Abstract
Objective: to analyze clinical and follow-up indicators in patients with mental disorders and COVID-19 and to identify on their basis predictors of poor outcomes associated with mental state.Patients and methods. We conducted a prospective study in a multidisciplinary hospital. The severity of coronavirus infection was determined according to the temporary guidelines. Data collection was carried out using a patient chart consisting of 109 variables. Predictors of poor outcomes were determined using predictive models (logit regression, Cox model). The study included 97 patients: 41 men (42.3%) and 56 (57.7%) women, mean age – 62.3±15.3 years. 26 patients died; 71 patients recovered.Results and discussion. The death occurred on 11.5 day. The mental state of these patients was severe, with a predominance of delirium cases. With increasing age, the probability of non-lethal outcome decreases [hazard ratio (HR) 1.03; 95% confidence interval (CI) 1.00–1.06; p=0.037]. The risk of death increased by 1.03 (p=0.037) for each year of life. An improvement in the mental state of patients during psychotropic therapy is associated with an 11.11-fold decrease in the risk of poor outcome of coronavirus infection (HR 0.09; 95% CI 0.01–0.76; p=0.027). Delirium is a predictor of low patient survival, especially in prolonged hospitalizations (HR 4.55; 95% CI 1.66–12.48; p=0.003). The severity of coronavirus infection makes the greatest contribution to the poor outcome: the risk of death increases by 33.17 times (CR 33.17; 95% CI 4.01–274.65; p<0.001). The severity of the mental disorder had a greater impact on the risk of death compared with age, increasing it by 4.55 times (p=0.003).Conclusion. We found significant differences between the groups of deceased and surviving patients with COVID-19 concerning the variables related to certain mental disorders, their severity and dynamics, and the severity of coronavirus infection. In addition, the age of the patients had a significant impact on the prognosis of COVID-19. The results reflect the special prognostic significance of delirium in the structure of mental disorders developing in patients with coronavirus infection.
Highlights
Цель исследования – провести анализ клинико-динамических показателей больных COVID-19 с психическими расстройствами и выявить на его основе предикторы неблагоприятного исхода, связанные с психическим состоянием
Objective: to analyze clinical and follow-up indicators in patients with mental disorders and COVID-19 and to identify on their basis predictors of poor outcomes associated with mental state
The probability of non-lethal outcome decreases [hazard ratio (HR) 1.03; 95% confidence interval (CI) 1.00–1.06; p=0.037]
Summary
Петрова Н.Н.1, Пашковский В.Э.1, 2, Сивашова М.С.1, 3, Гвоздецкий А.Н.4, Прокопович Г.А.4 1Кафедра психиатрии и наркологии ФГБОУ ВО «Санкт-Петербургский государственный университет», Санкт-Петербург; 2ФГБУ «Национальный медицинский исследовательский центр психиатрии и неврологии им. Улучшение психического состояния пациентов в процессе психотропной терапии ассоциировано со снижением риска неблагоприятного исхода коронавирусной инфекции в 11,11 раза (КО 0,09; 95% ДИ 0,01–0,76; p=0,027). Исследование, проведенное на 153 пациентах с COVID-19 в возрасте от 23 до 94 лет, продемонстрировало, что у 31% обследованных имелись психические расстройства, причем 49% пациентов с психическими расстройствами были моложе 60 лет и 51% – старше 60 лет. Цель исследования – анализ клинико-динамических характеристик больных COVID-19 с психическими расстройствами для определения предикторов неблагоприятного исхода заболевания, связанных с психическим состоянием пациентов. Тяжесть новой коронавирусной инфекции опреде- ские переменные различались только по уровню занятости: лялась согласно временным методическим рекомендаци- в 1-й группе пенсионеров было значимо больше Сбор данных осуществлялся при помощи карты па- случаев делирия (F05.8),в то время как в группе выживших циента, состоящей из 109 переменных.
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