中国武汉 COVID-19 卒中患者的临床病程和死亡率。
Clinical Course and Mortality of Stroke Patients With Coronavirus Disease 2019 in Wuhan, China.
机构信息
Intensive Care Unit (L.Z., W.S., Y.W., X.W., Y.L., D.L., L.Y.), the Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, China.
Department of Pulmonary and Critical Care Medicine (S.Z.), the Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, China.
出版信息
Stroke. 2020 Sep;51(9):2674-2682. doi: 10.1161/STROKEAHA.120.030642. Epub 2020 Jul 31.
BACKGROUND AND PURPOSE
No studies have reported the effect of the coronavirus disease 2019 (COVID-19) epidemic on patients with preexisting stroke. We aim to study the clinical course of COVID-19 patients with preexisting stroke and to investigate death-related risk factors.
METHODS
We consecutively included 651 adult inpatients with COVID-19 from the Central Hospital of Wuhan between January 2 and February 15, 2020. Data on the demography, comorbidities, clinical manifestations, laboratory findings, treatments, complications, and outcomes (ie, discharged or death) of the participants were extracted from electronic medical records and compared between patients with and without preexisting stroke. The association between risk factors and mortality was estimated using a Cox proportional hazards regression model for stroke patients infected with severe acute respiratory syndrome coronavirus 2.
RESULTS
Of the 651 patients with COVID-19, 49 with preexisting stroke tended to be elderly, male, had more underlying comorbidities and greater severity of illness, prolonged length of hospital stay, and greater hospitalization expenses than those without preexisting stroke. Cox regression analysis indicated that the patients with stroke had a higher risk of developing critical pneumonia (adjusted hazard ratio, 2.01 [95% CI, 1.27-3.16]) and subsequent mortality (adjusted hazard ratio, 1.73 [95% CI, 1.00-2.98]) than the patients without stroke. Among the 49 stroke patients, older age and higher score of Glasgow Coma Scale or Sequential Organ Failure Assessment were independent risk factors associated with in-hospital mortality.
CONCLUSIONS
Preexisting stroke patients infected with severe acute respiratory syndrome coronavirus 2 were readily predisposed to death, providing an important message to individuals and health care workers that preventive measures must be implemented to protect and reduce transmission in stroke patients in this COVID-19 crisis.
背景与目的
尚无研究报道过 2019 年冠状病毒病（COVID-19）流行对既往存在脑卒中的患者的影响。本研究旨在探讨 COVID-19 合并既往脑卒中患者的临床病程，并分析与死亡相关的危险因素。
方法
我们连续纳入 2020 年 1 月 2 日至 2 月 15 日期间武汉中心医院收治的 651 例成年 COVID-19 住院患者。从电子病历中提取患者的人口统计学、合并症、临床表现、实验室检查结果、治疗、并发症和结局（即出院或死亡）等数据，并对有和无既往脑卒中患者的数据进行比较。采用 Cox 比例风险回归模型对感染严重急性呼吸综合征冠状病毒 2 的脑卒中患者的危险因素与死亡率之间的关系进行评估。
结果
在 651 例 COVID-19 患者中，49 例既往存在脑卒中的患者更倾向于高龄、男性、存在更多的基础合并症、疾病严重程度更高、住院时间更长、住院费用更高。Cox 回归分析表明，与无脑卒中患者相比，脑卒中患者发生重症肺炎（调整后的危险比，2.01 [95%CI，1.27-3.16]）和随后死亡（调整后的危险比，1.73 [95%CI，1.00-2.98]）的风险更高。在 49 例脑卒中患者中，年龄较大、格拉斯哥昏迷评分或序贯器官衰竭评估评分较高是与院内死亡相关的独立危险因素。
结论
感染严重急性呼吸综合征冠状病毒 2 的既往存在脑卒中患者更容易死亡，这为个人和医护人员提供了一个重要信息，即在 COVID-19 危机期间，必须采取预防措施来保护和减少脑卒中患者的传播。
Zotero 插件