Hadidchi Roham, Al-Ani Yousef, Choi Solbie, Renteria Silhouette, Duong Katie S, Henry Sonya, Wang Stephen H, Duong Tim Q
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.
J Neurol Sci. 2025 Jun 15;473:123477. doi: 10.1016/j.jns.2025.123477. Epub 2025 Apr 2.
This study investigated post COVID-19 outcomes of patients with pre-existing neurological conditions up to 3.5 years post-infection.
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.
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).
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.
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。
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。
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）。
在调整主要竞争风险后，感染新冠病毒的既往有神经系统疾病的患者与对照组相比，预后更差。识别高危个体有助于进行更密切的随访。
