Neurological manifestations of COVID-19 in adults and children
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Abstract
Las distintas manifestaciones neurológicas de la enfermedad por coronavirus 2019 (COVID-19) en adultos y niños, y su impacto, no se han caracterizado bien. Nuestro objetivo fue determinar la prevalencia de manifestaciones neurológicas y complicaciones intrahospitalarias entre pacientes hospitalizados con COVID-19 y comprobar las diferencias entre adultos y niños. Realizamos un estudio observacional prospectivo multicéntrico utilizando la cohorte del International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) en 1507 centros de todo el mundo, del 30 de enero de 2020 al 25 de mayo de 2021. Los análisis de las manifestaciones y complicaciones neurológicas consideraron estimaciones de prevalencia no ajustadas para subgrupos de pacientes predefinidos, así como estimaciones ajustadas en función de la edad del paciente y el momento de la hospitalización mediante modelos lineales generalizados. En total, se incluyeron 161 239 pacientes (158 267 adultos; 2972 niños) hospitalizados con COVID-19 y evaluados para detectar manifestaciones y complicaciones neurológicas. En adultos y niños, las manifestaciones neurológicas más frecuentes al ingreso fueron fatiga (adultos: 37,4%; niños: 20,4%), alteración de la consciencia (20,9%; 6,8%), mialgia (16,9%; 7,6%), disgeusia (7,4%; 1,9%), anosmia (6,0%; 2,2%) y crisis convulsivas (1,1%; 5,2%). En adultos, las complicaciones neurológicas intrahospitalarias más frecuentes fueron el ictus (1,5%), las crisis convulsivas (1%) y la infección del SNC (0,2%). Cada una de ellas se produjo con mayor frecuencia en la unidad de cuidados intensivos (UCI) que en los pacientes no ingresados en UCI. En niños, las crisis convulsivas fueron la única complicación neurológica que se produjo con mayor frecuencia en UCI frente a no UCI (7,1% frente a 2,3%, P < 0,001). La prevalencia de ictus aumentó con la edad, mientras que la infección del SNC y las crisis convulsivas disminuyeron progresivamente con la edad. Se observó una disminución drástica del ictus a lo largo del tiempo durante la pandemia. La hipertensión, la enfermedad neurológica crónica y el uso de oxigenación por membrana extracorpórea se asociaron con un mayor riesgo de ictus. La alteración de la consciencia se asoció con infección del SNC, crisis convulsivas e ictus. Todas las complicaciones neurológicas intrahospitalarias se asociaron con mayores probabilidades de muerte. La probabilidad de muerte aumentó con la edad, especialmente después de los 25 años. En conclusión, los adultos y los niños presentan manifestaciones neurológicas y complicaciones intrahospitalarias distintas asociadas a la COVID-19. El riesgo de ictus aumentó con la edad, mientras que el riesgo de infección del SNC y de crisis convulsivas disminuyó con la edad. [Traducción automática al español; idioma original: inglés.]
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Publisher Copyright: © 2022 The Author(s). Published by Oxford University Press on behalf of the Guarantors of Brain.
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