tetano
Editor, Senior Moderator
J Neurol Sci
. 2021 Aug 5;428:117610.
doi: 10.1016/j.jns.2021.117610. Online ahead of print.
Neurological comorbidities and COVID-19-related case fatality: A cohort study
Alberto Romagnolo[SUP] 1 [/SUP], Gabriele Imbalzano[SUP] 2 [/SUP], Carlo Alberto Artusi[SUP] 2 [/SUP], Roberta Balestrino[SUP] 3 [/SUP], Claudia Ledda[SUP] 2 [/SUP], Francesco Giuseppe De Rosa[SUP] 4 [/SUP], Franco Riccardini[SUP] 5 [/SUP], Elisa Montanaro[SUP] 2 [/SUP], Marco Bozzali[SUP] 6 [/SUP], Mario Giorgio Rizzone[SUP] 2 [/SUP], Maurizio Zibetti[SUP] 2 [/SUP], Leonardo Lopiano[SUP] 2 [/SUP]
Affiliations
Abstract
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.
Keywords: COVID-19; Dementia; Mortality; Neurology; Stroke.
. 2021 Aug 5;428:117610.
doi: 10.1016/j.jns.2021.117610. Online ahead of print.
Neurological comorbidities and COVID-19-related case fatality: A cohort study
Alberto Romagnolo[SUP] 1 [/SUP], Gabriele Imbalzano[SUP] 2 [/SUP], Carlo Alberto Artusi[SUP] 2 [/SUP], Roberta Balestrino[SUP] 3 [/SUP], Claudia Ledda[SUP] 2 [/SUP], Francesco Giuseppe De Rosa[SUP] 4 [/SUP], Franco Riccardini[SUP] 5 [/SUP], Elisa Montanaro[SUP] 2 [/SUP], Marco Bozzali[SUP] 6 [/SUP], Mario Giorgio Rizzone[SUP] 2 [/SUP], Maurizio Zibetti[SUP] 2 [/SUP], Leonardo Lopiano[SUP] 2 [/SUP]
Affiliations
- PMID: 34384971
- DOI: 10.1016/j.jns.2021.117610
Abstract
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.
Keywords: COVID-19; Dementia; Mortality; Neurology; Stroke.