Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
IRCCS Istituto delle Scienze Neurologiche di Bologna, Scientific Institute for Research and Health Care, full member of the European Reference Network EpiCARE, Bologna, Italy.
Epilepsia. 2022 Sep;63(9):2279-2289. doi: 10.1111/epi.17356. Epub 2022 Jul 17.
Data on COVID-19 outcomes in persons with epilepsy (PWE) are scarce and inconclusive. We aimed to study the risk of hospitalization and death for COVID-19 in a large cohort of PWE from March 1, 2020 to October 31, 2021.
The historical cohort design (EpiLink Bologna) compared adult PWE grouped into people with focal epilepsy (PFE), idiopathic generalized epilepsy (PIGE), and developmental and/or epileptic encephalopathy (PDEE), and a population cohort matched (ratio 1:10) for age, sex, residence, and comorbidity (assessed with the multisource comorbidity score), living in the local health trust of Bologna (approximately 800 000 residents). Clinical data were linked to health administrative data.
In both cohorts (EpiLink: n = 1575 subjects, 1128 PFE, 267 PIGE, 148 PDEE, 32 other; controls: n = 15 326 subjects), 52% were females, and the mean age was 50 years (SD = 18). Hospital admissions for COVID-19 in the whole period were 49 (3.1%) in PWE and 225 (1.5%) in controls. The adjusted hazard ratio (aHR) in PWE was 1.9 (95% confidence interval [CI] = 1.4-2.7). The subgroups at higher risk were PFE (aHR = 1.9, 95% CI = 1.3-2.8) and PDEE (aHR = 3.9, 95% CI = 1.7-8.7), whereas PIGE had a risk comparable to the controls (aHR = 1.1, 95% CI = .3-3.5). Stratified analyses of the two main epidemic waves (March-May 2020, October 2020-May 2021) disclosed a higher risk of COVID-19-related hospitalization during the first epidemic wave (March-May 2020; aHR = 3.8, 95% CI = 2.2-6.7). Polytherapy with antiseizure medications contributed to a higher risk of hospital admission. Thirty-day risk of death after hospitalization was 14% in both PWE and controls.
During the first 20 months since the outbreak of COVID-19 in Bologna, PWE had a doubled risk of COVID-19 hospital admission compared to a matched control population. Conversely, epilepsy did not represent a risk factor for COVID-19-related death.
关于 COVID-19 在癫痫患者（PWE）中的结局的数据很少且不确定。我们旨在研究 2020 年 3 月 1 日至 2021 年 10 月 31 日期间，来自博洛尼亚当地卫生保健区的一大群 PWE 因 COVID-19 住院和死亡的风险。
历史队列设计（EpiLink Bologna）将成人 PWE 分为局灶性癫痫（PFE）、特发性全面性癫痫（PIGE）、发育性和/或癫痫性脑病（PDEE）人群，并匹配了年龄、性别、居住地和合并症（使用多源合并症评分评估）的人群队列（比为 1:10），居住在博洛尼亚当地卫生保健区（约 800 000 名居民）。临床数据与健康管理数据相关联。
在两个队列中（EpiLink：n = 1575 例，1128 例 PFE、267 例 PIGE、148 例 PDEE、32 例其他；对照组：n = 15 326 例），52%为女性，平均年龄为 50 岁（标准差= 18 岁）。在整个研究期间，COVID-19 住院患者为 49 例（3.1%）在 PWE 和 225 例（1.5%）在对照组。PWE 的调整后的危险比（aHR）为 1.9（95%置信区间[CI] = 1.4-2.7）。风险较高的亚组为 PFE（aHR = 1.9，95%CI = 1.3-2.8）和 PDEE（aHR = 3.9，95%CI = 1.7-8.7），而 PIGE 的风险与对照组相当（aHR = 1.1，95%CI =.3-3.5）。对两个主要流行波（2020 年 3 月至 5 月、2020 年 10 月至 2021 年 5 月）的分层分析显示，COVID-19 相关住院的风险在第一波疫情（2020 年 3 月至 5 月）期间更高（aHR = 3.8，95%CI = 2.2-6.7）。抗癫痫药物的联合治疗增加了住院的风险。PWE 和对照组的 30 天住院死亡率均为 14%。
自 COVID-19 在博洛尼亚爆发以来的 20 个月内，与匹配的对照组相比，PWE 因 COVID-19 住院的风险增加了一倍。相反，癫痫并不是 COVID-19 相关死亡的危险因素。
