新冠病毒感染相关神经系统表现的频率：一项系统评价和荟萃分析。
Frequency of Neurologic Manifestations in COVID-19: A Systematic Review and Meta-analysis.
机构信息
From the Department of Neurology (S.M., D.R., A.K., A.D., A.K.S., A.A.), All India Institute of Medical Sciences, New Delhi, India; Brain Health Unit (K.K., T.D.), World Health Organization, Geneva, Switzerland; Department of Clinical Research and Epidemiology (M.P.), Institute of Liver and Biliary Sciences, New Delhi, India; Columbia University Irving Medical Center-New York Presbyterian Hospital (K.T.T.), NY; Institute of Infection, Veterinary and Ecological Sciences (T.S., B.D.M., G.K.W.), University of Liverpool; Department of Neurology (T.S., B.D.M.), Walton Centre NHS Foundation Trust; NIHR Health Protection Research Unit for Emerging and Zoonotic Infection (B.D.M.), Liverpool, UK; Center for Global Health (A.S.W.), Department of Neurology, Technical University of Munich, Germany; Centre for Global Health (A.S.W.), Institute of Health and Society, University of Oslo, Norway; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (E.B.), Milan, Italy; Moscow Research and Clinical Center for Neuropsychiatry and Pirogov Russian National Research Medical University (A.G.), Russia; Departments of Neurology and Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore, MD; University of Pittsburgh School of Medicine (S.H.-Y.C.); Department of Critical Care Medicine (E.L.F.), UPMC Children's Hospital of Pittsburgh, PA; Department of Neurology (E.S.), Medical University Innsbruck, Austria; Departments of Neurology and Otolaryngology-Head & Neck Surgery (A.K.), The Johns Hopkins Hospital, Baltimore, MD; Department of Neurology (F.K.H.), Faculty of Medicine and Health Sciences, University Putra Malaysia, Seri Kembangan; and Rajendra Institute of Medical Sciences (K.P.), Ranchi, Jharkhand, India.
出版信息
Neurology. 2021 Dec 7;97(23):e2269-e2281. doi: 10.1212/WNL.0000000000012930. Epub 2021 Oct 11.
BACKGROUND AND OBJECTIVES
One year after the onset of the coronavirus disease 2019 (COVID-19) pandemic, we aimed to summarize the frequency of neurologic manifestations reported in patients with COVID-19 and to investigate the association of these manifestations with disease severity and mortality.
METHODS
We searched PubMed, Medline, Cochrane library, ClinicalTrials.gov, and EMBASE for studies from December 31, 2019, to December 15, 2020, enrolling consecutive patients with COVID-19 presenting with neurologic manifestations. Risk of bias was examined with the Joanna Briggs Institute scale. A random-effects meta-analysis was performed, and pooled prevalence and 95% confidence intervals (CIs) were calculated for neurologic manifestations. Odds ratio (ORs) and 95% CIs were calculated to determine the association of neurologic manifestations with disease severity and mortality. Presence of heterogeneity was assessed with , meta-regression, and subgroup analyses. Statistical analyses were conducted in R version 3.6.2.
RESULTS
Of 2,455 citations, 350 studies were included in this review, providing data on 145,721 patients with COVID-19, 89% of whom were hospitalized. Forty-one neurologic manifestations (24 symptoms and 17 diagnoses) were identified. Pooled prevalence of the most common neurologic symptoms included fatigue (32%), myalgia (20%), taste impairment (21%), smell impairment (19%), and headache (13%). A low risk of bias was observed in 85% of studies; studies with higher risk of bias yielded higher prevalence estimates. Stroke was the most common neurologic diagnosis (pooled prevalence 2%). In patients with COVID-19 ≥60 years of age, the pooled prevalence of acute confusion/delirium was 34%, and the presence of any neurologic manifestations in this age group was associated with mortality (OR 1.80, 95% CI 1.11-2.91).
DISCUSSION
Up to one-third of patients with COVID-19 analyzed in this review experienced at least 1 neurologic manifestation. One in 50 patients experienced stroke. In those >60 years of age, more than one-third had acute confusion/delirium; the presence of neurologic manifestations in this group was associated with nearly a doubling of mortality. Results must be interpreted with the limitations of observational studies and associated bias in mind.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO CRD42020181867.
背景和目的
在 2019 年冠状病毒病（COVID-19）大流行爆发一年后，我们旨在总结 COVID-19 患者报告的神经系统表现的频率，并研究这些表现与疾病严重程度和死亡率的关系。
方法
我们检索了 2019 年 12 月 31 日至 2020 年 12 月 15 日的 PubMed、Medline、Cochrane 图书馆、ClinicalTrials.gov 和 EMBASE，纳入了有神经系统表现的连续 COVID-19 患者的研究。使用 Joanna Briggs 研究所量表评估偏倚风险。进行了随机效应荟萃分析，并计算了神经系统表现的汇总患病率和 95%置信区间（CI）。计算了比值比（OR）和 95%CI，以确定神经系统表现与疾病严重程度和死亡率的关系。使用 、荟萃回归和亚组分析评估异质性的存在。统计分析在 R 版本 3.6.2 中进行。
结果
在 2455 条引文中有 350 项研究被纳入本综述，为 145721 名 COVID-19 患者提供了数据，其中 89%的患者住院。确定了 41 种神经系统表现（24 种症状和 17 种诊断）。最常见的神经系统症状包括疲劳（32%）、肌痛（20%）、味觉障碍（21%）、嗅觉障碍（19%）和头痛（13%）。85%的研究存在低偏倚风险；偏倚风险较高的研究得出的患病率较高。卒中是最常见的神经系统诊断（汇总患病率 2%）。在 COVID-19 年龄≥60 岁的患者中，急性意识混乱/谵妄的患病率为 34%，该年龄组任何神经系统表现的存在与死亡率相关（OR 1.80，95%CI 1.11-2.91）。
讨论
在本综述中分析的 COVID-19 患者中，多达三分之一的患者至少经历过一种神经系统表现。每 50 例患者中就有一例发生卒中。在年龄>60 岁的患者中，三分之一以上的患者有急性意识混乱/谵妄；该组中存在神经系统表现与死亡率几乎增加一倍相关。在解释结果时，必须考虑到观察性研究的局限性和相关的偏倚。
系统评价注册
PROSPERO CRD42020181867。
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