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Encephalopathy at admission predicts adverse outcomes in patients with SARS-CoV-2 infection.
Tang, Lei; Liu, Shixin; Xiao, Yanhe; Tran, Thi My Linh; Choi, Ji Whae; Wu, Jing; Halsey, Kasey; Huang, Raymond Y; Boxerman, Jerrold; Patel, Sohil H; Kung, David; Liu, Renyu; Feldman, Michael D; Danoski, Daniel D; Liao, Wei-Hua; Kasner, Scott E; Liu, Tao; Xiao, Bo; Zhang, Paul J; Reznik, Michael; Bai, Harrison X; Yang, Li.
  • Tang L; Department of Neurology, Xiangya Hospital, Central South University, Changsha, China.
  • Liu S; Xiangya School of Medicine, Central South University, Changsha, China.
  • Xiao Y; Department of Neurology, Xiangya Hospital, Central South University, Changsha, China.
  • Tran TML; Xiangya School of Medicine, Central South University, Changsha, China.
  • Choi JW; Xiangya School of Medicine, Central South University, Changsha, China.
  • Wu J; Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University, Providence, RI, USA.
  • Halsey K; Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University, Providence, RI, USA.
  • Huang RY; Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, China.
  • Boxerman J; Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University, Providence, RI, USA.
  • Patel SH; Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA.
  • Kung D; Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University, Providence, RI, USA.
  • Liu R; Department of Radiology, University of Virginia, Charlottesville, VA, USA.
  • Feldman MD; Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
  • Danoski DD; Department of Anaesthesiology and critical care medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
  • Liao WH; Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
  • Kasner SE; Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
  • Liu T; Department of Radiology, Xiangya Hospital, Central South University, Changsha, China.
  • Xiao B; Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
  • Zhang PJ; Department of Biostatistics and Public Health, Brown University, Providence, RI, USA.
  • Reznik M; Department of Neurology, Xiangya Hospital, Central South University, Changsha, China.
  • Bai HX; Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
  • Yang L; Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI, USA.
CNS Neurosci Ther ; 27(10): 1127-1135, 2021 10.
Article in English | MEDLINE | ID: covidwho-1270830
Semantic information from SemMedBD (by NLM)
1. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
2. Encephalopathies PROCESS_OF Patients
Subject
Encephalopathies
Predicate
PROCESS_OF
Object
Patients
3. 2019 novel coronavirus PROCESS_OF Patients
Subject
2019 novel coronavirus
Predicate
PROCESS_OF
Object
Patients
4. Neurologic Symptoms PROCESS_OF Patients
Subject
Neurologic Symptoms
Predicate
PROCESS_OF
Object
Patients
5. Laboratory Infection PROCESS_OF hospitalized patients
Subject
Laboratory Infection
Predicate
PROCESS_OF
Object
hospitalized patients
6. Subgroup A Nepoviruses COEXISTS_WITH Encephalopathies
Subject
Subgroup A Nepoviruses
Predicate
COEXISTS_WITH
Object
Encephalopathies
7. Neurologic Manifestations PROCESS_OF Patients
Subject
Neurologic Manifestations
Predicate
PROCESS_OF
Object
Patients
8. Cessation of life ASSOCIATED_WITH COVID-19
Subject
Cessation of life
Predicate
ASSOCIATED_WITH
Object
COVID-19
9. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
10. Encephalopathies PROCESS_OF Patients
Subject
Encephalopathies
Predicate
PROCESS_OF
Object
Patients
11. 2019 novel coronavirus PROCESS_OF Patients
Subject
2019 novel coronavirus
Predicate
PROCESS_OF
Object
Patients
12. Neurologic Symptoms PROCESS_OF Patients
Subject
Neurologic Symptoms
Predicate
PROCESS_OF
Object
Patients
13. Laboratory Infection PROCESS_OF hospitalized patients
Subject
Laboratory Infection
Predicate
PROCESS_OF
Object
hospitalized patients
14. Subgroup A Nepoviruses COEXISTS_WITH Encephalopathies
Subject
Subgroup A Nepoviruses
Predicate
COEXISTS_WITH
Object
Encephalopathies
15. Neurologic Manifestations PROCESS_OF Patients
Subject
Neurologic Manifestations
Predicate
PROCESS_OF
Object
Patients
16. Cessation of life ASSOCIATED_WITH COVID-19
Subject
Cessation of life
Predicate
ASSOCIATED_WITH
Object
COVID-19
ABSTRACT

AIMS:

To determine if neurologic symptoms at admission can predict adverse outcomes in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

METHODS:

Electronic medical records of 1053 consecutively hospitalized patients with laboratory-confirmed infection of SARS-CoV-2 from one large medical center in the USA were retrospectively analyzed. Univariable and multivariable Cox regression analyses were performed with the calculation of areas under the curve (AUC) and concordance index (C-index). Patients were stratified into subgroups based on the presence of encephalopathy and its severity using survival statistics. In sensitivity analyses, patients with mild/moderate and severe encephalopathy (defined as coma) were separately considered.

RESULTS:

Of 1053 patients (mean age 52.4 years, 48.0% men [n = 505]), 35.1% (n = 370) had neurologic manifestations at admission, including 10.3% (n = 108) with encephalopathy. Encephalopathy was an independent predictor for death (hazard ratio [HR] 2.617, 95% confidence interval [CI] 1.481-4.625) in multivariable Cox regression. The addition of encephalopathy to multivariable models comprising other predictors for adverse outcomes increased AUCs (mortality 0.84-0.86, ventilation/ intensive care unit [ICU] 0.76-0.78) and C-index (mortality 0.78 to 0.81, ventilation/ICU 0.85-0.86). In sensitivity analyses, risk stratification survival curves for mortality and ventilation/ICU based on severe encephalopathy (n = 15) versus mild/moderate encephalopathy (n = 93) versus no encephalopathy (n = 945) at admission were discriminative (p < 0.001).

CONCLUSIONS:

Encephalopathy at admission predicts later progression to death in SARS-CoV-2 infection, which may have important implications for risk stratification in clinical practice.
Subject(s)
Keywords

Full text: Available Collection: International databases Database: MEDLINE Main subject: Patient Admission / Brain Diseases / COVID-19 Type of study: Controlled clinical trial / Etiology study / Incidence study / Observational study / Prognostic study / Risk factors Limits: Adult / Aged / Female / Humans / Male / Middle aged Language: English Journal: CNS Neurosci Ther Journal subject: Neurology / Therapeutics Year: 2021 Document Type: Article Affiliation country: Cns.13687

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Patient Admission / Brain Diseases / COVID-19 Type of study: Controlled clinical trial / Etiology study / Incidence study / Observational study / Prognostic study / Risk factors Limits: Adult / Aged / Female / Humans / Male / Middle aged Language: English Journal: CNS Neurosci Ther Journal subject: Neurology / Therapeutics Year: 2021 Document Type: Article Affiliation country: Cns.13687