Desouky Adam, Fuentes Venessa, Tiwari Chhitij, Usui Hikari, Smith Ayala Arthor H, Wilson Susan E, Diaz Monica M
Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
Department of Neurology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States.
Front Neurol. 2024 Jul 10;15:1434046. doi: 10.3389/fneur.2024.1434046. eCollection 2024.
Coronavirus disease 2019 (COVID-19) infection has been associated with severe neurological consequences, including stroke or seizures, and less severe neurological sequelae, including headaches, dizziness, and anosmia. Earlier COVID-19 variants were associated with high morbidity and mortality; however, knowledge of the impact of neurological conditions in the setting of COVID-19 on healthcare outcomes is limited. We sought to determine the impact of acute neurological conditions and acute COVID-19 infection on inpatient hospitalization outcomes.
This was a retrospective, observational study of adult patients who were admitted to a large academic medical center in the Southeastern US between April 2020 and December 2021 with acute COVID-19 infection and a neurological diagnosis. Patient demographics, medical history, neurological diagnoses, and hospitalization outcomes were obtained from the medical record. Descriptive statistics and unadjusted and adjusted logistic regression analyses were performed.
Of the 1,387 patients included in this study, 27% died and 23% were kept under ventilation during hospitalization. The mean +/- standard deviation (SD) age was 64.6+/-16.9 years, with 52.8% women and 30.1% identifying as Black/African American. The most common neurological conditions included ischemic stroke (35.0%), movement disorder (12.0%), and hemorrhagic stroke (10.7%). In-hospital death was most common among those with epilepsy ( = 0.024), headache ( = 0.026), and dementia ( < 0.0001) compared to individuals without those conditions. Ventilation support was given more commonly to dementia patients ( = 0.020). Age was a significant risk factor for death ( < 0.001) and hospital length of stay (LOS) for ventilation ( < 0.001), but no neurological condition was a significant factor in adjusted logistic regression analyses.
Mortality was high in this study, with more than one-quarter of patients dying in the hospital. Death was the most common among those with epilepsy, headache, or dementia, but no neurological condition increased the risk of in-hospital mortality or ventilation. Future studies would determine the long-term neurological sequelae of those discharged from the hospital with COVID-19 and a neurological condition.
2019冠状病毒病（COVID-19）感染与严重的神经系统后果有关，包括中风或癫痫发作，以及不太严重的神经系统后遗症，如头痛、头晕和嗅觉丧失。早期的COVID-19变体与高发病率和死亡率相关；然而，关于COVID-19背景下神经系统疾病对医疗结果影响的了解有限。我们试图确定急性神经系统疾病和急性COVID-19感染对住院治疗结果的影响。
这是一项对2020年4月至2021年12月期间入住美国东南部一家大型学术医疗中心、患有急性COVID-19感染并伴有神经系统诊断的成年患者进行的回顾性观察研究。从病历中获取患者的人口统计学信息、病史、神经系统诊断和住院治疗结果。进行描述性统计以及未调整和调整后的逻辑回归分析。
本研究纳入的1387例患者中，27%死亡，23%在住院期间接受通气治疗。平均年龄±标准差为64.6±16.9岁，女性占52.8%，黑人/非裔美国人占30.1%。最常见的神经系统疾病包括缺血性中风（35.0%）、运动障碍（12.0%）和出血性中风（10.7%）。与没有癫痫、头痛和痴呆症的患者相比，患有癫痫（P = 0.024）、头痛（P = 0.026）和痴呆症（P < 0.0001）的患者住院死亡最为常见。痴呆症患者更常接受通气支持（P = 0.020）。年龄是死亡（P < 0.001）和通气住院时间（LOS）的显著危险因素（P < 0.001），但在调整后的逻辑回归分析中，没有神经系统疾病是显著因素。
本研究中的死亡率很高，超过四分之一的患者在医院死亡。死亡在患有癫痫、头痛或痴呆症的患者中最为常见，但没有神经系统疾病会增加住院死亡率或通气风险。未来的研究将确定患有COVID-19和神经系统疾病出院患者的长期神经系统后遗症。
