，我们纳入了2020年2月21日开始入住神经-COVID病房的所有确诊COVID-19的成年住院患者，他们在4月5日之前出院或死亡，2020.从病历中提取人口统计学、临床、治疗和实验室数据，并与同期收治的非COVID-19神经系统患者进行比较（错误发现率校正）。COVID-19患者年龄较大（77.0岁，四分位距[IQR] 67.0-83.8岁vs 70.1岁，IQR 52.9-78.6岁，p = 0.006），在入院诊断（包括脑血管疾病）方面具有不同的分布（n = 43，76.8% vs n = 68，58.1%），入院时快速序贯器官衰竭评估（qSOFA）评分较高（0.9，IQR 0.7-1.1 vs 0.5，IQR 0.4-0.6，p = 0.006）。COVID-19组的住院死亡率（n = 21，37.5% vs n = 5，4.3%，p < 0.001）和偶发性谵妄（n = 15，26.8% vs n = 9，7.7%，p = 0.003）显著较高。患有COVID-19和未患有COVID的卒中患者具有相似的基线特征，但患有COVID-19的患者在出院时具有更高的改良兰金量表评分（5.0，IQR 2.0-6.0 vs 2.0，IQR 1.0-3.0，p < 0.001），具有良好结局的患者数量显著较少（n = 11，25.6% vs n = 48，70.6%，p < 0.001）。在COVID-19患者中，多变量回归显示，住院死亡的几率增加与较高的qSOFA评分相关（比值比[OR] 4.47，95%置信区间[CI] 1.21-16.5，p = 0.025），血小板计数较低（OR 0.98，95% CI 0.97-0.99，p = 0.005），乳酸脱氢酶升高（OR 1.01，95%CI 1.00-1.03，p = 0.009）。与非COVID-19患者相比，住院死亡率和偶发性谵妄以及残疾率显著更高。
ObjectiveTo report clinical and laboratory characteristics, treatment, and clinical outcomes of patients admitted for neurologic diseases with and without coronavirus disease 2019 (COVID-19).MethodsIn this retrospective, single-center cohort study, we included all adult inpatients with confirmed COVID-19 admitted to a neuro-COVID unit beginning February 21, 2020, who had been discharged or died by April 5, 2020. Demographic, clinical, treatment, and laboratory data were extracted from medical records and compared (false discovery rate corrected) to those of neurologic patients without COVID-19 admitted in the same period.ResultsOne hundred seventy-three patients were included in this study, of whom 56 were positive and 117 were negative for COVID-19. Patients with COVID-19 were older (77.0 years, interquartile range [IQR] 67.0-83.8 years vs 70.1 years, IQR 52.9-78.6 years, p = 0.006), had a different distribution regarding admission diagnoses, including cerebrovascular disorders (n = 43, 76.8% vs n = 68, 58.1%), and had a higher quick Sequential Organ Failure Assessment (qSOFA) score on admission (0.9, IQR 0.7-1.1 vs 0.5, IQR 0.4-0.6, p = 0.006). In-hospital mortality rates (n = 21, 37.5% vs n = 5, 4.3%, p < 0.001) and incident delirium (n = 15, 26.8% vs n = 9, 7.7%, p = 0.003) were significantly higher in the COVID-19 group. Patients with COVID-19 and without COVID with stroke had similar baseline characteristics, but patients with COVID-19 had highermodified Rankin Scale scores at discharge (5.0, IQR 2.0-6.0 vs 2.0, IQR 1.0-3.0, p < 0.001), with a significantly lower number of patients with a good outcome (n = 11, 25.6% vs n = 48, 70.6%, p < 0.001). In patients with COVID-19, multivariable regressions showed increasing odds of inhospital death associated with higher qSOFA scores (odds ratio [OR] 4.47, 95% confidence interval [CI] 1.21-16.5, p = 0.025), lower platelet count (OR 0.98, 95% CI 0.97-0.99, p = 0.005), and higher lactate dehydrogenase (OR 1.01, 95% CI 1.00-1.03, p = 0.009) on admission.ConclusionsPatients withCOVID-19 admittedwith neurologic disease, including stroke, have a significantly higher in-hospitalmortality and incident deliriumand higher disability than patients without COVID-19.