Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy; SC Neurologia 2U, AOU Città della Salute e della Scienza, Turin, Italy.
Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy; SC Neurologia 2U, AOU Città della Salute e della Scienza, Turin, Italy.
J Neurol Sci. 2021 Sep 15;428:117610. doi: 10.1016/j.jns.2021.117610. Epub 2021 Aug 5.
Neurological involvement in Coronavirus disease-2019 (COVID-19) is widely recognized. However, the role of pre-existing neurological comorbidities in modulating COVID-19-related mortality still remains unclear. This cohort study evaluates the COVID-19-related case fatality rate (CFR) of patients with pre-existing neurological diseases.
We retrospectively evaluated all patients consecutively admitted to our hospital with a diagnosis of COVID-19 between March and April 2020. We used a multivariate regression analysis to estimate the association between pre-existing neurological diseases and COVID-19-related mortality. Then, we compared the CFR and survival curves of two cohorts (patients suffering vs. those not suffering from pre-existing neurological disease), matched trough the propensity score (PS). Age and other comorbidities were considered for PS calculation. We applied a 1:1 matching for the entire neurological cohort and, separately, for cerebrovascular, neurodegenerative, and other neurological diseases.
Among 332 patients, 75 (22.6%) were affected by pre-existing neurological disease (n = 29 cerebrovascular, n = 26 neurodegenerative, n = 20 others). From the multivariate regression analysis, they resulted with a significant increase of COVID-19-related mortality (OR:2.559; 95%CI 1.181-5.545; p < 0.017). From the cohort analysis, CFR resulted 2-fold higher in patients with neurological disease (48.0% vs. 24.0%; p = 0.002). CFR was significantly higher in patients with neurodegenerative diseases compared to matched individuals (73.9% vs. 39.1%; p = 0.017), while CFR increase in patients with cerebrovascular diseases did not reach statistical significance (48.3% vs. 41.4%; p = 0.597).
Pre-existing neurological comorbidities, in particular neurodegenerative diseases, increase significantly COVID-19-related case fatality, indicating a clear priority for viral screening, access to care facilities and vaccination in these populations.
新型冠状病毒病 2019（COVID-19）的神经受累已被广泛认识。然而，先前存在的神经合并症在调节 COVID-19 相关死亡率方面的作用仍不清楚。本队列研究评估了患有先前存在的神经疾病的 COVID-19 患者的 COVID-19 相关病死率（CFR）。
我们回顾性评估了 2020 年 3 月至 4 月期间连续因 COVID-19 住院的所有患者。我们使用多变量回归分析来估计先前存在的神经疾病与 COVID-19 相关死亡率之间的关联。然后，我们通过倾向评分（PS）比较了两组患者（患有和不患有先前存在的神经疾病）的 CFR 和生存曲线。年龄和其他合并症被用于 PS 计算。我们对整个神经科队列和单独的脑血管、神经退行性和其他神经疾病队列进行了 1:1 匹配。
在 332 名患者中，有 75 名（22.6%）患有先前存在的神经疾病（n=29 名脑血管疾病，n=26 名神经退行性疾病，n=20 名其他神经疾病）。多变量回归分析表明，COVID-19 相关死亡率显著增加（OR：2.559；95%CI 1.181-5.545；p<0.017）。从队列分析中，患有神经疾病的患者的 CFR 高出两倍（48.0% vs. 24.0%；p=0.002）。与匹配个体相比，患有神经退行性疾病的患者的 CFR 显著升高（73.9% vs. 39.1%；p=0.017），而患有脑血管疾病的患者的 CFR 升高没有达到统计学意义（48.3% vs. 41.4%；p=0.597）。
先前存在的神经合并症，特别是神经退行性疾病，显著增加了 COVID-19 相关的病死率，表明这些人群需要进行病毒筛查、获得医疗保健设施和接种疫苗的优先级更高。
