Sorbonne Université, AP-HP, Pitié-Salpêtrière Charles-Foix Hospital Group, Clinical Neurophysiology Department, EEG-Epilepsy Unit, Functional Exploration Unit for the Older Patients, Paris, France.
Sorbonne Université, AP-HP, Pitié-Salpêtrière Hospital, Epileptology Unit, Paris, France.
Brain Behav. 2022 Dec;12(12):e2787. doi: 10.1002/brb3.2787. Epub 2022 Nov 10.
Little is known about risk factors for mortality in older patients with COVID-19 and neuropsychiatric conditions.
We conducted a multicentric retrospective observational study at Assistance Publique-Hôpitaux de Paris. We selected inpatients aged 70 years or older, with COVID-19 and preexisting neuropsychiatric comorbidities and/or new neuropsychiatric manifestations. We examined demographics, comorbidities, functional status, and presentation including neuropsychiatric symptoms and disorders, as well as paraclinical data. Cox survival analysis was conducted to determine risk factors for mortality at 40 days after the first symptoms of COVID-19.
Out of 191 patients included (median age 80 [interquartile range 74-87]), 135 (71%) had neuropsychiatric comorbidities including cognitive impairment (39%), cerebrovascular disease (22%), Parkinsonism (6%), and brain tumors (6%). A total of 152 (79%) patients presented new-onset neuropsychiatric manifestations including sensory symptoms (6%), motor deficit (11%), behavioral (18%) and cognitive (23%) disturbances, gait impairment (11%), and impaired consciousness (18%). The mortality rate at 40 days was 19.4%. A history of brain tumor or Parkinsonism or the occurrence of impaired consciousness were neurological factors associated with a higher risk of mortality. A lower Activities of Daily Living score (hazard ratio [HR] 0.69, 95% confidence interval [CI] 0.58-0.82), a neutrophil-to-lymphocyte ratio ≥ 9.9 (HR 5.69, 95% CI 2.69-12.0), and thrombocytopenia (HR 5.70, 95% CI 2.75-11.8) independently increased the risk of mortality (all p < .001).
Understanding mortality risk factors in older inpatients with COVID-19 and neuropsychiatric conditions may be helpful to neurologists and geriatricians who manage these patients in clinical practice.
对于 COVID-19 合并神经精神疾病的老年患者的死亡风险因素，我们知之甚少。
我们在巴黎公立医院集团进行了一项多中心回顾性观察性研究。我们选择了年龄在 70 岁或以上、患有 COVID-19 且合并有神经精神共病或新发神经精神表现的住院患者。我们检查了人口统计学、合并症、功能状态和表现，包括神经精神症状和障碍以及临床相关数据。我们进行了 Cox 生存分析，以确定 COVID-19 症状出现后 40 天死亡的风险因素。
共纳入 191 例患者（中位年龄 80 岁[四分位距 74-87]），其中 135 例（71%）存在神经精神合并症，包括认知障碍（39%）、脑血管病（22%）、帕金森病（6%）和脑肿瘤（6%）。共有 152 例（79%）患者出现新发神经精神表现，包括感觉症状（6%）、运动缺陷（11%）、行为（18%）和认知（23%）障碍、步态障碍（11%）和意识障碍（18%）。40 天死亡率为 19.4%。脑瘤或帕金森病病史或意识障碍的发生是与死亡率升高相关的神经学因素。日常生活活动评分较低（危险比[HR]0.69，95%置信区间[CI]0.58-0.82）、中性粒细胞与淋巴细胞比值≥9.9（HR5.69，95%CI2.69-12.0）和血小板减少症（HR5.70，95%CI2.75-11.8）均独立增加死亡风险（均 P<0.001）。
了解 COVID-19 合并神经精神疾病的老年住院患者的死亡风险因素可能有助于管理这些患者的神经病学家和老年病学家在临床实践中进行决策。
