一项关于纽约市住院 COVID-19 患者神经系统疾病的前瞻性研究。
A Prospective Study of Neurologic Disorders in Hospitalized Patients With COVID-19 in New York City.
机构信息
From the New York University Grossman School of Medicine (J.A.F., S.S., R.L., T.F., B.F., P.M.-V., T.S., S.B., D.Y., A.G., N.M., P.P., J.G., K.M., S.A., M.B., A.A., E.V., M.O., A.K., K.L., Daniel Friedman, David Friedman, M.H., J.H., S.T., J.H., N.A.-F., P.K., A.L., A.S.L., T.Z., D.E.K., B.M.C., J.T., S.Y., K.I., E.S., D.P., M.L., T.W., A.B.T., L.B., S.G.), New YorkUniversity of Pittsburgh School of Medicine (S.H.-Y.C., E.L.F.), PAThe Ohio State University (M.M., S.M.), ColumbusMedical University of Innsbruck (R.H.), AustriaThe Johns Hopkins University School of Medicine (C.R., J.I.S., W.Z.), Baltimore, MDUniversity of Utah School of Medicine (M.S., A.d.H.), Salt Lake CityUniversity of Cambridge (D.M.), UK.
出版信息
Neurology. 2021 Jan 26;96(4):e575-e586. doi: 10.1212/WNL.0000000000010979. Epub 2020 Oct 5.
OBJECTIVE
To determine the prevalence and associated mortality of well-defined neurologic diagnoses among patients with coronavirus disease 2019 (COVID-19), we prospectively followed hospitalized severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive patients and recorded new neurologic disorders and hospital outcomes.
METHODS
We conducted a prospective, multicenter, observational study of consecutive hospitalized adults in the New York City metropolitan area with laboratory-confirmed SARS-CoV-2 infection. The prevalence of new neurologic disorders (as diagnosed by a neurologist) was recorded and in-hospital mortality and discharge disposition were compared between patients with COVID-19 with and without neurologic disorders.
RESULTS
Of 4,491 patients with COVID-19 hospitalized during the study timeframe, 606 (13.5%) developed a new neurologic disorder in a median of 2 days from COVID-19 symptom onset. The most common diagnoses were toxic/metabolic encephalopathy (6.8%), seizure (1.6%), stroke (1.9%), and hypoxic/ischemic injury (1.4%). No patient had meningitis/encephalitis or myelopathy/myelitis referable to SARS-CoV-2 infection and 18/18 CSF specimens were reverse transcriptase PCR negative for SARS-CoV-2. Patients with neurologic disorders were more often older, male, white, hypertensive, diabetic, intubated, and had higher sequential organ failure assessment (SOFA) scores (all < 0.05). After adjusting for age, sex, SOFA scores, intubation, history, medical complications, medications, and comfort care status, patients with COVID-19 with neurologic disorders had increased risk of in-hospital mortality (hazard ratio [HR] 1.38, 95% confidence interval [CI] 1.17-1.62, < 0.001) and decreased likelihood of discharge home (HR 0.72, 95% CI 0.63-0.85, < 0.001).
CONCLUSIONS
Neurologic disorders were detected in 13.5% of patients with COVID-19 and were associated with increased risk of in-hospital mortality and decreased likelihood of discharge home. Many observed neurologic disorders may be sequelae of severe systemic illness.
目的
确定患有 2019 年冠状病毒病（COVID-19）的患者中明确诊断的神经系统疾病的流行率和相关死亡率，我们前瞻性地随访了住院的严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）阳性患者，并记录了新发神经系统疾病和住院结局。
方法
我们对纽约市大都市区内实验室确诊的 SARS-CoV-2 感染的连续住院成年患者进行了一项前瞻性、多中心、观察性研究。记录新的神经系统疾病（由神经病学家诊断）的患病率，并比较 COVID-19 患者有无神经系统疾病的住院死亡率和出院去向。
结果
在研究期间，4491 例 COVID-19 住院患者中有 606 例（13.5%）在 COVID-19 症状发作后中位数为 2 天出现新发神经系统疾病。最常见的诊断为中毒/代谢性脑病（6.8%）、癫痫发作（1.6%）、中风（1.9%）和缺氧/缺血性损伤（1.4%）。没有患者患有与 SARS-CoV-2 感染相关的脑膜炎/脑炎或脊髓病/脊髓炎，18 份脑脊液标本的逆转录酶聚合酶链反应均为 SARS-CoV-2 阴性。有神经系统疾病的患者年龄较大、男性、白人、高血压、糖尿病、插管，序贯器官衰竭评估（SOFA）评分较高（均<0.05）。在校正年龄、性别、SOFA 评分、插管、既往史、医疗并发症、药物和舒适度护理状况后，患有 COVID-19 并伴有神经系统疾病的患者的住院死亡率风险增加（风险比 [HR] 1.38，95%置信区间 [CI] 1.17-1.62，<0.001），出院回家的可能性降低（HR 0.72，95%CI 0.63-0.85，<0.001）。
结论
COVID-19 患者中有 13.5%发现有神经系统疾病，与住院死亡率风险增加和出院回家的可能性降低相关。许多观察到的神经系统疾病可能是严重全身疾病的后遗症。
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