Xiong Weixi, Lu Lu, Zhang Baiyang, Luo Jianfei, Li Weimin, He Li, Sander Josemir W, Mu Jie, Zhu Cairong, Zhou Dong
Department of Neurology, West China Hospital of Sichuan University, Chengdu, China.
Institute of Brain Science and Brain-inspired technology of West China Hospital, Sichuan University, Chengdu, China.
Acta Neurol Scand. 2021 Sep;144(3):251-259. doi: 10.1111/ane.13471. Epub 2021 May 24.
To investigate the association between impairment of consciousness and risk of death in people with COVID-19.
In this multicentre retrospective study, we enrolled people with confirmed COVID-19 from 44 hospitals in Wuhan and Sichuan, China, between 18 January and 30 March 2020. We extracted demographics, clinical, laboratory data and consciousness level (as measured by the Glasgow Coma Scale (GCS) score) from medical records. We used Cox proportional hazards regression, structural equation modelling and survival time analysis to compare people with different progressions of impaired consciousness.
We enrolled 1,143 people (average age 51.3 ± standard deviation 17.1-year-old; 50.3% males), of whom 76 died. Increased mortality risk was identified in people with GCS score between 9 and 14 (hazard ratio (HR) 46.76, p < .001) and below 9 (HR 65.86, p < .001). Pathway analysis suggested a significant direct association between consciousness level and death. Other factors, including age, oxygen saturation level and pH, had indirect associations with death mediated by GCS scores. People who developed impaired consciousness more rapidly either from symptoms onset (<10 days vs. 10-19 days, p = .025, <10 days vs. ≥20 days and 10-19 days vs. ≥20 days, <.001) or deterioration of oxygen saturation (≤2 days vs.>2 days, p = .028) had shorter survival times.
Altered consciousness and its progression had a direct link with death in COVID-19. Interactions with age, oxygen saturation level and pH suggest possible pathophysiology. Further work to confirm these findings explore prevention strategies and interventions to decrease mortality is warranted.
探讨新型冠状病毒肺炎（COVID-19）患者意识障碍与死亡风险之间的关联。
在这项多中心回顾性研究中，我们纳入了2020年1月18日至3月30日期间来自中国武汉和四川44家医院的确诊COVID-19患者。我们从病历中提取了人口统计学、临床、实验室数据以及意识水平（通过格拉斯哥昏迷量表（GCS）评分衡量）。我们使用Cox比例风险回归、结构方程模型和生存时间分析来比较意识障碍不同进展情况的患者。
我们纳入了1143名患者（平均年龄51.3±标准差17.1岁；50.3%为男性），其中76人死亡。GCS评分为9至14分的患者（风险比（HR）46.76，p<.001）和低于9分的患者（HR 65.86，p<.001）死亡风险增加。路径分析表明意识水平与死亡之间存在显著的直接关联。其他因素，包括年龄、血氧饱和度水平和pH值，通过GCS评分与死亡存在间接关联。意识障碍从症状出现起发展更快的患者（<10天与10 - 19天，p = .025，<10天与≥20天以及10 - 19天与≥20天，p<.001）或血氧饱和度恶化更快的患者（≤2天与>2天，p = .028）生存时间更短。
意识改变及其进展与COVID-19患者的死亡有直接关联。与年龄、血氧饱和度水平和pH值的相互作用提示了可能的病理生理学机制。有必要进一步开展工作以证实这些发现，探索预防策略和干预措施以降低死亡率。
