tetano
Editor, Senior Moderator
Ann Transl Med
. 2021 Jun;9(12):988.
doi: 10.21037/atm-21-2237.
Clinical course and outcomes of COVID-19 patients with a history of cerebrovascular disease: a retrospective study in Wuhan
Yang Bai[SUP] 1 2 [/SUP], Yong Liang[SUP] 1 [/SUP], Fang Wang[SUP] 3 [/SUP], Ligang Chen[SUP] 1 [/SUP], Yulong Zhao[SUP] 1 [/SUP], Shoujie Zhao[SUP] 4 [/SUP], Yejing Zhu[SUP] 4 [/SUP], Yushu Dong[SUP] 1 [/SUP], Guobiao Liang[SUP] 1 [/SUP], Dongfeng Chen[SUP] 2 [/SUP], Lei Liu[SUP] 2 5 [/SUP]
Affiliations
Abstract
Background: Data on patients with coronavirus disease 2019 (COVID-19) who have pre-existing cerebrovascular disease (CVD) are scarce. This study set out to describe the clinical course and outcomes of these patients.
Methods: This single-center retrospective study was performed at Huoshenshan Hospital in Wuhan, China. Patients with confirmed COVID-19 who had pre-existing CVD (N=69) were identified. COVID-19 patients without CVD were randomly selected and matched by age and sex to the patients with CVD. Clinical data were analyzed and compared between the 2 groups. The composite endpoint included intensive care unit admission, use of mechanical ventilation, and death. Multivariable Cox regression analyses with control for medical comorbidities were used to examine the relationship between pre-existing CVD and clinical outcome of COVID-19.
Results: Compared with patients without CVD, patients with pre-existing CVD were more likely to present with unapparent symptoms at first; however, at admission, these patients tended to be in a severer condition than those without CVD, with more underlying hypertension and diabetes. The levels of interleukin-6, creative kinase MB, aspartate transaminase, and creatinine, as well as prothrombin time, were also markedly higher in patients with CVD. Patients with pre-existing CVD were more likely to develop multi-organ dysfunction, deteriorate to critical condition, and yield poorer clinical outcomes than patients without CVD. Concerning therapeutics, greater proportions of patients with pre-existing CVD required mechanical ventilation, higher-order anti-bacterials, and drugs targeting underlying diseases and complications. In the multivariable analysis, pre-existing CVD was significantly associated with a poor clinical outcome.
Conclusions: Patients with a history of CVD are more vulnerable to an over-activated inflammatory response and subsequent multi-organ dysfunction, resulting in a poor clinical outcome. Close monitoring is advisable for these patients.
Keywords: Coronavirus disease 2019 (COVID-19); cerebrovascular disease (CVD); clinical course; clinical outcome; severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2).
. 2021 Jun;9(12):988.
doi: 10.21037/atm-21-2237.
Clinical course and outcomes of COVID-19 patients with a history of cerebrovascular disease: a retrospective study in Wuhan
Yang Bai[SUP] 1 2 [/SUP], Yong Liang[SUP] 1 [/SUP], Fang Wang[SUP] 3 [/SUP], Ligang Chen[SUP] 1 [/SUP], Yulong Zhao[SUP] 1 [/SUP], Shoujie Zhao[SUP] 4 [/SUP], Yejing Zhu[SUP] 4 [/SUP], Yushu Dong[SUP] 1 [/SUP], Guobiao Liang[SUP] 1 [/SUP], Dongfeng Chen[SUP] 2 [/SUP], Lei Liu[SUP] 2 5 [/SUP]
Affiliations
- PMID: 34277788
- PMCID: PMC8267260
- DOI: 10.21037/atm-21-2237
Abstract
Background: Data on patients with coronavirus disease 2019 (COVID-19) who have pre-existing cerebrovascular disease (CVD) are scarce. This study set out to describe the clinical course and outcomes of these patients.
Methods: This single-center retrospective study was performed at Huoshenshan Hospital in Wuhan, China. Patients with confirmed COVID-19 who had pre-existing CVD (N=69) were identified. COVID-19 patients without CVD were randomly selected and matched by age and sex to the patients with CVD. Clinical data were analyzed and compared between the 2 groups. The composite endpoint included intensive care unit admission, use of mechanical ventilation, and death. Multivariable Cox regression analyses with control for medical comorbidities were used to examine the relationship between pre-existing CVD and clinical outcome of COVID-19.
Results: Compared with patients without CVD, patients with pre-existing CVD were more likely to present with unapparent symptoms at first; however, at admission, these patients tended to be in a severer condition than those without CVD, with more underlying hypertension and diabetes. The levels of interleukin-6, creative kinase MB, aspartate transaminase, and creatinine, as well as prothrombin time, were also markedly higher in patients with CVD. Patients with pre-existing CVD were more likely to develop multi-organ dysfunction, deteriorate to critical condition, and yield poorer clinical outcomes than patients without CVD. Concerning therapeutics, greater proportions of patients with pre-existing CVD required mechanical ventilation, higher-order anti-bacterials, and drugs targeting underlying diseases and complications. In the multivariable analysis, pre-existing CVD was significantly associated with a poor clinical outcome.
Conclusions: Patients with a history of CVD are more vulnerable to an over-activated inflammatory response and subsequent multi-organ dysfunction, resulting in a poor clinical outcome. Close monitoring is advisable for these patients.
Keywords: Coronavirus disease 2019 (COVID-19); cerebrovascular disease (CVD); clinical course; clinical outcome; severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2).