Outcomes of COVID-19 patients admitted to the intensive care unit with neurologic manifestations

ABSTRACT

INTRODUCTION: Coronavirus disease 2019 (COVID-19) is a multisystem disease. It can affect the central and peripheral nervous systems. Neurological manifestations at the time of disease presentation may have severe outcomes of COVID-19. The objective of our study is to evaluate the outcomes of hospitalized COVID-19 patients admitted in the intensive care unit who presented with neurological symptoms. METHODS: This is a multi-center, retrospective, and observational study of hospitalized COVID-19 patients in the city of Louisville, Kentucky, and southern Indiana region from March 10, 2020 to June 20, 2020. Patients were included in this analysis if they were tested positive for COVID-19 by reverse transcriptase-polymerase chain reaction and admitted to the intensive care unit (ICU) in one of the nine hospitals in Louisville, Kentucky. Patients were considered to have a neurological symptom if one of the following clinical features was present during admission 1) headache 2) dizziness 3) confusion 4) anosmia 5) ageusia and 6) altered mental status. Baseline characteristics and outcomes were compared using t-tests of means for continuous data, and t-test of proportions for categorical data. P-values < 0.05 was considered statistically significant. RESULTS: Out of 700 hospitalized COVID-19 patients in the study, 231 were admitted to ICU. Among 231 ICU patients, 92 (39.82%) patients had neurological symptoms at the presentation. Among the patients admitted to ICU, those who presented with neurological symptoms have higher mortality than those who had no neurological symptoms at presentation (50% vs 30%, p=0.003). In addition, ICU patients who presented with neurological symptoms had a higher rate of cardiac arrest (16% vs 2%, p<0.001) and cerebrovascular accident (7% vs 1%, p=0.034) during hospitalization in comparison to ICU patient without neurological symptoms at presentation. CONCLUSIONS: Our study demonstrated that among the patients admitted in ICU, patients who presented with neurological symptoms have higher mortality than those without neurological symptoms. In addition, ICU patients have a higher rate of cardiac arrest and cerebrovascular accidents if they presented with neurological symptoms.