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Prolonged intubation in patients with prior cerebrovascular disease and COVID-19
Neurology ; 96(15 SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1407891
ABSTRACT

Objective:

To determine the odds of critical illness by day 28 and duration of mechanical ventilation (MV) over 45-day observation period in patients with history of cerebrovascular disease and COVID-19.

Background:

COVID-19-associated morbidity is correlated with multiple factors including age, comorbidities, and host response to the virus. Our understanding of the risk of critical illness due to prior neurological conditions remains limited. Here, we hypothesized that prior cerebrovascular disease is a risk factor for severe outcomes in COVID-19, including increased duration of MV. Design/

Methods:

A cross-sectional study of 1128 consecutive adult patients admitted to a tertiary care center in Boston, Massachusetts, and diagnosed with laboratory-confirmed COVID-19. The association between history of cerebrovascular disease and critical illness defined as MV or death was examined using logistic regression with inverse probability weighting of the propensity score. Cumulative incidence of successful extubation without death over 45 days was examined using competing risk analysis.

Results:

Of the 1128 adults admitted with COVID-19, 350 (36%) were critically ill by day 28. The median age was 59 years (standard deviation 18 years), 640 (57%) were men, and 401 (36%) were Latinx ethnicity. As of June 2nd, 2020, 127 (11%) patients died. A total of 257 (23%) of patients had a prior neurological diagnosis;most common was cerebrovascular disease (16%). 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.

Conclusions:

History of cerebrovascular disease adversely affects COVID-19 outcomes including increased risk of critical illness and prolonged intubation. Further studies are needed to define measures that reduce risk of poor outcomes in this subpopulation.
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Collection: Databases of international organizations Database: EMBASE Language: English Journal: Neurology Year: 2021 Document Type: Article

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Collection: Databases of international organizations Database: EMBASE Language: English Journal: Neurology Year: 2021 Document Type: Article