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Zhong J, Wu Y, Zhou S, Liu C, Wen Y, Liang M, Li T, Lu T, Lv S, Gong Z, Lao D, Cao X, Tang Y, Huang W. The impact of COVID-19 on a Southern Chinese cohort with neuromyelitis optica spectrum disorders. Mult Scler Relat Disord 2024; 81:105120. [PMID: 37979411 DOI: 10.1016/j.msard.2023.105120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/07/2023] [Accepted: 10/31/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND There are few studies on risk factors for coronavirus disease 2019 (COVID-19) infection in patients with Neuromyelitis Optica Spectrum Disorders (NMOSD). The relationship between NMOSD relapse and COVID-19 needs to be evaluated. The objective of our study is to identify the risk factors of COVID-19 infection and NMOSD relapse among NMOSD patients with COVID-19. METHOD A total of 379 NMOSD patients registered in a NMOSD database were included in this case-control study after the end of the COVID-19 quarantine and restriction policies on December 6, 2022 in China. Data were obtained from the database. Additional information was obtained by questionnaires and the Neurology out-patient clinic. The clinical characteristics of NMOSD patients with COVID-19 were described. Risk factors associated with COVID-19 infection and outcome among patients with NMOSD were analyzed. Risk factors associated with relapse in NMOSD patients with COVID-19 were also identified. RESULTS 239 (63.1%) NMOSD patients were infected with COVID-19. Patients with NMOSD who were infected with COVID-19, in comparison to those without COVID-19, were younger at the time of interview (median [IQR] age: 43.00 [32.00-55.00] vs 49.50 [35.25-56.00] years, P = 0.029), younger at NMOSD onset (median [IQR] age: 38.00 [27.00-51.00] vs 45.00 [32.00-52.75] years, P = 0.013), had abnormal visual evoked potentials before infection (73.4% vs 54.3% P = 0.029), had lower baseline Activities of Daily Living Scale (ADL) scores (median [IQR] ADL: 14.00 [14.00-16.00] vs 14.00 [14.00-19.00], P = 0.014) or lower baseline modified Rankin Scale (mRS) scores (1.12±0.749 vs 1.33±0.991, P = 0.037), and were less frequently treated with more than 10 mg prednisone or 8 mg methylprednisolone (25.0% vs 36.0%,p = 0.026). All 9 NMOSD patients who had symptomatic cerebral syndrome developed moderate/severe COVID-19. A higher percentage of patients with moderate/severe COVID-19 experienced more than one core clinical NMOSD symptoms (61.5% vs 55.1%, p = 0.044), compared to patients with mild COVID-19. Higher risk of NMOSD relapse among NMOSD patients with COVID-19 was associated with higher Expanded Disability Status Scale (EDSS) scores (median[IQR] EDSS: 2.00 [1.00-3.00] vs 1.50 [1.00-2.25], P = 0.037) and drug treatments disruption (21.6% vs 5.0% P<0.001). CONCLUSIONS NMOSD patients with younger age, lower baseline ADL or mRS had higher incidence of being diagnosed with COVID-19 during pandemic. Glucocorticoid use may decrease the risk of COVID-19. NMOSD patients with symptomatic cerebral syndrome before the COVID-19 pandemic are associated with worse COVID-19 outcomes. Drug treatment disruption may result in relapse among NMOSD patients with COVID-19.
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Affiliation(s)
- Jian Zhong
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | - Yu Wu
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Shaodan Zhou
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | - Chao Liu
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | - Yishuang Wen
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | - Manli Liang
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | - Taiyan Li
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | - Ting Lu
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | - Sirao Lv
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | - Zhuowei Gong
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | - Dayuan Lao
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | - Xiaoli Cao
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | - Yulan Tang
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | - Wen Huang
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Guangxi, China.
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Guo Y, Lin J, Wu T, Zhou T, Mu Y. Risk factors for delirium among hospitalized adults with COVID-19: A systematic review and meta-analysis of cohort studies. Int J Nurs Stud 2023; 148:104602. [PMID: 37801933 DOI: 10.1016/j.ijnurstu.2023.104602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 07/13/2023] [Accepted: 08/28/2023] [Indexed: 10/08/2023]
Abstract
OBJECTIVES This study aims to systematically assess the risk factors, the overall strength of association, and evidence quality related to delirium among adults hospitalized with COVID-19. METHODS A comprehensive search was conducted in thirteen databases from inception to February 10, 2023. The included databases were thoroughly searched, including PubMed, Web of Science, Proquest, Ovid MEDLINE, CINAHL, Scopus, the Cochrane Library, FMRS, Wanfang Database, Chinese Biomedical Database (CBM), China Knowledge Resource Integrated Database (CNKI), Weipu Database (VIP), and Embase. The search was limited to articles published in English and Chinese. The selected studies were screened, data were extracted, and the quality was evaluated using the Newcastle-Ottawa Scale. Meta-analysis was performed using RevMan 5.4 software. The certainty of the evidence was assessed using the GRADE criteria. RESULTS A total of 22 cohort studies with a sample size of 11,957 individuals were included in the analysis. Among these studies, 20 were of high quality, while the remaining 2 were of moderate quality. The risk factors that showed the strongest association with delirium were prior cognitive impairment (including dementia), mechanical ventilation, and ICU admission. Age, frailty (Clinical Frailty Scale score > 5), antipsychotic use, benzodiazepine use, neutrophil-to-lymphocyte ratio, and vasopressor use were identified as moderate risk factors for delirium. According to the GRADE evaluation, ICU admission, benzodiazepine use, neutrophil-to-lymphocyte ratio, and vasopressor use had a high-quality body of evidence, while antipsychotic usage had an intermediate-quality body of evidence. All other risk factors had a low-quality body of evidence. CONCLUSIONS This systematic review and meta-analysis identified several medium- to high-intensity risk factors for delirium in hospitalized adults with COVID-19. ICU admission, benzodiazepine usage, neutrophil-to-lymphocyte ratio, antipsychotic use, and vasopressor use were associated with delirium and were supported by medium- to high-quality evidence. These findings provide healthcare professionals with an evidence-based basis for managing and treating delirium in hospitalized adults with COVID-19.
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Affiliation(s)
- Yating Guo
- College of Nursing, Fujian University of Traditional Chinese Medicine, Fujian, China.
| | - Jiamin Lin
- College of Nursing, Fujian University of Traditional Chinese Medicine, Fujian, China.
| | | | - Tingting Zhou
- School of Nursing, Fudan University, Shanghai, China.
| | - Yan Mu
- Fujian Provincial Hospital, Teaching Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, China.
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Otani K, Fukushima H, Matsuishi K. COVID-19 delirium and encephalopathy: Pathophysiology assumed in the first 3 years of the ongoing pandemic. BRAIN DISORDERS 2023; 10:100074. [PMID: 37056914 PMCID: PMC10076074 DOI: 10.1016/j.dscb.2023.100074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 04/03/2023] [Accepted: 04/04/2023] [Indexed: 04/15/2023] Open
Abstract
Background The coronavirus disease (COVID-19) continues to spread worldwide. It has a high rate of delirium, even in young patients without comorbidities. Infected patients required isolation because of the high infectivity and virulence of COVID-19. The high prevalence of delirium in COVID-19 primarily results from encephalopathy and neuroinflammation caused by acute respiratory distress syndrome (ARDS)-associated cytokine storm. Acute respiratory distress syndrome has been linked to delirium and psychotic symptoms in the subacute phase (4 to 12 weeks), termed post-acute COVID-19 syndrome (PACS), and to brain fog, cognitive dysfunction, and fatigue, termed "long COVID," which persists beyond 12 weeks. However, no review article that mentions "COVID-19 delirium" have never been reported. Basic Procedures This narrative review summarizes data on delirium associated with acute severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and related neurological symptoms of persistent post-infection illness (PACS or long COVID) after persistence of cognitive dysfunction. Thus, we describe the pathophysiological hypothesis of COVID-19 delirium and its continuation as long COVID. This review also describes the treatment of delirium complicated by COVID-19 pneumonia. Main Findings SARS-CoV-2 infection is associated with encephalopathy and delirium. An association between COVID-19 infection and Alzheimer's disease has been suggested, and studies are being conducted from multiple facets including genetics, cytology, and postmortem study. Principal Conclusions This review suggests that COVID-19 has important short and long-term neuropsychiatric effects. Several hypotheses have been proposed that highlight potential neurobiological mechanisms as causal factors, including neuronal-inflammatory pathways by cytokine storm and cellular senescence, and chronic inflammation.
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Affiliation(s)
- Kyohei Otani
- Department of Psychiatry, Kobe City Medical Center General Hospital, 2-1-1, Minatojima Minamimachi, Chuo-ku, Kobe, Hyogo, 650-0047, Japan
- Department of Psychiatry, Kakogawa Central City Hospital, 439, Kakogawa-cho honmachi, Kakogawa City, Hyogo, 675-8611, Japan
| | - Haruko Fukushima
- Department of Psychiatry, Kobe City Medical Center General Hospital, 2-1-1, Minatojima Minamimachi, Chuo-ku, Kobe, Hyogo, 650-0047, Japan
| | - Kunitaka Matsuishi
- Department of Psychiatry, Kobe City Medical Center General Hospital, 2-1-1, Minatojima Minamimachi, Chuo-ku, Kobe, Hyogo, 650-0047, Japan
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Capuzzi E, Caldiroli A, Cella F, Turco M, Buoli M, Clerici M. Sociodemographic and clinical characteristics associated with delirium in hospitalized patients with COVID-19: are immigrants a vulnerable group? Intern Emerg Med 2023; 18:937-941. [PMID: 36877433 PMCID: PMC9987365 DOI: 10.1007/s11739-023-03232-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 02/14/2023] [Indexed: 03/07/2023]
Affiliation(s)
- Enrico Capuzzi
- Psychiatric Department, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Via Pergolesi 33, 20900, Monza, Italy.
| | - Alice Caldiroli
- Psychiatric Department, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Via Pergolesi 33, 20900, Monza, Italy
| | - Francesca Cella
- School of Medicine and Surgery, University of Milano Bicocca, Via Cadore 38, 20900, Monza, MB, Italy
| | - Marco Turco
- School of Medicine and Surgery, University of Milano Bicocca, Via Cadore 38, 20900, Monza, MB, Italy
| | - Massimiliano Buoli
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Massimo Clerici
- Psychiatric Department, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Via Pergolesi 33, 20900, Monza, Italy
- School of Medicine and Surgery, University of Milano Bicocca, Via Cadore 38, 20900, Monza, MB, Italy
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Finsterer J. Psychiatric abnormalities in COVID-19 patients should prompt work-up for neuro-COVID. Asian J Psychiatr 2023; 80:103373. [PMID: 36462392 PMCID: PMC9700390 DOI: 10.1016/j.ajp.2022.103373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 10/03/2022] [Accepted: 10/29/2022] [Indexed: 11/27/2022]
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Tikhonova YG, Kinkulkina MA, Volkov AV, Sedelkova VA, Avdeeva TI, Izyumina TA, Makarova MA, Maximova TN, Brovko MY, Moiseev SV, Ivanets NN. [Prevalence and risk factors of delirium in COVID-19]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:86-92. [PMID: 37490670 DOI: 10.17116/jnevro202312307186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
OBJECTIVE To assess the frequency and risk factors of delirium in patients hospitalized with COVID-19. MATERIAL AND METHODS Four hundred and forty patients admitted to the Infectious Diseases Hospital of the University Clinical Hospital No.3 of Sechenov University were included in the study. The Patient Health Questionnaire (PHQ-9), the Generalized Anxiety Disorder Screening Questionnaire-7 (GAD-7), the Insomnia Severity Index (ISI), the Delirium severity rating scale (DRS-R-98) were administered. RESULTS Delirium was detected in 27.8% of patients. Significant risk factors were age (p=0.002), severity of respiratory failure (p=0.005), concomitant somatic disease (p=0.003), and respiratory therapy (p<0.001). There was an association between severe anxiety (p<0.001) and insomnia (p=0.07) observed at admission with the risk of developing delirium during the hospital stay. CONCLUSION The study reveals a high prevalence of delirium in patients with COVID-19. In order to prevent delirium and/or reduce the risk, early diagnosis and identification of preclinical forms are of particular importance.
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Affiliation(s)
- Yu G Tikhonova
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - M A Kinkulkina
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - A V Volkov
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - V A Sedelkova
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - T I Avdeeva
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - T A Izyumina
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - M A Makarova
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - T N Maximova
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - M Yu Brovko
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - S V Moiseev
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - N N Ivanets
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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Callea A, Conti G, Caporotundo S, Della Marca G, Rollo E. Delirium in COVID‑19 pneumonia: looking inside the geriatric unit-reply. Intern Emerg Med 2022; 17:1843. [PMID: 35460015 PMCID: PMC9033410 DOI: 10.1007/s11739-022-02987-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 04/07/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Antonio Callea
- Department of Neurology, ASST Nord Milano, Ospedale Bassini, Via Massimo Gorki, 50, Cinisello Balsamo, 20092, Milan, Italy.
| | - Giancarlo Conti
- Department of Neurology, ASST Nord Milano, Ospedale Bassini, Via Massimo Gorki, 50, Cinisello Balsamo, 20092, Milan, Italy
| | - Silvia Caporotundo
- Department of Geriatrics, ASST Nord Milano, Ospedale Bassini, Cinisello Balsamo, Milan, Italy
| | - Giacomo Della Marca
- Dipartimento Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, IRCCS Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
- Department of Neurosciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Eleonora Rollo
- Department of Neurosciences, Università Cattolica del Sacro Cuore, Rome, Italy
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Vargas N, Fabbo A, Glossop A, Esquinas AM. Delirium in COVID‑19 pneumonia: looking inside the geriatric unit. Intern Emerg Med 2022; 17:1551-1552. [PMID: 35277829 PMCID: PMC8916949 DOI: 10.1007/s11739-022-02969-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 03/01/2022] [Indexed: 01/10/2023]
Affiliation(s)
- Nicolas Vargas
- Medicine Department, Geriatric ward., San Giuseppe Moscati High Survey Hospital, Avellino, Italy.
| | - Andrea Fabbo
- Geriatric Service, Cognitive Disorders and Dementia Unit, Health Authority and Services (AUSL ) of Modena, Modena, Italy
| | - Alastair Glossop
- Department of Anaesthesia, Sheffield Teaching Hospitals, NHS Foundation Trust, Sheffield, UK
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Matsuzawa Y, Kimura K, Ogawa H, Tamura K. Impact of renin-angiotensin-aldosterone system inhibitors on COVID-19. Hypertens Res 2022; 45:1147-1153. [PMID: 35581498 PMCID: PMC9113925 DOI: 10.1038/s41440-022-00922-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 03/19/2022] [Accepted: 03/22/2022] [Indexed: 11/14/2022]
Abstract
Since the onset of the coronavirus disease 2019 (COVID-19) pandemic, the possible roles of renin–angiotensin system (RAS) inhibitors in COVID-19 have been debated as favorable, harmful, or neutral. Angiotensin-converting enzyme 2 (ACE2) not only is the entry route of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection but also triggers a major mechanism of COVID-19 aggravation by promoting tissue RAS dysregulation, which induces a hyperinflammatory state in several organs, leading to lung injury, hematological alterations, and immunological dysregulation. ACE inhibitors and angiotensin II type-1 receptor blockers (ARBs) inhibit the detrimental hyperactivation of the RAS by SARS-CoV-2 and increase the expression of ACE2, which is a counter-regulator of the RAS. Several studies have investigated the beneficial profile of RAS inhibitors in COVID-19; however, this finding remains unclear. Further prospective studies are warranted to confirm the role of RAS inhibitors in COVID-19. In this review, we summarize the potential effects of RAS inhibitors that have come to light thus far and review the impact of RAS inhibitors on COVID-19. ![]()
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Affiliation(s)
- Yasushi Matsuzawa
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan.
| | - Kazuo Kimura
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan.,Yokosuka City Hospital, Yokosuka, Japan
| | | | - Kouichi Tamura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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Guedes BF. NeuroCOVID-19: a critical review. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:281-289. [PMID: 35976326 PMCID: PMC9491425 DOI: 10.1590/0004-282x-anp-2022-s136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 04/29/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The COVID-19 pandemic has challenged neurologists since its early days. Neurology consultation services were then overloaded by emergency department and intensive-care patients with acute neurological syndromes. These complications are better explained today, but the growing number of patients with reported longstanding neurological symptoms constitute an emerging, complex, and still poorly understood phenomenon. OBJECTIVE This review summarizes data on relevant neurological manifestations of acute SARS-CoV-2 infection and lasting post-infectious disease, also known as Long COVID. The complex history of Long COVID is examined to illustrate the upsides and challenges imposed by the active participation of patient communities in the production of medical knowledge. METHODS Narrative review. RESULTS Infection with the severe acute respiratory syndrome coronavirus 2 is associated with encephalopathy/delirium, cerebrovascular disease, headache, and peripheral nervous system involvement. Long COVID is a living concept jointly defined by patient communities, physicians and scientists, including neurologists. CONCLUSION Co-production of Long COVID knowledge between scientists and patients has initiated an era of patient-led research and evidence-based activism that acts as a two-edged sword - putting patient's suffering in the spotlight, but with a tradeoff in methodological consistency.
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Affiliation(s)
- Bruno Fukelmann Guedes
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Neurologia, São Paulo, SP, Brazil
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