Neuropsychiatric Ramifications of Severe COVID-19 and Other Severe Acute Respiratory Infections.
Neuropsychiatric Ramifications of Severe COVID-19 and Other Severe Acute Respiratory Infections.
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DOI：
10.1001/jamapsychiatry.2022.1067
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发表时间：
2022-07-01
期刊：
影响因子：
25.8
通讯作者：
Watkinson, Peter
中科院分区：
文献类型：
--
作者：
Clift, Ashley Kieran;Ranger, Tom Alan;Patone, Martina;Coupland, Carol A. C.;Hatch, Robert;Thomas, Karen;Hippisley-Cox, Julia;Watkinson, Peter
在COVID-19住院治疗后幸存的成年人中，神经精神疾病的风险是什么，与非COVID严重呼吸道感染相比如何？在这项对英格兰800多万成年人数据的队列研究中，在COVID-19大流行期间，与普通人群相比，因COVID-19或其他严重急性呼吸道感染住院治疗幸存的成年人新发焦虑症、痴呆症、精神病性障碍和双相情感障碍诊断的风险显著增加。COVID-19和非COVID严重呼吸道感染的神经精神疾病或开始相关药物治疗的风险相似。这项研究的结果表明，疾病的严重程度，而不是病原体，是一个相关的因素与神经精神的后果后，严重的呼吸道感染。严重COVID-19幸存者可能会增加神经精神后遗症的风险。对这些风险的有力评估可能有助于提高对COVID后综合征的临床理解，在持续的大流行期间帮助临床护理，并为大流行后规划提供信息。量化COVID-19相关住院患者出院后新发神经精神疾病和新的神经精神药物处方的风险，并将其与COVID-19大流行期间因其他严重急性呼吸道感染（SARI）住院患者出院后的风险进行比较。在这项队列研究中，成人（≥18岁）是从QResearch初级保健和链接的电子健康记录数据库中确定的，包括2020年1月24日至2021年7月7日英格兰的国家SARS-CoV-2检测，医院事件统计，重症监护入院数据和死亡登记。COVID-19相关或SARI相关住院（包括重症监护住院）。出院后12个月随访期间新发神经精神疾病（焦虑、痴呆、精神病、抑郁、双相情感障碍）或首次处方相关药物（抗抑郁药、催眠药/抗焦虑药、抗精神病药）。使用灵活的参数生存模型估计最大校正风险比（HR）和95% CI。在这项队列研究中，数据来自838万名成年人（418万名女性，420万名男性;平均[SD]年龄49.18 [18.45]岁）; 16679名（0.02%）因SARI住院存活，32525名（0.03%）因COVID-19住院存活。与其余人群相比，SARI和COVID-19住院治疗的幸存者随后被诊断为神经精神疾病的风险更高。例如，SARI幸存者的焦虑HR为1.86（95% CI，1.56-2.21），COVID-19感染幸存者为2.36（95%可信区间，2.03-2.74）; SARI幸存者痴呆的HR为2.55（95%CI，2.17-3.00），COVID-19感染幸存者为2.63（95%CI，2.21-3.14）。在所有分析的药物中观察到类似的结果;例如，SARI幸存者首次处方抗抑郁药的HR为2.55（95%CI，2.24-2.90），COVID-19感染幸存者为3.24（95%CI，2.91-3.61）。直接比较COVID-19组与SARI组时，除了前者的抗精神病药物处方风险较低外，未观察到显著差异（HR，0.80; 95%CI，0.69-0.92）。在这项队列研究中，发现严重COVID-19感染的神经精神后遗症与其他SARI相似。这一发现可能为SARI幸存者的出院后支持提供信息。这项针对英格兰800多万人的电子医疗保健数据的队列研究试图量化COVID-19住院出院后的神经精神后遗症，并与因非COVID-19严重急性呼吸道感染住院而存活的患者进行比较。
What are the risks of neuropsychiatric disorders in adults surviving COVID-19 hospitalization, and how do these compare with non-COVID severe respiratory infections? In this cohort study of data from more than 8 million adults in England, during the COVID-19 pandemic, risks of new anxiety disorder, dementia, psychotic disorder, and bipolar disorder diagnoses were significantly increased in adults surviving hospitalization for COVID-19 or other severe acute respiratory infections compared with the general population. Risks of neuropsychiatric illnesses or commencement of related medications were similar for COVID-19 and non-COVID severe respiratory infections. The results of this study suggest that disease severity, rather than pathogen, is a relevant factor associated with neuropsychiatric ramifications after severe respiratory infections. Individuals surviving severe COVID-19 may be at increased risk of neuropsychiatric sequelae. Robust assessment of these risks may help improve clinical understanding of the post–COVID syndrome, aid clinical care during the ongoing pandemic, and inform postpandemic planning. To quantify the risks of new-onset neuropsychiatric conditions and new neuropsychiatric medication prescriptions after discharge from a COVID-19–related hospitalization, and to compare these with risks after discharge from hospitalization for other severe acute respiratory infections (SARI) during the COVID-19 pandemic. In this cohort study, adults (≥18 years of age) were identified from QResearch primary care and linked electronic health record databases, including national SARS-CoV-2 testing, hospital episode statistics, intensive care admissions data, and mortality registers in England, from January 24, 2020, to July 7, 2021. COVID-19–related or SARI-related hospital admission (including intensive care admission). New-onset diagnoses of neuropsychiatric conditions (anxiety, dementia, psychosis, depression, bipolar disorder) or first prescription for relevant medications (antidepressants, hypnotics/anxiolytics, antipsychotics) during 12 months of follow-up from hospital discharge. Maximally adjusted hazard ratios (HR) with 95% CIs were estimated using flexible parametric survival models. In this cohort study of data from 8.38 million adults (4.18 million women, 4.20 million men; mean [SD] age 49.18 [18.45] years); 16 679 (0.02%) survived a hospital admission for SARI, and 32 525 (0.03%) survived a hospital admission for COVID-19. Compared with the remaining population, survivors of SARI and COVID-19 hospitalization had higher risks of subsequent neuropsychiatric diagnoses. For example, the HR for anxiety in survivors of SARI was 1.86 (95% CI, 1.56-2.21) and for survivors of COVID-19 infection was 2.36 (95% CI, 2.03-2.74); the HR for dementia for survivors of SARI was 2.55 (95% CI, 2.17-3.00) and for survivors of COVID-19 infection was 2.63 (95% CI, 2.21-3.14). Similar findings were observed for all medications analyzed; for example, the HR for first prescriptions of antidepressants in survivors of SARI was 2.55 (95% CI, 2.24-2.90) and for survivors of COVID-19 infection was 3.24 (95% CI, 2.91-3.61). There were no significant differences observed when directly comparing the COVID-19 group with the SARI group apart from a lower risk of antipsychotic prescriptions in the former (HR, 0.80; 95% CI, 0.69-0.92). In this cohort study, the neuropsychiatric sequelae of severe COVID-19 infection were found to be similar to those for other SARI. This finding may inform postdischarge support for people surviving SARI. This cohort study of electronic health care data of more than 8 million individuals in England attempts to quantify the neuropsychiatric sequelae following discharge from COVID-19 hospitalization compared with patients surviving hospitalization due to non–COVID-19 severe acute respiratory infections.
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影响因子：
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作者：
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DOI：
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期刊：
BMJ (Clinical research ed.)
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DOI：
10.1016/s2215-0366(21)00120-6
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期刊：
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影响因子：
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通讯作者：
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DOI：
10.1016/s2215-0366(21)00084-5
发表时间：
2021-05
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The lancet. Psychiatry
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