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García-Azorín D, Martínez-Pías E, Trigo J, Hernández-Pérez I, Valle-Peñacoba G, Talavera B, Simón-Campo P, de Lera M, Chavarría-Miranda A, López-Sanz C, Gutiérrez-Sánchez M, Martínez-Velasco E, Pedraza M, Sierra Á, Gómez-Vicente B, Guerrero Á, Ezpeleta D, Peñarrubia MJ, Gómez-Herreras JI, Bustamante-Munguira E, Abad-Molina C, Orduña-Domingo A, Ruiz-Martin G, Jiménez-Cuenca MI, Juarros S, Del Pozo-Vegas C, Dueñas-Gutierrez C, de Paula JMP, Cantón-Álvarez B, Vicente JM, Arenillas JF. Neurological Comorbidity Is a Predictor of Death in Covid-19 Disease: A Cohort Study on 576 Patients. Front Neurol 2020; 11:781. [PMID: 32733373 PMCID: PMC7358573 DOI: 10.3389/fneur.2020.00781] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 06/25/2020] [Indexed: 01/08/2023] Open
Abstract
Introduction: Prognosis of Coronavirus disease 2019 (Covid-19) patients with vascular risk factors, and certain comorbidities is worse. The impact of chronic neurological disorders (CND) on prognosis is unclear. We evaluated if the presence of CND in Covid-19 patients is a predictor of a higher in-hospital mortality. As secondary endpoints, we analyzed the association between CND, Covid-19 severity, and laboratory abnormalities during admission. Methods: Retrospective cohort study that included all the consecutive hospitalized patients with confirmed Covid-19 disease from March 8th to April 11th, 2020. The study setting was Hospital Clínico, tertiary academic hospital from Valladolid. CND was defined as those neurological conditions causing permanent disability. We assessed demography, clinical variables, Covid-19 severity, laboratory parameters and outcome. The primary endpoint was in-hospital all-cause mortality, evaluated by multivariate cox-regression log rank test. We analyzed the association between CND, covid-19 severity and laboratory abnormalities. Results: We included 576 patients, 43.3% female, aged 67.2 years in mean. CND were present in 105 (18.3%) patients. Patients with CND were older, more disabled, had more vascular risk factors and comorbidities and fewer clinical symptoms of Covid-19. They presented 1.43 days earlier to the emergency department. Need of ventilation support was similar. Presence of CND was an independent predictor of death (HR 2.129, 95% CI: 1.382–3.280) but not a severer Covid-19 disease (OR: 1.75, 95% CI: 0.970–3.158). Frequency of laboratory abnormalities was similar, except for procalcitonin and INR. Conclusions: The presence of CND is an independent predictor of mortality in hospitalized Covid-19 patients. That was not explained neither by a worse immune response to Covid-19 nor by differences in the level of care received by patients with CND.
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Affiliation(s)
- David García-Azorín
- Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Enrique Martínez-Pías
- Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Javier Trigo
- Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Isabel Hernández-Pérez
- Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Gonzalo Valle-Peñacoba
- Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Blanca Talavera
- Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Paula Simón-Campo
- Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Mercedes de Lera
- Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Alba Chavarría-Miranda
- Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Cristina López-Sanz
- Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | - Elena Martínez-Velasco
- Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - María Pedraza
- Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Álvaro Sierra
- Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Beatriz Gómez-Vicente
- Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Ángel Guerrero
- Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.,Department of Medicine, University of Valladolid, Valladolid, Spain
| | - David Ezpeleta
- Department of Neurology, Hospital Universtitario Quironsalud Madrid, Madrid, Spain
| | - María Jesús Peñarrubia
- Department of Hematology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Jose Ignacio Gómez-Herreras
- Department of Anestesiology and Reanimation, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Elena Bustamante-Munguira
- Department of Intensive Care Medicine, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Cristina Abad-Molina
- Department of Microbiology and Immunology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Antonio Orduña-Domingo
- Department of Microbiology and Immunology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Guadalupe Ruiz-Martin
- Department of Clinical Chemistry, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | - Santiago Juarros
- Department of Pneumology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Carlos Del Pozo-Vegas
- Emergency Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Carlos Dueñas-Gutierrez
- Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | | | | | - Juan Francisco Arenillas
- Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.,Department of Medicine, University of Valladolid, Valladolid, Spain.,Neurovascular Research Laboratory, Instituto de Biología y Genética Molecular, Universidad de Valladolid - Consejo Superior de Investigaciones Científicas, Madrid, Spain
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