Objectives

Acute encephalopathy (AE) has been described as a severe complication of COVID-19. Inflammation has been suggested as a pathogenic mechanism, with high-dose glucocorticoids (GC) showing a beneficial effect. Here, we retrospectively analyzed the clinical and radiological features in a group of COVID-19 AE patients who received GC treatment (GT) and in a non-treated (NT) group.

Method

Thirty-six patients with COVID-19 AE (mean age 72.6 \(\pm\) 11 years; 86.11% men) were evaluated for GC treatment. Twelve patients (mean age 73.6 \(\pm\) 4.5 years; 66.67% men) received GC, whereas 24 patients who showed signs of spontaneous remission were not treated with GC (mean age 70.1 \(\pm\) 8.6 years; 95.83% men). Differences in clinical characteristics and correlations with imaging features were explored.

Results

The GT group showed signs of vulnerability, with a longer hospitalization (p = 0.009) and AE duration (p = 0.012) and a higher hypertensive arteriopathy (HTNA) score (p = 0.022), when compared to NT group. At hospital discharge, the two groups were comparable in terms of clinical outcome (modified Rankin scale; p = 0.666) or mortality (p = 0.607). In our whole group analyses, AE severity was positively correlated with periventricular white matter hyperintensities (p = 0.011), deep enlarged perivascular spaces (p = 0.039) and HTNA score (p = 0.014).

Conclusion

This study suggests that, despite signs of radiological vulnerability and AE severity, patients treated by high-dose GC showed similar outcome at discharge, with respect to NT patients. Imaging features of cerebral small vessel disease correlated with AE severity, supporting the hypothesis that brain structural vulnerability can impact AE in COVID-19.

中文翻译：

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大剂量糖皮质激素治疗患有急性脑病的 COVID-19 患者：回顾性队列研究的临床和影像学结果

目标

急性脑病 (AE) 被描述为 COVID-19 的严重并发症。炎症被认为是一种致病机制，高剂量糖皮质激素 (GC) 显示出有益的作用。在这里，我们回顾性分析了一组接受 GC 治疗（GT）和未治疗（NT）组的 COVID-19 AE 患者的临床和放射学特征。

方法

36 名 COVID-19 AE 患者（平均年龄 72.6 \(\pm\) 11 岁；86.11% 为男性）接受了 GC 治疗评估。 12 名患者（平均年龄 73.6 \(\pm\) 4.5 岁；66.67% 男性）接受了 GC 治疗，而 24 名表现出自发缓解迹象的患者未接受 GC 治疗（平均年龄 70.1 \(\pm\) 8.6 岁；95.83 % 男性）。探讨了临床特征的差异以及与影像学特征的相关性。

结果

 与 NT 组相比，GT 组表现出脆弱的迹象，住院时间较长 ( p  = 0.009)，AE 持续时间较长 ( p  = 0.012)，高血压动脉病 (HTNA) 评分较高 ( p = 0.022)。出院时，两组在临床结果（改良Rankin量表；p  = 0.666）或死亡率（p  = 0.607）方面具有可比性。在我们的整个组分析中，AE 严重程度与脑室周围白质高信号 ( p  = 0.011)、血管周围间隙深度扩大 ( p  = 0.039) 和 HTNA 评分 ( p = 0.014)呈正相关 。

结论

这项研究表明，尽管存在放射学脆弱性和 AE 严重程度的迹象，但接受高剂量 GC 治疗的患者在出院时表现出与 NT 患者相似的结果。脑小血管疾病的影像学特征与 AE 严重程度相关，支持大脑结构脆弱性可能影响 COVID-19 中 AE 的假设。