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Neurologic Manifestations of Severe Acute Respiratory Syndrome Coronavirus 2 Infection in Hospitalized Patients During the First Year of the COVID-19 Pandemic.
Cervantes-Arslanian, Anna M; Venkata, Chakradhar; Anand, Pria; Burns, Joseph D; Ong, Charlene J; LeMahieu, Allison M; Schulte, Phillip J; Singh, Tarun D; Rabinstein, Alejandro A; Deo, Neha; Bansal, Vikas; Boman, Karen; Domecq Garces, Juan Pablo; Lee Armaignac, Donna; Christie, Amy B; Melamed, Roman R; Tarabichi, Yasir; Cheruku, Sreekanth R; Khanna, Ashish K; Denson, Joshua L; Banner-Goodspeed, Valerie M; Anderson, Harry L; Gajic, Ognjen; Kumar, Vishakha K; Walkey, Allan; Kashyap, Rahul.
  • Cervantes-Arslanian AM; Department of Neurology, Boston University School of Medicine and Boston Medical Center, Boston, MA.
  • Venkata C; Department of Neurosurgery, Boston University School of Medicine and Boston Medical Center, Boston, MA.
  • Anand P; Department of Medicine (Infectious Diseases), Boston University School of Medicine and Boston Medical Center, Boston, MA.
  • Burns JD; Department of Critical Care Medicine, Mercy Hospital, St. Louis, MO.
  • Ong CJ; Department of Neurology, Boston University School of Medicine and Boston Medical Center, Boston, MA.
  • LeMahieu AM; Department of Neurology, Lahey Hospital and Medical Center, Burlington, MA.
  • Schulte PJ; Department of Neurology, Tufts University School of Medicine, Boston, MA.
  • Singh TD; Department of Neurosurgery, Tufts University School of Medicine, Boston, MA.
  • Rabinstein AA; Department of Neurology, Boston University School of Medicine and Boston Medical Center, Boston, MA.
  • Deo N; Department of Neurosurgery, Boston University School of Medicine and Boston Medical Center, Boston, MA.
  • Bansal V; Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN.
  • Boman K; Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN.
  • Domecq Garces JP; Department of Neurology, Mayo Clinic, Rochester, MN.
  • Lee Armaignac D; Department of Neurology, Mayo Clinic, Rochester, MN.
  • Christie AB; Mayo Clinic Alix School of Medicine, Rochester, MN.
  • Melamed RR; Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
  • Tarabichi Y; Society of Critical Care Medicine, Mount Prospect, IL.
  • Cheruku SR; Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
  • Khanna AK; Center for Advanced Analytics, Baptist Health South Florida, Coral Gables, FL.
  • Denson JL; Atrium Health Navicent, Macon, GA.
  • Banner-Goodspeed VM; Abbott Northwestern Hospital, Allina Health, Minneapolis, MN.
  • Anderson HL; Center for Clinical Informatics Research and Education, MetroHealth Medical Center, Cleveland, OH.
  • Gajic O; Department of Pulmonary and Critical Care Medicine, MetroHealth Medical Center, Cleveland, OH.
  • Kumar VK; Department of Anesthesiology and Medical Center, UT Southwestern Medical Center, Dallas, TX.
  • Walkey A; Wake Forest University School of Medicine, Winston-Salem, NC.
  • Kashyap R; Atrium Health Wake Forest Baptist Network, Winston-Salem, NC.
Crit Care Explor ; 4(4): e0686, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1816286
ABSTRACT
To describe the prevalence, associated risk factors, and outcomes of serious neurologic manifestations (encephalopathy, stroke, seizure, and meningitis/encephalitis) among patients hospitalized with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.

DESIGN:

Prospective observational study.

SETTING:

One hundred seventy-nine hospitals in 24 countries within the Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study COVID-19 Registry. PATIENTS Hospitalized adults with laboratory-confirmed SARS-CoV-2 infection.

INTERVENTIONS:

None.

RESULTS:

Of 16,225 patients enrolled in the registry with hospital discharge status available, 2,092 (12.9%) developed serious neurologic manifestations including 1,656 (10.2%) with encephalopathy at admission, 331 (2.0%) with stroke, 243 (1.5%) with seizure, and 73 (0.5%) with meningitis/encephalitis at admission or during hospitalization. Patients with serious neurologic manifestations of COVID-19 were older with median (interquartile range) age 72 years (61.0-81.0 yr) versus 61 years (48.0-72.0 yr) and had higher prevalence of chronic medical conditions, including vascular risk factors. Adjusting for age, sex, and time since the onset of the pandemic, serious neurologic manifestations were associated with more severe disease (odds ratio [OR], 1.49; p < 0.001) as defined by the World Health Organization ordinal disease severity scale for COVID-19 infection. Patients with neurologic manifestations were more likely to be admitted to the ICU (OR, 1.45; p < 0.001) and require critical care interventions (extracorporeal membrane oxygenation OR, 1.78; p = 0.009 and renal replacement therapy OR, 1.99; p < 0.001). Hospital, ICU, and 28-day mortality for patients with neurologic manifestations was higher (OR, 1.51, 1.37, and 1.58; p < 0.001), and patients had fewer ICU-free, hospital-free, and ventilator-free days (estimated difference in days, -0.84, -1.34, and -0.84; p < 0.001).

CONCLUSIONS:

Encephalopathy at admission is common in hospitalized patients with SARS-CoV-2 infection and is associated with worse outcomes. While serious neurologic manifestations including stroke, seizure, and meningitis/encephalitis were less common, all were associated with increased ICU support utilization, more severe disease, and worse outcomes.
Keywords

Full text: Available Collection: International databases Database: MEDLINE Type of study: Observational study / Prognostic study Language: English Journal: Crit Care Explor Year: 2022 Document Type: Article Affiliation country: CCE.0000000000000686

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Observational study / Prognostic study Language: English Journal: Crit Care Explor Year: 2022 Document Type: Article Affiliation country: CCE.0000000000000686