有脑血管疾病史但无痴呆症会增加感染 SARS-CoV-2 时发生继发性血管事件的风险，尤其是感染奥密克戎变异株时：一项回顾性观察研究。
History of cerebrovascular disease but not dementia increases the risk for secondary vascular events during SARS-CoV-2 infection with presumed Omicron variant: a retrospective observational study.
机构信息
Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
出版信息
Eur J Neurol. 2023 Aug;30(8):2297-2304. doi: 10.1111/ene.15843. Epub 2023 May 25.
BACKGROUND AND PURPOSE
This study aimed to investigate if pre-existing neurological conditions, such as dementia and a history of cerebrovascular disease, increase the risk of severe outcomes including death, intensive care unit (ICU) admission and vascular events in patients hospitalized with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in 2022, when Omicron was the predominant variant.
METHODS
A retrospective analysis was conducted of all patients with SARS-CoV-2 infection, confirmed by polymerase chain reaction test, admitted to the University Medical Center Hamburg-Eppendorf from 20 December 2021 until 15 August 2022. In all, 1249 patients were included in the study. In-hospital mortality was 3.8% and the ICU admission rate was 9.9%. Ninety-three patients with chronic cerebrovascular disease and 36 patients with pre-existing all-cause dementia were identified and propensity score matching by age, sex, comorbidities, vaccination status and dexamethasone treatment was performed in a 1:4 ratio with patients without the respective precondition using nearest neighbor matching.
RESULTS
Analysis revealed that neither pre-existing cerebrovascular disease nor all-cause dementia increased mortality or the risk for ICU admission. All-cause dementia in the medical history also had no effect on vascular complications under investigation. In contrast, an increased odds ratio for both pulmonary artery embolism and secondary cerebrovascular events was observed in patients with pre-existing chronic cerebrovascular disease and myocardial infarction in the medical history.
CONCLUSION
These findings suggest that patients with pre-existing cerebrovascular disease and myocardial infarction in their medical history may be particularly susceptible to vascular complications following SARS-CoV-2 infection with presumed Omicron variant.
背景与目的
本研究旨在探讨 2022 年奥密克戎（Omicron）为主导变异株时，是否存在神经退行性疾病（如痴呆和脑血管疾病病史）等预先存在的神经状况会增加严重结局（包括死亡、入住重症监护病房（ICU）和血管事件）的风险，这些严重结局是在因严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）感染而住院的患者中发生的。
方法
对 2021 年 12 月 20 日至 2022 年 8 月 15 日期间因聚合酶链反应（PCR）检测确诊 SARS-CoV-2 感染而入住汉堡大学医学中心（德国）的所有患者进行了回顾性分析。共有 1249 例患者纳入本研究。院内死亡率为 3.8%，入住 ICU 的比例为 9.9%。共发现 93 例患有慢性脑血管疾病和 36 例患有预先存在的全因痴呆症的患者，通过年龄、性别、合并症、疫苗接种状态和地塞米松治疗进行倾向评分匹配，并以无相应条件的患者为对照组进行 1：4 的最近邻匹配。
结果
分析表明，预先存在的脑血管疾病或全因痴呆症均不会增加死亡率或 ICU 入住风险。既往病史中的全因痴呆症也不会增加正在研究的血管并发症的风险。相反，在预先存在慢性脑血管疾病和既往心肌梗死病史的患者中，观察到肺栓塞和继发性脑血管事件的比值比均增加。
结论
这些发现表明，患有预先存在的脑血管疾病和既往心肌梗死病史的患者可能特别容易在 SARS-CoV-2 感染后发生血管并发症，假设奥密克戎变异株是主要的感染源。
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