Background

Neurological involvement in Coronavirus disease-2019 (COVID-19) is widely recognized. However, the role of pre-existing neurological comorbidities in modulating COVID-19-related mortality still remains unclear. This cohort study evaluates the COVID-19-related case fatality rate (CFR) of patients with pre-existing neurological diseases.

Methods

We retrospectively evaluated all patients consecutively admitted to our hospital with a diagnosis of COVID-19 between March and April 2020. We used a multivariate regression analysis to estimate the association between pre-existing neurological diseases and COVID-19-related mortality. Then, we compared the CFR and survival curves of two cohorts (patients suffering vs. those not suffering from pre-existing neurological disease), matched trough the propensity score (PS). Age and other comorbidities were considered for PS calculation. We applied a 1:1 matching for the entire neurological cohort and, separately, for cerebrovascular, neurodegenerative, and other neurological diseases.

Results

Among 332 patients, 75 (22.6%) were affected by pre-existing neurological disease (n = 29 cerebrovascular, n = 26 neurodegenerative, n = 20 others). From the multivariate regression analysis, they resulted with a significant increase of COVID-19-related mortality (OR:2.559; 95%CI 1.181–5.545; p < 0.017). From the cohort analysis, CFR resulted 2-fold higher in patients with neurological disease (48.0% vs. 24.0%; p = 0.002). CFR was significantly higher in patients with neurodegenerative diseases compared to matched individuals (73.9% vs. 39.1%; p = 0.017), while CFR increase in patients with cerebrovascular diseases did not reach statistical significance (48.3% vs. 41.4%; p = 0.597).

Conclusions

Pre-existing neurological comorbidities, in particular neurodegenerative diseases, increase significantly COVID-19-related case fatality, indicating a clear priority for viral screening, access to care facilities and vaccination in these populations.

中文翻译：

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神经系统合并症和 COVID-19 相关病死率：一项队列研究

背景

2019 年冠状病毒病 (COVID-19) 的神经系统受累已得到广泛认可。然而，先前存在的神经系统合并症在调节 COVID-19 相关死亡率中的作用仍不清楚。这项队列研究评估了先前患有神经系统疾病的患者与 COVID-19 相关的病死率 (CFR)。

方法

我们回顾性评估了 2020 年 3 月至 2020 年 4 月期间连续入院诊断为 COVID-19 的所有患者。我们使用多元回归分析来估计既往神经系统疾病与 COVID-19 相关死亡率之间的关联。然后，我们比较了两个队列（患有与未患有既往神经系统疾病的患者）的病死率和生存曲线，通过倾向评分 (PS) 匹配。PS 计算考虑了年龄和其他合并症。我们对整个神经系统队列应用了 1:1 匹配，并分别对脑血管、神经退行性和其他神经系统疾病进行了匹配。

结果

在 332 名患者中，75 名 (22.6%) 受到先前存在的神经系统疾病的影响（n  = 29 脑血管疾病，n  = 26 神经退行性病变，n  = 20 其他疾病）。从多元回归分析来看，它们导致 COVID-19 相关死亡率显着增加（OR：2.559；95%CI 1.181–5.545；p  < 0.017）。从队列分析来看，神经系统疾病患者的病死率高出 2 倍（48.0% 对 24.0%；p  = 0.002）。与匹配的个体相比，神经退行性疾病患者的病死率显着更高（73.9% 对 39.1%；p  = 0.017），而脑血管病患者的病死率增加没有达到统计学意义（48.3% 对 41.4% ；p = 0.017）。p  = 0.597）。

结论

先前存在的神经系统合并症，特别是神经退行性疾病，会显着增加与 COVID-19 相关的病死率，这表明在这些人群中进行病毒筛查、获得护理设施和接种疫苗是明确的优先事项。