COVID-19 对美国颅内和蛛网膜下腔出血患者的住院、治疗和预后的影响。
Impact of COVID-19 on the hospitalization, treatment, and outcomes of intracerebral and subarachnoid hemorrhage in the United States.
机构信息
Department of Neurosurgery, Naval Medical Center San Diego, San Diego, California, United States of America.
Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, United States of America.
出版信息
PLoS One. 2021 Apr 14;16(4):e0248728. doi: 10.1371/journal.pone.0248728. eCollection 2021.
OBJECTIVE
To examine the outcomes of adult patients with spontaneous intracranial and subarachnoid hemorrhage diagnosed with comorbid COVID-19 infection in a large, geographically diverse cohort.
METHODS
We performed a retrospective analysis using the Vizient Clinical Data Base. We separately compared two cohorts of patients with COVID-19 admitted April 1-October 31, 2020-patients with intracerebral hemorrhage (ICH) and those with subarachnoid hemorrhage (SAH)-with control patients with ICH or SAH who did not have COVID-19 admitted at the same hospitals in 2019. The primary outcome was in-hospital death. Favorable discharge and length of hospital and intensive-care stay were the secondary outcomes. We fit multivariate mixed-effects logistic regression models to our outcomes.
RESULTS
There were 559 ICH-COVID patients and 23,378 ICH controls from 194 hospitals. In the ICH-COVID cohort versus controls, there was a significantly higher proportion of Hispanic patients (24.5% vs. 8.9%), Black patients (23.3% vs. 20.9%), nonsmokers (11.5% vs. 3.2%), obesity (31.3% vs. 13.5%), and diabetes (43.4% vs. 28.5%), and patients had a longer hospital stay (21.6 vs. 10.5 days), a longer intensive-care stay (16.5 vs. 6.0 days), and a higher in-hospital death rate (46.5% vs. 18.0%). Patients with ICH-COVID had an adjusted odds ratio (aOR) of 2.43 [1.96-3.00] for the outcome of death and an aOR of 0.55 [0.44-0.68] for favorable discharge. There were 212 SAH-COVID patients and 5,029 controls from 119 hospitals. The hospital (26.9 vs. 13.4 days) and intensive-care (21.9 vs. 9.6 days) length of stays and in-hospital death rate (42.9% vs. 14.8%) were higher in the SAH-COVID cohort compared with controls. Patients with SAH-COVID had an aOR of 1.81 [1.26-2.59] for an outcome of death and an aOR of 0.54 [0.37-0.78] for favorable discharge.
CONCLUSIONS
Patients with spontaneous ICH or SAH and comorbid COVID infection were more likely to be a racial or ethnic minority, diabetic, and obese and to have higher rates of death and longer hospital length of stay when compared with controls.
目的
在一个大型、地域多样化的队列中，研究确诊患有合并 COVID-19 感染的自发性颅内和蛛网膜下腔出血的成年患者的结局。
方法
我们使用 Vizient 临床数据库进行回顾性分析。我们分别比较了 2020 年 4 月 1 日至 10 月 31 日收治的两组 COVID-19 患者（脑出血 [ICH] 患者和蛛网膜下腔出血 [SAH] 患者）与同一医院 2019 年收治的没有 COVID-19 的 ICH 或 SAH 对照患者。主要结局是住院期间死亡。出院情况良好和住院及重症监护病房住院时间是次要结局。我们使用多变量混合效应逻辑回归模型来分析我们的结果。
结果
在 194 家医院中，有 559 例 ICH-COVID 患者和 23378 例 ICH 对照组。与对照组相比，ICH-COVID 队列中 Hispanic 患者（24.5% vs. 8.9%）、Black 患者（23.3% vs. 20.9%）、非吸烟者（11.5% vs. 3.2%）、肥胖患者（31.3% vs. 13.5%）和糖尿病患者（43.4% vs. 28.5%）的比例明显更高，住院时间更长（21.6 天 vs. 10.5 天），重症监护病房住院时间更长（16.5 天 vs. 6.0 天），住院死亡率更高（46.5% vs. 18.0%）。ICH-COVID 患者的死亡结局调整后的优势比（aOR）为 2.43 [1.96-3.00]，出院情况良好的 aOR 为 0.55 [0.44-0.68]。在 119 家医院中，有 212 例 SAH-COVID 患者和 5029 例对照组。与对照组相比，SAH-COVID 队列的住院（26.9 天 vs. 13.4 天）和重症监护（21.9 天 vs. 9.6 天）时间以及住院死亡率（42.9% vs. 14.8%）更高。SAH-COVID 患者的死亡结局 aOR 为 1.81 [1.26-2.59]，出院情况良好的 aOR 为 0.54 [0.37-0.78]。
结论
与对照组相比，自发性 ICH 或 SAH 合并 COVID 感染的患者更有可能是少数民族、糖尿病患者和肥胖患者，并且死亡率更高，住院时间更长。
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