What is the impact of previous cerebrovascular disease on critical COVID-19 patients' mortality? A prospective cohort study

Autores da FMUP

• Andreia Filipa Gomes Da Costa

  Autor

• André Da Silva Marques Pinto

  Autor

• José Artur Osório De Carvalho Paiva

  Autor

Participantes de fora da FMUP

• Teixeira Vaz, A
• Rocha, JA
• Moreira, TS
• Reis, DAE
• Oliveira, M

Unidades de investigação

• Medicina

• Neurociências Clínicas e Saúde Mental

Abstract

Objectives: We aimed to evaluate the effect of previous cerebrovascular disease (CVD) on mortality rates of critically ill COVID-19 patients. Materials methods: A prospective cohort study was performed between May/2020 and May/2021, at a tertiary -care-center. We consecutively included adult patients admitted to intensive care units (ICU) having as primary diagnosis Acute Respiratory Distress Syndrome due to SARS-CoV-2, requiring invasive mechanical ventilation for > 48 h. We considered as exposure the diagnosis of previous CVD and as main outcome the in-ICU mortality. Results: The study sample included 178 patients: 74.2% were males, with a mean age of 63 +/- 12.4 years-old(yo). Previous CVD was documented in 17 patients (9.6%). During the study period, the mortality rate at ICU was of 33.1% (n = 59). The proportion of mortality at ICU was higher in patients with prior CVD (58.8% vs 30.4%; p = 0.02). Also, older patients (66 +/- 11.4 yo vs. 62 +/- 12.7 yo, p = 0.04) and those with higher score at SAPSII at ICU admission (47.8 +/- 15.4 vs. 40.7 +/- 15.9; p = 0.01) had a higher ICU deathrate. Patients with previous CVD had a 2.70 (95%CI = 1.36-5.39) higher likelihood of dying compared to those who had no previous CVD. After adjustment (for gender, age, SAPSII and total length of stay), multivariate Cox analysis revealed that previous CVD remained a strong predictor for in-ICU death in critically ill COVID-19 patients (HR = 2.51; 95%CI = 1.15-5.51). Conclusions: Previous CVD was significantly associated to higher mortality in critical COVID-19 patients. We suggest that, in patients with previous CVD, prioritization of vaccination strategies should be implemented alongst with higher surveillance when infected with SARS-CoV-2.

Keywords

• Stroke; Cerebrovascular disease; COVID-19; Critical COVID-19; Mortality