Prolonged Intubation in Patients With Prior Cerebrovascular Disease and COVID-19
intubation, covid-19, Stroke, respiratory failure, Cerebrovascular disease, history of neurological disease
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.
Shibani S. Mukerji, M. Brandon Westover, Shibani S. Mukerji, Sudeshna Das, Sudeshna Das, Haitham Alabsi, Haitham Alabsi, Haitham Alabsi, Laura N. Brenner, Laura N. Brenner, Aayushee Jain, Aayushee Jain, Colin Magdamo, Sarah I. Collens, Elissa Ye, Kiana Keller, Christine L. Boutros, Michael J. Leone, Amy Newhouse, Amy Newhouse, Amy Newhouse, Brody Foy, Brody Foy, Matthew D. Li, Matthew D. Li, Min Lang, Melis N. Anahtar, Yu-Ping Shao, Wendong Ge, Haoqi Sun, Haoqi Sun, Haoqi Sun, Virginia A. Triant, Virginia A. Triant, Virginia A. Triant, Virginia A. Triant, Jayashree Kalpathy-Cramer, Jayashree Kalpathy-Cramer, John Higgins, John Higgins, Jonathan Rosand, Jonathan Rosand, Jonathan Rosand, Gregory K. Robbins, Gregory K. Robbins, M. Brandon Westover, M. Brandon Westover, M. Brandon Westover
Neurology. Diseases of the nervous system