Objective

To describe the clinical features and disease course of COVID-19 in veterans with spinal cord injury (SCI).

Design

Case series of consecutive veterans with SCI treated at a single center.

Setting

SCI Unit at an urban Veterans Administration hospital at the epicenter of the COVID-19 pandemic in the US.

Participants

Seven SCI veterans with confirmed COVID-19 infection by PCR; all veterans were male, mean age was 60.6. Five had cervical level of injury, and five had complete injury (AIS A). Six veterans had a BMI > 22; three had chronic obstructive pulmonary disease; three had chronic kidney disease.

Interventions

None.

Outcome Measures

Presence of co-morbidities, diagnostic values, and clinical findings.

Results

Each case presented differently; the most common presenting sign was fever. In the three individuals with critical and fatal infection, pre-existing comorbidities were more common and inflammatory markers were markedly elevated.

Conclusion

Level and completeness of SCI did not appear to correlate with COVID-19 severity, as mild and asymptomatic illness was noted in persons with high grade SCI. As has been shown to be the case in the general population, pre-existing comorbidities are the most reliable predictors of severe SARS-CoV-2 infection currently available for persons with chronic SCI. Contrary to concerns that SCI may mask the cardinal signs of COVID-19, such as fever and cough, by way of compromised thermoregulation and thoracoabdominal musculature, such signs were common in our series. To facilitate early detection, prompt treatment, and minimized viral spread, the implementation of preventive strategies by SCI units is recommended.

中文翻译：

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退伍军人管理医院脊髓损伤患者的 COVID-19：病例系列

客观的

描述 COVID-19 在脊髓损伤 (SCI) 退伍军人中的临床特征和病程。

设计

在一个中心接受 SCI 治疗的连续退伍军人病例系列。

环境

位于美国 COVID-19 大流行中心的城市退伍军人管理局医院的脊髓损伤科。

参加者

七名经 PCR 确认感染 COVID-19 的 SCI 退伍军人；所有退伍军人均为男性，平均年龄为 60.6 岁。五个有颈椎损伤，五个有完全损伤（AIS A）。六名退伍军人的 BMI > 22；三人患有慢性阻塞性肺病；三人患有慢性肾病。

干预措施

没有任何。

结果措施

合并症的存在、诊断价值和临床发现。

结果

每个案例都有不同的表现；最常见的症状是发烧。在三个患有危重和致命感染的个体中，预先存在的合并症更为常见，并且炎症标志物显着升高。

结论

SCI 的水平和完整性似乎与 COVID-19 的严重程度无关，因为在严重 SCI 的人中发现了轻度和无症状的疾病。正如在普通人群中所证明的那样，已有的合并症是目前可用于慢性 SCI 患者的严重 SARS-CoV-2 感染的最可靠预测指标。与 SCI 可能通过体温调节和胸腹肌肉组织受损来掩盖 COVID-19 的主要体征（例如发烧和咳嗽）的担忧相反，这些体征在我们的系列中很常见。为了促进早期发现、及时治疗和尽量减少病毒传播，建议 SCI 单位实施预防策略。