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

项目概要/摘要 在冠状病毒（COVID-19）大流行期间，被诊断患有急性呼吸道疾病的患者人数 在美国，急性呼吸窘迫综合征（ARDS）的发病率急剧上升。COVID-19相关ARDS的特征是 高发病率，包括需要长期的机械呼吸机支持。大幅 住院、神经认知功能障碍和残留缺陷存活的患者百分比 肺损伤被报道为所谓的COVID-19急性后遗症（PASC）。因此，我们认为， 必须紧急确定导致不良结果的可解决因素。在COVID-19之前 大流行，我们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。醇 滥用也可传播谵妄的发展，这可能增加认知障碍的风险， 复苏值得注意的是，ICU中一半的COVID-19患者报告了谵妄， 似乎增加了其发展的可能性。尽管有报道称， 大流行病是广泛的，可能是一个可改变的因素驱动疾病的严重程度和结果， 对COVID-19疾病轨迹的影响尚未得到充分评估。本提案的目的是 确定酒精滥用是否会促进ICU谵妄，从而增加对机械的需求。 COVID-19相关ARDS患者的通气。同时，我们希望确定是否滥用酒精 有助于COVID-19幸存者的持续认知和呼吸PASC。为了解决这些问题， 提出了两个目标。目的1：在COVID-19相关ARDS住院患者中，确定酒精是否 误用与机械通气需求增加有关，如果谵妄进一步影响这一点， 关系研究将在前瞻性入组的COVID-19患者队列中进行， 相关的ARDS，他们在科罗拉多大学医院的ICU（Aim 1a），并在回顾性研究中 一群曾在科罗拉多大学卫生系统住院的COVID-19患者 (Aim 1 b）。目标2：在从COVID-19中康复的患者中，确定酒精滥用对 认知和呼吸功能的恢复，占急性疾病的特点，包括 需要机械通气和ICU谵妄。将在随访的患者中进行研究 在一个多学科的COVID-19康复诊所，谁将有认知，心理和呼吸健康 在出院后一年内进行评估。我们提出的研究将有助于确定 酒精滥用需要有针对性的策略来识别和治疗COVID-19相关环境中的谵妄 呼吸衰竭，它将澄清住院的COVID-19和酒精滥用患者是否代表 可能需要特定服务或干预的PASC风险独特亚组。

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.