Acute encephalopathy is associated with worse outcomes in COVID-19 patients

Abstract

Background Acute encephalopathy with COVID-19 has been reported in several studies but its impact on outcomes remains unclear. We hypothesized that hospitalized COVID-19 patients with encephalopathy have worse COVID-19 related outcomes. Methods We used TriNetX, with a large COVID-19 database, collecting real-time electronic medical records data. We included hospitalized COVID-19 patients since January 20, 2020 who had encephalopathy based on ICD-10 coding. We examined clinical outcomes comprising need for critical care services, intubation and mortality among these patients and compared it with patients without encephalopathy before and after propensity-score matching. Results Of 12,601 hospitalized COVID-19 patients, 1092 (8.7%) developed acute encephalopathy. Patients in the acute encephalopathy group were older (67 vs. 61 years) and had higher prevalence of medical co-morbidities including obesity, hypertension, diabetes, heart disease, COPD, chronic kidney and liver disease among others. Before and after propensity score-matching for co-morbidities, patients with acute encephalopathy were more likely to need critical care services (35.6% vs. 16.9%, p ​< ​0.0001), intubation (19.5% vs. 6.0%, p ​< ​0.0001) and had higher 30-day mortality (24.3% vs. 17.9%, p 0.0002). Conclusion Among hospitalized COVID-19 patients, acute encephalopathy is common and more likely to occur in patients with medical co-morbidities and are more likely to need critical care, intubation and have higher 30-day mortality even after adjusting for age and underlying medical co-morbidities.

Global Incidence of Neurological Manifestations Among Patients Hospitalized With COVID-19—A Report for the GCS-NeuroCOVID Consortium and the ENERGY Consortium

“…Existing data from prior cohorts report incidence of acute encephalopathy ranging from 8% to 84%. 6 , 10 , 20 , 21 , 31 , 32 , 33 In our large multicenter all COVID-19 patient cohort, we observed a 50% incidence of acute encephalopathy. Meanwhile, our 2 cohorts with neurological manifestation as entry criteria observed incidences of encephalopathy between 24% and 53%, likely reflecting differences in case ascertainment and severity of illness in the underlying populations.…”

Neurologic and Neuroscientific Evidence in Aged COVID-19 Patients

“…This apparent increase in the prevalence of delirium during the COVID-19 pandemic is likely to be due to both infectious as well as environmental factors such as social isolation (LaHue et al, 2020 ). Moreover, while acute encephalopathy is more common in older COVID-19 patients with medical comorbidities, when controlled for age and comorbidities, the presence of acute encephalopathy was still noted to be a predictor of critical care need, intubation, and 30-day mortality (Shah et al, 2020 ).…”

Encephalitis in a Pandemic

“…In the face of amassing evidence of encephalitis in COVID-19, rigorous critique of these case reports and series is needed as several studies lack vital investigations and report diagnoses with minimal evidence ( 13 , 19 ). However, a common finding among multiple studies is that the presence of neurological complications in COVID-19 has a negative impact on outcomes and delays recovery, although the long-term impact of these complications is not yet known and whether delayed emergent, post-infectious, complications develop is unclear ( 28 – 30 ).…”