All authors: Department of Neurology, Division of Critical Care Neurology, Mayo Clinic, Rochester, MN.
Crit Care Med. 2018 Sep;46(9):e955-e958. doi: 10.1097/CCM.0000000000003257.
To assess the long-term outcomes of patients hospitalized with severe West Nile neuroinvasive disease.
Retrospective cohort.
Patients admitted to a referral center (Saint Mary's Hospital, Mayo Clinic).
Twenty-six patients with West Nile neuroinvasive disease were identified by retrospective search of electronic database of Saint Mary's Hospital from January 1999 to November 2016.
Retrospective electronic medical records review and prospective telephone follow-up.
Functional disability and cognitive outcomes were evaluated with the modified Rankin Scale and the Telephone Interview for Cognitive Status scores. Data on the time that the patient returned home after the hospitalization for West Nile neuroinvasive disease and the time of return to work were also collected. We identified 26 patients (81% males), 59 ± 17 years old. After a median hospital stay of 14.5 days (3-126), four patients died and 90% of survivors had a modified Rankin Scale of 3-5. Two additional patients died, and 80% of survivors had a modified Rankin Scale of 0-2 after a median follow-up of 73 months (1-144). Seven patients had cognitive impairment, which was severe in two of them. The combination of encephalitis and acute flaccid paralysis at presentation was associated with lower likelihood of returning home within 1 month after discharge (p < 0.01). Patients who required mechanical ventilation were more likely to have a modified Rankin Scale of 3-5 at last follow-up (p = 0.03), less likely to return home within 1 month of discharge (p < 0.01), less likely to return to their jobs (p < 0.01), and showed a trend toward having cognitive impairment (p = 0.05).
Despite having poor outcomes at discharge, most West Nile neuroinvasive disease survivors with severe early disability can recover functional independence in the long term, justifying aggressive support during the acute phase and extensive rehabilitation efforts.
评估因严重西尼罗河神经侵袭性疾病住院患者的长期预后。
回顾性队列研究。
一家转诊中心（圣玛丽医院，梅奥诊所）的患者。
通过对圣玛丽医院电子病历数据库的回顾性搜索，从 1999 年 1 月至 2016 年 11 月期间，确定了 26 例西尼罗河神经侵袭性疾病患者。
回顾性电子病历审查和前瞻性电话随访。
采用改良 Rankin 量表和电话认知状态评分评估功能障碍和认知结果。还收集了患者从西尼罗河神经侵袭性疾病住院后返回家中的时间和重返工作岗位的时间数据。我们共纳入 26 例患者（81%为男性），年龄 59±17 岁。中位住院时间为 14.5 天（3-126 天），4 例患者死亡，90%的幸存者改良 Rankin 量表评分为 3-5 分。2 例患者死亡后，80%的幸存者改良 Rankin 量表评分为 0-2 分，中位随访时间为 73 个月（1-144 个月）。7 例患者存在认知障碍，其中 2 例为严重认知障碍。发病时伴有脑炎和急性弛缓性瘫痪的患者出院后 1 个月内返回家中的可能性较低（p<0.01）。需要机械通气的患者在末次随访时改良 Rankin 量表评分为 3-5 分的可能性更高（p=0.03），出院后 1 个月内返回家中的可能性更低（p<0.01），重返工作岗位的可能性更低（p<0.01），且有认知障碍的趋势（p=0.05）。
尽管出院时预后较差，但大多数患有严重早期残疾的西尼罗河神经侵袭性疾病幸存者在长期内都能恢复功能独立性，这证明在急性期给予积极支持和广泛的康复治疗是合理的。
