感染新型冠状病毒2（SARS-CoV-2）之前就存在神经系统疾病的患者的长期预后。

Long-term outcomes of patients with a pre-existing neurological condition after SARS-CoV-2 infection.

作者信息

Hadidchi Roham, Al-Ani Yousef, Choi Solbie, Renteria Silhouette, Duong Katie S, Henry Sonya, Wang Stephen H, Duong Tim Q

机构信息

Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA.

Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA; Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.

出版信息

J Neurol Sci. 2025 Jun 15;473:123477. doi: 10.1016/j.jns.2025.123477. Epub 2025 Apr 2.

DOI:10.1016/j.jns.2025.123477

PMID:40328113

Abstract

OBJECTIVES

This study investigated post COVID-19 outcomes of patients with pre-existing neurological conditions up to 3.5 years post-infection.

METHODS

This retrospective study consisted of 1664 patients with COVID-19 (of which 1320 had been hospitalized for acute COVID-19) and 8985 non-COVID patients from the Montefiore Health System in the Bronx (Jan-2016 to Jul-2023). Pre-existing neurological conditions include dementia, mild cognitive impairment, multiple sclerosis, and Parkinson's disease. Primary outcomes were all-cause mortality and major adverse cardiovascular events (MACE) post-COVID-19. Secondary outcomes were depression, anxiety, fatigue, headache, sleep disturbances, altered mental status, and dyspnea post-COVID-19. Multivariate Cox proportional hazards model was used to calculate adjusted hazard ratios for primary outcomes. Cumulative incidence function and Fine-Gray sub-distribution hazards model analysis were performed for secondary outcomes.

RESULTS

Patients with a pre-existing neurological disorders hospitalized for COVID-19 were more likely to die (adjusted hazard ratio = 1.90 [CI:1.57, 2.28], P < 0.005) whereas patients non-hospitalized for COVID-19 had similar mortality rate (aHR = 0.85 [CI:0.47, 1.54]. P = 0.59) compared to non-COVID patients. Patients with a neurological disorders (hospitalized for COVID-19 aHR = 1.76 [CI:1.53, 2.03], P < 0.005; not hospitalized for COVID-19: aHR = 1.50 [CI:1.09, 2.05], P = 0.01) were more likely to experience a MACE compared to non-COVID-19 patients. Blacks (aHR = 1.49) and Hispanics (aHR = 1.35) had a higher risk of post-COVID-19 MACE. Both hospitalized and non-hospitalized COVID-19 patients were more likely to develop altered mental status, fatigue, sleep disturbance, dyspnea compared to non-COVID patients (p < 0.05).

CONCLUSIONS

Patients with pre-existing neurological conditions who contracted SARS-CoV-2 were more likely to have worse outcomes compared to controls after adjusting for major competing risks. Identifying at-risk individuals could enable more diligent follow-up.

摘要

目的

本研究调查了既往有神经系统疾病的患者在感染新冠病毒后长达3.5年的预后情况。

方法

这项回顾性研究纳入了蒙特菲奥里医疗系统（位于布朗克斯区，时间为2016年1月至2023年7月）的1664例新冠病毒感染患者（其中1320例因急性新冠病毒感染住院）和8985例非新冠患者。既往存在的神经系统疾病包括痴呆、轻度认知障碍、多发性硬化症和帕金森病。主要结局为新冠病毒感染后的全因死亡率和主要不良心血管事件（MACE）。次要结局为新冠病毒感染后的抑郁、焦虑、疲劳、头痛、睡眠障碍、精神状态改变和呼吸困难。采用多变量Cox比例风险模型计算主要结局的调整后风险比。对次要结局进行累积发病率函数和Fine-Gray亚分布风险模型分析。

结果

因新冠病毒感染住院的既往有神经系统疾病的患者死亡风险更高（调整后风险比=1.90[CI：1.57,2.28]，P<0.005），而未因新冠病毒感染住院的患者与非新冠患者相比死亡率相似（调整后风险比=0.85[CI：0.47,1.54]，P=0.59）。与非新冠患者相比，患有神经系统疾病的患者（因新冠病毒感染住院：调整后风险比=1.76[CI：1.53,2.03]，P<0.005；未因新冠病毒感染住院：调整后风险比=1.50[CI：1.09,2.05]，P=0.01）发生MACE的可能性更大。黑人（调整后风险比=1.49）和西班牙裔（调整后风险比=1.35）发生新冠病毒感染后MACE的风险更高。与非新冠患者相比，因新冠病毒感染住院和未住院的患者发生精神状态改变、疲劳、睡眠障碍、呼吸困难的可能性更大（P<0.05）。