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Abstract Details

Prolonged intubation in patients with prior cerebrovascular disease and COVID-19
Infectious Disease
Infectious Disease Posters (7:00 AM-5:00 PM)
018
To determine the odds of critical illness by day 28 and duration of mechanical ventilation (MV) over 45-day observation period in patients with history of cerebrovascular disease and COVID-19.
COVID-19-associated morbidity is correlated with multiple factors including age, comorbidities, and host response to the virus. Our understanding of the risk of critical illness due to prior neurological conditions remains limited. Here, we hypothesized that prior cerebrovascular disease is a risk factor for severe outcomes in COVID-19, including increased duration of MV.

A cross-sectional study of 1128 consecutive adult patients admitted to a tertiary care center in Boston, Massachusetts, and diagnosed with laboratory-confirmed COVID-19. The association between history of cerebrovascular disease and critical illness defined as MV or death was examined using logistic regression with inverse probability weighting of the propensity score. Cumulative incidence of successful extubation without death over 45 days was examined using competing risk analysis.

Of the 1128 adults admitted with COVID-19, 350 (36%) were critically ill by day 28. The median age was 59 years (standard deviation: 18 years), 640 (57%) were men, and 401 (36%) were Latinx ethnicity. As of June 2nd, 2020, 127 (11%) patients died. A total of 257 (23%) of patients had a prior neurological diagnosis; most common was cerebrovascular disease (16%). 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.
History of cerebrovascular disease adversely affects COVID-19 outcomes including increased risk of critical illness and prolonged intubation. Further studies are needed to define measures that reduce risk of poor outcomes in this subpopulation.
Authors/Disclosures
Shibani S. Mukerji, MD, PhD (Massachusetts General Hospital)
PRESENTER 		Dr. Mukerji has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Dynamed. Dr. Mukerji has or had stock in Gilead Science.Dr. Mukerji has or had stock in Ranpack.Dr. Mukerji has or had stock in Snowflake. An immediate family member of Dr. Mukerji has or had stock in Amgen. The institution of Dr. Mukerji has received research support from NIH. The institution of Dr. Mukerji has received research support from Massachusetts General Hospital.
Sudeshna Das (MGH) No disclosure on file
Haitham Alabsi, DO (Massachusetts General Hospital, Brigham, Harvard) Dr. Alabsi has received personal compensation for serving as an employee of Biogen.
No disclosure on file
No disclosure on file
No disclosure on file
No disclosure on file
Kiana Keller Ms. Keller has nothing to disclose.
No disclosure on file
Michael J. Leone Michael J. Leone has nothing to disclose.
No disclosure on file
Amy Newhouse (Massachusetts General Hospital) No disclosure on file
No disclosure on file
No disclosure on file
No disclosure on file
No disclosure on file
No disclosure on file
No disclosure on file
Haoqi Sun, PhD (Massachusetts General Hospital) Dr. Sun has nothing to disclose.
No disclosure on file
No disclosure on file
No disclosure on file
Jonathan Rosand, MD (Massachusetts General Hospital) Dr. Rosand has received personal compensation for serving as an employee of Massachusetts General Hospital. Dr. Rosand has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Eli Lilly and Co. Dr. Rosand has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Elsevier. The institution of Dr. Rosand has received research support from NIH. The institution of Dr. Rosand has received research support from American Heart Association. Dr. Rosand has received personal compensation in the range of $0-$499 for serving as a Peer reviewer with National Institutes of Health. Dr. Rosand has a non-compensated relationship as a Trustee with Columbia University that is relevant to Â鶹´«Ã½Ó³»­ interests or activities.
No disclosure on file
M. B. Westover, MD, PhD (MGH) Dr. Westover has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for Beacon Biosignals. Dr. Westover has stock in Beacon Biosignals. The institution of Dr. Westover has received research support from NIH. Dr. Westover has received publishing royalties from a publication relating to health care. Dr. Westover has a non-compensated relationship as a cofounder with Beacon Biosignals that is relevant to Â鶹´«Ã½Ó³»­ interests or activities.