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.
ABSTRACT
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Subject(s)
Humans , Female , Adult , Bone Neoplasms/diagnostic imaging , Maxillary Sinus , Osteochondroma/diagnostic imaging , Diagnosis, DifferentialSubject(s)
Bone Neoplasms , Maxillary Sinus , Osteochondroma , Adult , Bone Neoplasms/diagnostic imaging , Female , Humans , Osteochondroma/diagnostic imagingABSTRACT
A 61 year-old man with a history of hypertension, type2 diabetes, chronic renal failure, tuberculosis and peripheral arterial disease presented with gangrene in the right leg. A right supracondylar amputation was performed, despite which the patient continued with a high fever, oliguria and hypotension (90/50). Laboratory work-up showed neutrophilic leukocytosis and metabolic acidosis. CT revealed pneumoperitoneum, emphysema and thickening of the gastric wall. Changing the CT window we can appreciate air dissecting the layers of the gastric wall. This clinical-radiological picture is consistent with emphysematous infectious gastritis, complicated with septic shock and the death of the patient despite treatment. The final histopathology reported gastric necrosis caused by mucormycosis affecting the entire thickness of the gastric wall and embolizing vessels.
Subject(s)
Emphysema/microbiology , Gastritis/microbiology , Mucormycosis/diagnosis , Emphysema/diagnostic imaging , Fatal Outcome , Gastritis/diagnostic imaging , Humans , Male , Middle Aged , Mucormycosis/complications , Mucormycosis/pathology , Tomography, X-Ray ComputedABSTRACT
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Subject(s)
Humans , Male , Middle Aged , Gastritis/complications , Leukocytosis , Acidosis , Shock, Septic/complications , Oliguria , Hypotension , Mycoses/complications , Diagnosis, Differential , Risk Factors , Emphysema/complications , EmphysemaABSTRACT
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