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Prolonged Intubation in Patients With Prior Cerebrovascular Disease and COVID-19.
Mukerji, Shibani S; Das, Sudeshna; Alabsi, Haitham; Brenner, Laura N; Jain, Aayushee; Magdamo, Colin; Collens, Sarah I; Ye, Elissa; Keller, Kiana; Boutros, Christine L; Leone, Michael J; Newhouse, Amy; Foy, Brody; Li, Matthew D; Lang, Min; Anahtar, Melis N; Shao, Yu-Ping; Ge, Wendong; Sun, Haoqi; Triant, Virginia A; Kalpathy-Cramer, Jayashree; Higgins, John; Rosand, Jonathan; Robbins, Gregory K; Westover, M Brandon.
  • Mukerji SS; Department of Neurology, Massachusetts General Hospital, Boston, MA, United States.
  • Das S; Harvard Medical School, Boston, MA, United States.
  • Alabsi H; Department of Neurology, Massachusetts General Hospital, Boston, MA, United States.
  • Brenner LN; Harvard Medical School, Boston, MA, United States.
  • Jain A; Department of Neurology, Massachusetts General Hospital, Boston, MA, United States.
  • Magdamo C; Harvard Medical School, Boston, MA, United States.
  • Collens SI; Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, United States.
  • Ye E; Harvard Medical School, Boston, MA, United States.
  • Keller K; Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, United States.
  • Boutros CL; Department of Neurology, Massachusetts General Hospital, Boston, MA, United States.
  • Leone MJ; Clinical Data A.I. Center (CDAC), Massachusetts General Hospital, Boston, MA, United States.
  • Newhouse A; Department of Neurology, Massachusetts General Hospital, Boston, MA, United States.
  • Foy B; Department of Neurology, Massachusetts General Hospital, Boston, MA, United States.
  • Li MD; Clinical Data A.I. Center (CDAC), Massachusetts General Hospital, Boston, MA, United States.
  • Lang M; Department of Neurology, Massachusetts General Hospital, Boston, MA, United States.
  • Anahtar MN; Department of Neurology, Massachusetts General Hospital, Boston, MA, United States.
  • Shao YP; Clinical Data A.I. Center (CDAC), Massachusetts General Hospital, Boston, MA, United States.
  • Ge W; Harvard Medical School, Boston, MA, United States.
  • Sun H; Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States.
  • Triant VA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.
  • Kalpathy-Cramer J; Department of Pathology, Massachusetts General Hospital, Boston, MA, United States.
  • Higgins J; Department of Systems Biology, Harvard Medical School, Boston, MA, United States.
  • Rosand J; Department of Radiology, Massachusetts General Hospital, Boston, MA, United States.
  • Robbins GK; Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, United States.
  • Westover MB; Department of Radiology, Massachusetts General Hospital, Boston, MA, United States.
Front Neurol ; 12: 642912, 2021.
Article in English | MEDLINE | ID: covidwho-1202073
Semantic information from SemMedBD (by NLM)
1. Cerebrovascular Disorders PROCESS_OF Patients
Subject
Cerebrovascular Disorders
Predicate
PROCESS_OF
Object
Patients
2. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
3. Increased risk COEXISTS_WITH COVID-19
Subject
Increased risk
Predicate
COEXISTS_WITH
Object
COVID-19
4. Comorbidity PROCESS_OF Patients
Subject
Comorbidity
Predicate
PROCESS_OF
Object
Patients
5. Critical Illness PROCESS_OF Patients
Subject
Critical Illness
Predicate
PROCESS_OF
Object
Patients
6. Intubated PROCESS_OF Patients
Subject
Intubated
Predicate
PROCESS_OF
Object
Patients
7. COVID-19 PROCESS_OF Adult
Subject
COVID-19
Predicate
PROCESS_OF
Object
Adult
8. Critical Illness COEXISTS_WITH Cerebrovascular Disorders
Subject
Critical Illness
Predicate
COEXISTS_WITH
Object
Cerebrovascular Disorders
9. Cerebrovascular Disorders PROCESS_OF hospitalized patients
Subject
Cerebrovascular Disorders
Predicate
PROCESS_OF
Object
hospitalized patients
10. Disease Progression COEXISTS_WITH COVID-19
Subject
Disease Progression
Predicate
COEXISTS_WITH
Object
COVID-19
11. Cerebrovascular Disorders PROCESS_OF Patients
Subject
Cerebrovascular Disorders
Predicate
PROCESS_OF
Object
Patients
12. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
13. Increased risk COEXISTS_WITH COVID-19
Subject
Increased risk
Predicate
COEXISTS_WITH
Object
COVID-19
14. Comorbidity PROCESS_OF Patients
Subject
Comorbidity
Predicate
PROCESS_OF
Object
Patients
15. Critical Illness PROCESS_OF Patients
Subject
Critical Illness
Predicate
PROCESS_OF
Object
Patients
16. Intubated PROCESS_OF Patients
Subject
Intubated
Predicate
PROCESS_OF
Object
Patients
17. COVID-19 PROCESS_OF Adult
Subject
COVID-19
Predicate
PROCESS_OF
Object
Adult
18. Critical Illness COEXISTS_WITH Cerebrovascular Disorders
Subject
Critical Illness
Predicate
COEXISTS_WITH
Object
Cerebrovascular Disorders
19. Cerebrovascular Disorders PROCESS_OF hospitalized patients
Subject
Cerebrovascular Disorders
Predicate
PROCESS_OF
Object
hospitalized patients
20. Disease Progression COEXISTS_WITH COVID-19
Subject
Disease Progression
Predicate
COEXISTS_WITH
Object
COVID-19
ABSTRACT

Objectives:

Patients with comorbidities are at increased risk for poor outcomes in COVID-19, yet data on patients with prior neurological disease remains limited. Our objective was to determine the odds of critical illness and duration of mechanical ventilation in patients with prior cerebrovascular disease and COVID-19.

Methods:

A observational study of 1,128 consecutive adult patients admitted to an academic center in Boston, Massachusetts, and diagnosed with laboratory-confirmed COVID-19. We tested the association between prior cerebrovascular disease and critical illness, defined as mechanical ventilation (MV) or death by day 28, using logistic regression with inverse probability weighting of the propensity score. Among intubated patients, we estimated the cumulative incidence of successful extubation without death over 45 days using competing risk analysis.

Results:

Of the 1,128 adults with COVID-19, 350 (36%) were critically ill by day 28. The median age of patients was 59 years (SD 18 years) and 640 (57%) were men. As of June 2nd, 2020, 127 (11%) patients had died. A total of 177 patients (16%) had a prior cerebrovascular disease. Prior cerebrovascular disease was significantly associated with critical illness (OR = 1.54, 95% CI = 1.14-2.07), lower rate of successful extubation (cause-specific HR = 0.57, 95% CI = 0.33-0.98), and increased duration of intubation (restricted mean time difference = 4.02 days, 95% CI = 0.34-10.92) compared to patients without cerebrovascular disease.

Interpretation:

Prior cerebrovascular disease adversely affects COVID-19 outcomes in hospitalized patients. Further study is required to determine if this subpopulation requires closer monitoring for disease progression during COVID-19.
Keywords

Full text: Available Collection: International databases Database: MEDLINE Language: English Journal: Front Neurol Year: 2021 Document Type: Article Affiliation country: Fneur.2021.642912

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Full text: Available Collection: International databases Database: MEDLINE Language: English Journal: Front Neurol Year: 2021 Document Type: Article Affiliation country: Fneur.2021.642912