Impact of Alcohol Misuse on Cognitive and Respiratory Outcomes in COVID-19-associated Acute Respiratory Failure

项目摘要/摘要 在冠状病毒(COVID)-19大流行期间，被诊断为急性呼吸道疾病的患者数量 在美国，窘迫综合征(ARDS)的发病率急剧上升。新冠肺炎相关性急性呼吸窘迫综合征的特点是 由于发病率高，包括需要长时间的机械呼吸机支持。在很大程度上 住院患者存活百分比，缺陷包括神经认知功能障碍和残留物 肺损害被报道为所谓的新冠肺炎急性后遗症(PASC)。因此， 当务之急是紧急确定导致糟糕结果的可解决因素。在共建新冠肺炎之前 大流行，我们的研究小组的调查表明，酒精滥用与 ARDS的严重程度增加，这可能导致幸存者的残余肺功能障碍。酒精 滥用还会导致精神错乱的发展，这可能会增加认知障碍的风险。 恢复。值得注意的是，据报道，ICU中所有新冠肺炎患者中有一半出现精神错乱，以及酗酒 似乎增加了它发展的几率。尽管有报道称酒精滥用在 大流行是普遍存在的，可能是驱动疾病严重程度和结果的一个可改变的因素，其 对新冠肺炎疾病轨迹的影响还没有得到充分评估。这项提议的目标是 确定酒精滥用是否会导致ICU精神错乱，进而增加对机械治疗的要求 新冠肺炎相关急性呼吸窘迫综合征患者的呼吸机。此外，我们还希望确定酒精是否滥用 有助于新冠肺炎幸存者持续的认知和呼吸功能障碍。为了解决这些问题， 提出了两个目标。目的1：在新冠肺炎相关性急性呼吸窘迫综合征住院患者中，确定酒精是否 误用与机械通气量增加有关，如果精神错乱进一步影响到这一点 两性关系。研究将在新冠肺炎患者的预期登记队列中进行- 相关ARDS，在科罗拉多大学医院的ICU(AIM 1a)，并在回顾中 曾被科罗拉多大学卫生系统收治的新冠肺炎住院患者队列 (目标1b)。目的2：在新冠肺炎康复患者中，确定酒精滥用对 康复中的认知和呼吸功能，说明急性疾病的特征，包括 机械通风和ICU精神错乱的要求。将对随访的患者进行调查 在多学科的新冠肺炎康复诊所，谁将拥有认知、心理和呼吸健康 在出院后一年内进行评估。我们建议的研究将有助于确定患者是否患有 酒精滥用授权证有针对性地识别和治疗新冠肺炎相关背景下的妄想症 呼吸衰竭，并将澄清住院的新冠肺炎患者和酗酒患者是否代表 PASC的独特风险亚群，可能需要特定的服务或干预。

Project Summary/Abstract During the Coronavirus (COVID)-19 pandemic, the number of patients diagnosed with the acute respiratory distress syndrome (ARDS) has increased dramatically in the US. COVID-19-associated ARDS is characterized by high morbidity, including a requirement for protracted mechanical ventilator support. In a substantial percentage of patients who survive hospitalization, deficits including neurocognitive dysfunction and residual pulmonary impairment have been reported as so-called Post-Acute Sequelae of COVID-19 (PASC). Therefore, it is imperative to urgently establish addressable factors that drive poor outcomes. Prior to the COVID-19 pandemic, investigations by our research group demonstrated that alcohol misuse is associated with an increased severity of ARDS, which may contribute to residual pulmonary dysfunction in survivors. Alcohol misuse can also propagate development of delirium that may increase risk for cognitive impairment in recovery. Notably, delirium has been reported in half of all COVID-19 patients in the ICU, and alcohol misuse appears to increase odds for its development. Although reports of increasing alcohol misuse during the pandemic are widespread and might be one modifiable factor driving severity of illness and outcomes, its impact on the trajectory of illness in COVID-19 has not been fully evaluated. The goal of this proposal is to determine if alcohol misuse promotes ICU delirium that in turn increases requirements for mechanical ventilation among patients with COVID-19-associated ARDS. Also, we wish to establish if alcohol misuse contributes to persistent cognitive and respiratory PASC in COVID-19 survivors. To address these questions, two aims are proposed. Aim 1: In hospitalized patients with COVID-19-associated ARDS, determine if alcohol misuse is associated with increased mechanical ventilation requirements, and if delirium further influences this relationship. Investigations will be conducted in a prospectively enrolled cohort of patients with COVID-19- associated ARDS, who are in the ICU at the University of Colorado Hospital (Aim 1a), and in a retrospective cohort of hospitalized patients with COVID-19, previously admitted in the University of Colorado Health system (Aim 1b). Aim 2: Among patients recovering from COVID-19, determine the impact of alcohol misuse on cognition and respiratory function in recovery, accounting for characteristics of acute illness that include requirements for mechanical ventilation and ICU delirium. Investigations will be conducted in patients followed in a multidisciplinary COVID-19 Recovery Clinic, who will have cognitive, mental, and respiratory health evaluated over the year following hospital discharge. Our proposed research will help determine if patients with alcohol misuse warrant targeted strategies to identify and treat delirium in the setting of COVID-19-associated respiratory failure, and it will clarify if hospitalized patients with COVID-19 and alcohol misuse represent a unique subgroup at risk for PASC who may merit specific services or interventions.