Serveur d'exploration sur la COVID chez les séniors

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Cerebral Microbleeds and Leukoencephalopathy in Critically Ill Patients With COVID-19.

Identifieur interne : 000830 ( Main/Exploration ); précédent : 000829; suivant : 000831

Cerebral Microbleeds and Leukoencephalopathy in Critically Ill Patients With COVID-19.

Auteurs : Shashank Agarwal [États-Unis] ; Rajan Jain [États-Unis] ; Siddhant Dogra [États-Unis] ; Penina Krieger [États-Unis] ; Ariane Lewis [États-Unis] ; Vinh Nguyen [États-Unis] ; Kara Melmed [États-Unis] ; Steven Galetta [États-Unis]

Source :

RBID : pubmed:32755456

Descripteurs français

English descriptors

Abstract

BACKGROUND AND PURPOSE

We conducted this study to investigate the prevalence and distribution of cerebral microbleeds and leukoencephalopathy in hospitalized patients with coronavirus disease 2019 (COVID-19) and correlate with clinical, laboratory, and functional outcomes.

METHODS

We performed a retrospective chart review of 4131 COVID-19 positive adult patients who were admitted to 3 tertiary care hospitals of an academic medical center at the epicenter of the COVID-19 pandemic in New York City from March 1, 2020, to May 10, 2020, to identify patients who had magnetic resonance imaging (MRI) of the brain. We evaluated the MRIs in detail, and identified a subset of patients with leukoencephalopathy and/or cerebral microbleeds. We compared clinical, laboratory, and functional outcomes for these patients to patients who had a brain MRI that did not show these findings.

RESULTS

Of 115 patients who had an MRI of the brain performed, 35 (30.4%) patients had leukoencephalopathy and/or cerebral microbleeds. Patients with leukoencephalopathy and/or cerebral microbleeds had neuroimaging performed later during the hospitalization course (27 versus 10.6 days;

CONCLUSIONS

The presence of leukoencephalopathy and/or cerebral microbleeds is associated with a critical illness, increased mortality, and worse functional outcome in patients with COVID-19.


DOI: 10.1161/STROKEAHA.120.030940
PubMed: 32755456
PubMed Central: PMC7434006


Affiliations:


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Le document en format XML

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<region type="state">État de New York</region>
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<region type="state">État de New York</region>
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<region type="state">État de New York</region>
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<title level="j">Stroke</title>
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<term>Aged (MeSH)</term>
<term>Cerebral Hemorrhage (complications)</term>
<term>Cerebral Hemorrhage (diagnostic imaging)</term>
<term>Cerebral Hemorrhage (epidemiology)</term>
<term>Coronavirus Infections (complications)</term>
<term>Coronavirus Infections (diagnostic imaging)</term>
<term>Coronavirus Infections (epidemiology)</term>
<term>Critical Illness (MeSH)</term>
<term>Female (MeSH)</term>
<term>Fibrin Fibrinogen Degradation Products (analysis)</term>
<term>Hospitalization (MeSH)</term>
<term>Humans (MeSH)</term>
<term>International Normalized Ratio (MeSH)</term>
<term>Length of Stay (MeSH)</term>
<term>Leukoencephalopathies (complications)</term>
<term>Leukoencephalopathies (diagnostic imaging)</term>
<term>Leukoencephalopathies (epidemiology)</term>
<term>Magnetic Resonance Imaging (MeSH)</term>
<term>Male (MeSH)</term>
<term>Middle Aged (MeSH)</term>
<term>New York City (epidemiology)</term>
<term>Pandemics (MeSH)</term>
<term>Platelet Count (MeSH)</term>
<term>Pneumonia, Viral (complications)</term>
<term>Pneumonia, Viral (diagnostic imaging)</term>
<term>Pneumonia, Viral (epidemiology)</term>
<term>Prevalence (MeSH)</term>
<term>Pulmonary Disease, Chronic Obstructive (complications)</term>
<term>Pulmonary Disease, Chronic Obstructive (epidemiology)</term>
<term>Respiration, Artificial (statistics & numerical data)</term>
<term>Retrospective Studies (MeSH)</term>
<term>Treatment Outcome (MeSH)</term>
</keywords>
<keywords scheme="KwdFr" xml:lang="fr">
<term>Adulte d'âge moyen (MeSH)</term>
<term>Broncho-pneumopathie chronique obstructive (complications)</term>
<term>Broncho-pneumopathie chronique obstructive (épidémiologie)</term>
<term>Durée du séjour (MeSH)</term>
<term>Femelle (MeSH)</term>
<term>Hospitalisation (MeSH)</term>
<term>Humains (MeSH)</term>
<term>Hémorragie cérébrale (complications)</term>
<term>Hémorragie cérébrale (imagerie diagnostique)</term>
<term>Hémorragie cérébrale (épidémiologie)</term>
<term>Imagerie par résonance magnétique (MeSH)</term>
<term>Infections à coronavirus (complications)</term>
<term>Infections à coronavirus (imagerie diagnostique)</term>
<term>Infections à coronavirus (épidémiologie)</term>
<term>Leucoencéphalopathies (complications)</term>
<term>Leucoencéphalopathies (imagerie diagnostique)</term>
<term>Leucoencéphalopathies (épidémiologie)</term>
<term>Maladie grave (MeSH)</term>
<term>Mâle (MeSH)</term>
<term>New York (ville) (épidémiologie)</term>
<term>Numération des plaquettes (MeSH)</term>
<term>Pandémies (MeSH)</term>
<term>Pneumopathie virale (complications)</term>
<term>Pneumopathie virale (imagerie diagnostique)</term>
<term>Pneumopathie virale (épidémiologie)</term>
<term>Produits de dégradation de la fibrine et du fibrinogène (analyse)</term>
<term>Prévalence (MeSH)</term>
<term>Rapport international normalisé (MeSH)</term>
<term>Résultat thérapeutique (MeSH)</term>
<term>Sujet âgé (MeSH)</term>
<term>Ventilation artificielle (statistiques et données numériques)</term>
<term>Études rétrospectives (MeSH)</term>
</keywords>
<keywords scheme="MESH" type="chemical" qualifier="analysis" xml:lang="en">
<term>Fibrin Fibrinogen Degradation Products</term>
</keywords>
<keywords scheme="MESH" type="geographic" qualifier="epidemiology" xml:lang="en">
<term>New York City</term>
</keywords>
<keywords scheme="MESH" qualifier="analyse" xml:lang="fr">
<term>Produits de dégradation de la fibrine et du fibrinogène</term>
</keywords>
<keywords scheme="MESH" qualifier="complications" xml:lang="en">
<term>Cerebral Hemorrhage</term>
<term>Coronavirus Infections</term>
<term>Leukoencephalopathies</term>
<term>Pneumonia, Viral</term>
<term>Pulmonary Disease, Chronic Obstructive</term>
</keywords>
<keywords scheme="MESH" qualifier="diagnostic imaging" xml:lang="en">
<term>Cerebral Hemorrhage</term>
<term>Coronavirus Infections</term>
<term>Leukoencephalopathies</term>
<term>Pneumonia, Viral</term>
</keywords>
<keywords scheme="MESH" qualifier="epidemiology" xml:lang="en">
<term>Cerebral Hemorrhage</term>
<term>Coronavirus Infections</term>
<term>Leukoencephalopathies</term>
<term>Pneumonia, Viral</term>
<term>Pulmonary Disease, Chronic Obstructive</term>
</keywords>
<keywords scheme="MESH" qualifier="imagerie diagnostique" xml:lang="fr">
<term>Hémorragie cérébrale</term>
<term>Infections à coronavirus</term>
<term>Leucoencéphalopathies</term>
<term>Pneumopathie virale</term>
</keywords>
<keywords scheme="MESH" qualifier="statistics & numerical data" xml:lang="en">
<term>Respiration, Artificial</term>
</keywords>
<keywords scheme="MESH" qualifier="statistiques et données numériques" xml:lang="fr">
<term>Ventilation artificielle</term>
</keywords>
<keywords scheme="MESH" qualifier="épidémiologie" xml:lang="fr">
<term>Broncho-pneumopathie chronique obstructive</term>
<term>Hémorragie cérébrale</term>
<term>Infections à coronavirus</term>
<term>Leucoencéphalopathies</term>
<term>New York (ville)</term>
<term>Pneumopathie virale</term>
</keywords>
<keywords scheme="MESH" xml:lang="en">
<term>Aged</term>
<term>Critical Illness</term>
<term>Female</term>
<term>Hospitalization</term>
<term>Humans</term>
<term>International Normalized Ratio</term>
<term>Length of Stay</term>
<term>Magnetic Resonance Imaging</term>
<term>Male</term>
<term>Middle Aged</term>
<term>Pandemics</term>
<term>Platelet Count</term>
<term>Prevalence</term>
<term>Retrospective Studies</term>
<term>Treatment Outcome</term>
</keywords>
<keywords scheme="MESH" xml:lang="fr">
<term>Adulte d'âge moyen</term>
<term>Durée du séjour</term>
<term>Femelle</term>
<term>Hospitalisation</term>
<term>Humains</term>
<term>Imagerie par résonance magnétique</term>
<term>Maladie grave</term>
<term>Mâle</term>
<term>Numération des plaquettes</term>
<term>Pandémies</term>
<term>Prévalence</term>
<term>Rapport international normalisé</term>
<term>Résultat thérapeutique</term>
<term>Sujet âgé</term>
<term>Études rétrospectives</term>
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<front>
<div type="abstract" xml:lang="en">
<p>
<b>BACKGROUND AND PURPOSE</b>
</p>
<p>We conducted this study to investigate the prevalence and distribution of cerebral microbleeds and leukoencephalopathy in hospitalized patients with coronavirus disease 2019 (COVID-19) and correlate with clinical, laboratory, and functional outcomes.</p>
</div>
<div type="abstract" xml:lang="en">
<p>
<b>METHODS</b>
</p>
<p>We performed a retrospective chart review of 4131 COVID-19 positive adult patients who were admitted to 3 tertiary care hospitals of an academic medical center at the epicenter of the COVID-19 pandemic in New York City from March 1, 2020, to May 10, 2020, to identify patients who had magnetic resonance imaging (MRI) of the brain. We evaluated the MRIs in detail, and identified a subset of patients with leukoencephalopathy and/or cerebral microbleeds. We compared clinical, laboratory, and functional outcomes for these patients to patients who had a brain MRI that did not show these findings.</p>
</div>
<div type="abstract" xml:lang="en">
<p>
<b>RESULTS</b>
</p>
<p>Of 115 patients who had an MRI of the brain performed, 35 (30.4%) patients had leukoencephalopathy and/or cerebral microbleeds. Patients with leukoencephalopathy and/or cerebral microbleeds had neuroimaging performed later during the hospitalization course (27 versus 10.6 days; </p>
</div>
<div type="abstract" xml:lang="en">
<p>
<b>CONCLUSIONS</b>
</p>
<p>The presence of leukoencephalopathy and/or cerebral microbleeds is associated with a critical illness, increased mortality, and worse functional outcome in patients with COVID-19.</p>
</div>
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<DateCompleted>
<Year>2020</Year>
<Month>09</Month>
<Day>09</Day>
</DateCompleted>
<DateRevised>
<Year>2020</Year>
<Month>09</Month>
<Day>16</Day>
</DateRevised>
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<Journal>
<ISSN IssnType="Electronic">1524-4628</ISSN>
<JournalIssue CitedMedium="Internet">
<Volume>51</Volume>
<Issue>9</Issue>
<PubDate>
<Year>2020</Year>
<Month>09</Month>
</PubDate>
</JournalIssue>
<Title>Stroke</Title>
<ISOAbbreviation>Stroke</ISOAbbreviation>
</Journal>
<ArticleTitle>Cerebral Microbleeds and Leukoencephalopathy in Critically Ill Patients With COVID-19.</ArticleTitle>
<Pagination>
<MedlinePgn>2649-2655</MedlinePgn>
</Pagination>
<ELocationID EIdType="doi" ValidYN="Y">10.1161/STROKEAHA.120.030940</ELocationID>
<Abstract>
<AbstractText Label="BACKGROUND AND PURPOSE">We conducted this study to investigate the prevalence and distribution of cerebral microbleeds and leukoencephalopathy in hospitalized patients with coronavirus disease 2019 (COVID-19) and correlate with clinical, laboratory, and functional outcomes.</AbstractText>
<AbstractText Label="METHODS">We performed a retrospective chart review of 4131 COVID-19 positive adult patients who were admitted to 3 tertiary care hospitals of an academic medical center at the epicenter of the COVID-19 pandemic in New York City from March 1, 2020, to May 10, 2020, to identify patients who had magnetic resonance imaging (MRI) of the brain. We evaluated the MRIs in detail, and identified a subset of patients with leukoencephalopathy and/or cerebral microbleeds. We compared clinical, laboratory, and functional outcomes for these patients to patients who had a brain MRI that did not show these findings.</AbstractText>
<AbstractText Label="RESULTS">Of 115 patients who had an MRI of the brain performed, 35 (30.4%) patients had leukoencephalopathy and/or cerebral microbleeds. Patients with leukoencephalopathy and/or cerebral microbleeds had neuroimaging performed later during the hospitalization course (27 versus 10.6 days;
<i>P</i>
<0.001), were clinically sicker at the time of brain MRI (median GCS 6 versus 14;
<i>P</i>
<0.001), and had higher peak D-dimer levels (8018±6677 versus 3183±3482;
<i>P</i>
<0.001), lower nadir platelet count (116.9±62.2 versus 158.3±76.2;
<i>P</i>
=0.03), higher peak international normalized ratio (2.2 versus 1.57;
<i>P</i>
<0.001) values when compared with patients who had a brain MRI that did not show these findings. They required longer ventilator support (34.6 versus 9.1 days;
<i>P</i>
<0.001) and were more likely to have moderate and severe acute respiratory distress syndrome score (88.6% versus 23.8%,
<i>P</i>
<0.001). These patients had longer hospitalizations (42.1 versus 20.9 days;
<i>P</i>
<0.001), overall worse functional status on discharge (mRS 5 versus 4;
<i>P</i>
=0.001), and higher mortality (20% versus 9%;
<i>P</i>
=0.144).</AbstractText>
<AbstractText Label="CONCLUSIONS">The presence of leukoencephalopathy and/or cerebral microbleeds is associated with a critical illness, increased mortality, and worse functional outcome in patients with COVID-19.</AbstractText>
</Abstract>
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<LastName>Agarwal</LastName>
<ForeName>Shashank</ForeName>
<Initials>S</Initials>
<AffiliationInfo>
<Affiliation>Department of Neurology (S.A., A.L., K.M., S.G.), NYU Langone Health, New York, NY.</Affiliation>
</AffiliationInfo>
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<LastName>Jain</LastName>
<ForeName>Rajan</ForeName>
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<AffiliationInfo>
<Affiliation>Department of Radiology (R.J., S.D., P.K., V.N.), NYU Langone Health, New York, NY.</Affiliation>
</AffiliationInfo>
<AffiliationInfo>
<Affiliation>Department of Neurosurgery (R.J., A.L., K.M.), NYU Langone Health, New York, NY.</Affiliation>
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<Affiliation>Department of Radiology (R.J., S.D., P.K., V.N.), NYU Langone Health, New York, NY.</Affiliation>
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<AffiliationInfo>
<Affiliation>Department of Radiology (R.J., S.D., P.K., V.N.), NYU Langone Health, New York, NY.</Affiliation>
</AffiliationInfo>
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<LastName>Lewis</LastName>
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<Initials>A</Initials>
<AffiliationInfo>
<Affiliation>Department of Neurology (S.A., A.L., K.M., S.G.), NYU Langone Health, New York, NY.</Affiliation>
</AffiliationInfo>
<AffiliationInfo>
<Affiliation>Department of Neurosurgery (R.J., A.L., K.M.), NYU Langone Health, New York, NY.</Affiliation>
</AffiliationInfo>
</Author>
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<LastName>Nguyen</LastName>
<ForeName>Vinh</ForeName>
<Initials>V</Initials>
<AffiliationInfo>
<Affiliation>Department of Radiology (R.J., S.D., P.K., V.N.), NYU Langone Health, New York, NY.</Affiliation>
</AffiliationInfo>
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<AffiliationInfo>
<Affiliation>Department of Neurology (S.A., A.L., K.M., S.G.), NYU Langone Health, New York, NY.</Affiliation>
</AffiliationInfo>
<AffiliationInfo>
<Affiliation>Department of Neurosurgery (R.J., A.L., K.M.), NYU Langone Health, New York, NY.</Affiliation>
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<LastName>Galetta</LastName>
<ForeName>Steven</ForeName>
<Initials>S</Initials>
<AffiliationInfo>
<Affiliation>Department of Neurology (S.A., A.L., K.M., S.G.), NYU Langone Health, New York, NY.</Affiliation>
</AffiliationInfo>
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<Year>2020</Year>
<Month>08</Month>
<Day>05</Day>
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