新型冠状病毒肺炎与脑室分流术翻修术
COVID-19 and Ventricular Shunt Revisions.
作者信息
Hallan David R, Rizk Elias
机构信息
Neurosurgery, Penn State Health Milton S. Hershey Medical Center, Hershey, USA.
出版信息
Cureus. 2022 Jul 20;14(7):e27059. doi: 10.7759/cureus.27059. eCollection 2022 Jul.
INTRODUCTION
COVID-19 patients frequently experience headaches, malaise, and fatigue. For patients with shunted hydrocephalus, these signs and symptoms can often be indicative of shunt failure. Thus, it can be challenging to determine if shunt failure has occurred in this patient population. Therefore, we explored the question of how a diagnosis of COVID-19 in shunted hydrocephalus patients influences the rate of shunt revision.
METHODS
We used a deidentified database network (TriNetX) to gather information on patients with shunted hydrocephalus and COVID-19 versus no COVID-19 from January 20, 2020, through September 26, 2021. Our primary outcome of interest was shunt revision at 90 days, with secondary outcomes of mortality, hospitalization, ICU admission, mechanical ventilation, tracheostomy, PEG tube placement, fall, seizure, acute kidney injury (AKI), venous thromboembolism (VTE), ischemic stroke (I.S.), myocardial infarction (MI), and sepsis. Cohorts were propensity score-matched for common comorbidities and demographics.
RESULTS
After propensity score matching, 10,600 patients with shunted hydrocephalus and COVID-19 (cohort 1) and 10,600 patients with shunted hydrocephalus and no COVID-19 (cohort 2) were identified. Average age was 38.5 years. Eight hundred and thirty-four patients (7.869%) in cohort 1 and 180 (1.698%) patients in cohort 2 underwent shunt revision (p=<0.0001, OR 4.978, 95% CI 4.198, 5.821). Mortality was 4.642% vs. 2.113% (p<0.0001, OR 2.255, 95% CI 1.921, 2.647). Hospitalization rates were 27.72% vs. 10.303% (p<0.0001), and ICU admission rates 11.567% vs. 3.463% (p<0.0001). Ventilator dependence was 3.529% vs. 0.953% (p<0.0001), tracheostomy 1.142% vs. 0.236% (p<0.0001), PEG tube insertion 2.472% vs. 0.585% (p<0.0001), falls 2.321% vs. 1.076% (p<0.0001), seizure 11.369% vs. 5.953% (p<0.0001), AKI 4.416% vs. 1.717% (p<0.0001), VTE 3.538% vs. 1.293% (p<0.0001), sepsis 3.887% vs. 1.179% (p<0.0001), IS 0.585% vs. 0.16% (p<0.0001), and MI 1.34% vs. 0.519% (p<0.0001).
CONCLUSION
COVID-19 infection is associated with an almost five-fold increase in shunt revisions.
引言
新冠病毒病（COVID-19）患者经常出现头痛、不适和疲劳症状。对于患有分流性脑积水的患者，这些体征和症状通常可能表明分流失败。因此，确定该患者群体中是否发生分流失败可能具有挑战性。因此，我们探讨了分流性脑积水患者的COVID-19诊断如何影响分流修正率的问题。
方法
我们使用一个去识别化的数据库网络（TriNetX），收集2020年1月20日至2021年9月26日期间患有分流性脑积水且感染COVID-19与未感染COVID-19患者的信息。我们感兴趣的主要结局是90天时的分流修正，次要结局包括死亡率、住院率、重症监护病房（ICU）入住率、机械通气、气管切开术、经皮内镜下胃造口术（PEG）置管、跌倒、癫痫发作、急性肾损伤（AKI）、静脉血栓栓塞（VTE）、缺血性中风（I.S.）、心肌梗死（MI）和脓毒症。对队列进行倾向评分匹配，以平衡常见合并症和人口统计学特征。
结果
经过倾向评分匹配后，确定了10600例患有分流性脑积水且感染COVID-19的患者（队列1）和10600例患有分流性脑积水但未感染COVID-19的患者（队列2）。平均年龄为38.5岁。队列1中有834例患者（7.869%）接受了分流修正，队列2中有180例患者（1.698%）接受了分流修正（p<0.0001，比值比[OR]4.978，95%置信区间[CI]4.198，5.821）。死亡率分别为4.642%和2.113%（p<0.0001，OR 2.255，95%CI 1.921，2.647）。住院率分别为27.72%和10.303%（p<0.0001），ICU入住率分别为11.567%和3.463%（p<0.0001）。呼吸机依赖率分别为3.529%和0.953%（p<0.0001），气管切开率分别为1.142%和0.236%（p<0.0001），PEG置管率分别为2.472%和0.585%（p<0.0001），跌倒率分别为2.321%和1.076%（p<0.0001），癫痫发作率分别为11.369%和5.953%（p<0.0001），AKI发生率分别为4.416%和1.717%（p<0.0001），VTE发生率分别为3.538%和1.293%（p<0.0001），脓毒症发生率分别为3.887%和1.179%（p<0.0001），I.S.发生率分别为0.585%和0.16%（p<0.0001），MI发生率分别为1.34%和0.519%（p<0.0001）。
结论
COVID-19感染与分流修正率几乎增加五倍相关。
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