Dias Jesângeli de Sousa, Rebouças Maria Augusta Moreira, Carvalho Lilian Verena da Silva, Silva Thais Sampaio, Santos Jair Santana Dos, Melendez Astrid Xiomara Tatiana Otero, Brites Carlos
Programa de Pós-Graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Bahia, Brazil; Instituto Couto Maia, Salvador, Bahia, Brazil.
Instituto Couto Maia, Salvador, Bahia, Brazil.
Braz J Infect Dis. 2025 May 26;29(4):104542. doi: 10.1016/j.bjid.2025.104542.
Neurologic manifestations of Coronavirus Disease-19 (COVID-19) have been associated with patients' disease severity and outcome. This study aimed to describe the frequency and characteristics of the neurological manifestations in a group of hospitalized individuals with COVID-19 and their associations with patient outcomes.
Patients aged 18 years or older admitted to a local hospital between April and June 2020 with SARS-CoV-2 detected by RT-PCR were included in this retrospective observational study. The characteristics of participants were collected from electronic medical records using a structured questionnaire. A Poisson regression model was used to examine the influence of neurological manifestations on mortality.
A total of 305 participants with COVID-19 were included, with 57.7 % of them presenting neurological symptoms. There were 62 (20.3 %) individuals with acute encephalopathy, with a mean age of 65.5 ± 15.9 years. In this group, higher Prevalence Ratios (PR) of comorbidities (1.6) and severe disease (3.6) were present, predisposing factors for acute encephalopathy. They were also more likely to be admitted to the intensive care unit (3.1) and to die (2.4). The median Neutrophil-Lymphocyte Ratio (NLR) was 7 (Interquartile Range [IQR: 4‒12]). Fifty-two (17 %) participants presented chemosensory dysfunction, with a mean age 53.3 ± 14 years and a lower PR of comorbidity (0.8) than those without. The severe diseases' PR was slightly higher (1.1), but the PR of ICU admission (0.7), and deaths (0.4) was lower. The LNR was 3.8 (IQR: 2.2-7.8). Poisson regression analysis revealed that severe illness (PR = 3.13), cardiopathy (PR = 1.65), acute encephalopathy (PR = 1.49), diabetes (PR = 1.46), and neutrophil-lymphocyte ratio (PR = 1.04) were associated with death. Conversely, having chemosensory disorders (PR = 0.44) and a prolonged hospital stay (PR = 0.96) were associated with survival.
Patients with acute encephalopathy had more severe forms of COVID-19 and higher mortality. In contrast, chemosensory dysfunction was associated with milder disease manifestations and a better prognosis.
新型冠状病毒肺炎（COVID-19）的神经系统表现与患者的疾病严重程度及预后相关。本研究旨在描述一组住院COVID-19患者神经系统表现的频率和特征及其与患者预后的关联。
本回顾性观察性研究纳入了2020年4月至6月期间在当地医院住院、经逆转录聚合酶链反应（RT-PCR）检测出严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的18岁及以上患者。使用结构化问卷从电子病历中收集参与者的特征。采用泊松回归模型检验神经系统表现对死亡率的影响。
共纳入305例COVID-19患者，其中57.7%出现神经系统症状。有62例（20.3%）患者发生急性脑病，平均年龄为65.5±15.9岁。在这组患者中，合并症（患病率比[PR]为1.6）和重症（PR为3.6）的患病率较高，是急性脑病的易感因素。他们也更有可能入住重症监护病房（PR为3.1）和死亡（PR为2.4）。中性粒细胞与淋巴细胞比值（NLR）的中位数为7（四分位间距[IQR：4-12]）。52例（17%）参与者出现化学感觉功能障碍，平均年龄为53.3±14岁，合并症的PR（0.8）低于未出现化学感觉功能障碍的患者。重症的PR略高（1.1），但入住重症监护病房（PR为0.7）和死亡（PR为0.4）的PR较低。LNR为3.8（IQR：2.2-7.8）。泊松回归分析显示，重症（PR=3.13）、心脏病（PR=1.65）、急性脑病（PR=1.49）、糖尿病（PR=1.46）和中性粒细胞与淋巴细胞比值（PR=1.04）与死亡相关。相反，有化学感觉障碍（PR=0.44）和住院时间延长（PR=0.96）与生存相关。
急性脑病患者的COVID-19病情更严重，死亡率更高。相比之下，化学感觉功能障碍与较轻的疾病表现和较好的预后相关。
