Altered mental status is a predictor of poor outcomes in COVID-19 patients: A cohort study

Attia, Abdallah S.; Hussein, Mohammad; Aboueisha, Mohamed; Omar, Mahmoud; Youssef, Mohanad R.; Mankowski, Nicholas L.; Miller, Michael J.; Munshi, Ruhul; Swinford, Aubrey; Kline, Adam; Nguyen, Therese; Toraih, Eman A.; Duchesne, Juan; Kandil, Emad

doi:10.1371/journal.pone.0258095

Cited by 9 publications

(7 citation statements)

References 33 publications

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“…Typical clinical presentation is characterized by nonspecific delirium features or coma. Multicentre data obtained from large cohorts indicate that encephalopathy is observed in about 15% of cases, and associated with poorer outcomes in the hospital, including higher odds of ICU admission, prolonged invasive mechanical ventilation, acute kidney injury and mortality, and decreased likelihood of being discharged home [5 ▪▪ ,6]. A recent multicentre study of critically ill patients revealed that the incidence of new neurological disorders associated with COVID-19 at the acute phase was 12.7% [7 ▪ ].…”

Section: Epidemiologymentioning

confidence: 99%

“…This incidence appears comparable to the incidence of in-hospital stroke in the non-COVID-19 population, which is around 3%. COVID-19-associated strokes tend to occur in younger patients, with more frequent large vessel occlusion and higher mortality than described in patients without COVID-19 [5 ▪▪ ], and those associated with influenza [6]. A recent prospective multicentre study showed a dramatic decrease in the incidence of stroke over time during the pandemic [1 ▪▪ ].…”

Section: Epidemiologymentioning

confidence: 99%

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Neurological complications of critically ill COVID-19 patients

Sonneville

Dangayach

Newcombe

2023

Current Opinion in Critical Care

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Purpose of review COVID-19 and systemic critical illness are both associated with neurological complications. We provide an update on the diagnosis and critical care management of adult patients with neurological complications of COVID-19. Recent findingsLarge prospective multicentre studies conducted in the adult population over the last 18 months improved current knowledge on severe neurological complications of COVID-19. In COVID-19 patients presenting with neurological symptoms, a multimodal diagnostic workup (including CSF analysis, brain MRI, and EEG) may identify different syndromes associated with distinct trajectories and outcomes. Acute encephalopathy, which represents the most common neurological presentation of COVID-19, is associated with hypoxemia, toxic/metabolic derangements, and systemic inflammation. Other less frequent complications include cerebrovascular events, acute inflammatory syndromes, and seizures, which may be linked to more complex pathophysiological processes. Neuroimaging findings include infarction, haemorrhagic stroke, encephalitis, microhaemorrhages and leukoencephalopathy. In the absence of structural brain injury, prolonged unconsciousness is usually fully reversible, warranting a cautious approach for prognostication. Advanced quantitative MRI may provide useful insights into the extent and pathophysiology of the consequences of COVID-19 infection including atrophy and functional imaging changes in the chronic phase. SummaryOur review highlights the importance of a multimodal approach for the accurate diagnosis and management of complications of COVID-19, both at the acute phase and in the long-term.

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Section: Epidemiologymentioning

confidence: 99%

Section: Epidemiologymentioning

confidence: 99%

Neurological complications of critically ill COVID-19 patients

Sonneville

Dangayach

Newcombe

2023

Current Opinion in Critical Care

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“…The level of suffering experienced by humankind in the last two years can perhaps only be matched by the one inflicted by the Spanish flu pandemic. Even with the total number of deaths amounting to 1,813,188 by December 31, 2020 (data reported by the World Health Organization), the number of deaths may possibly be underestimated due to the undercount of deaths indirectly caused by COVID-19 as well as unreported deaths in countries with less developed health systems [1][2][3].…”

Section: Introductionmentioning

confidence: 99%

“…COVID-19 classically presents with general symptoms that are associated with viremias, such as myalgia, headache, fever, general exhaustion, as well as respiratory symptoms, namely dyspnea, cough, and chest pain. However, some other clinical findings may be seen as well, notably extrapulmonary, such as diarrhea, nausea, hyposmia, hypogeusia, liver dysfunction, and frequently in the elderly population, altered mental status [2][3][4].…”

Section: Introductionmentioning

confidence: 99%

The Impact of the Third Wave of the COVID-19 Pandemic on the Elderly and Very Elderly Population in a Tertiary Care Hospital in Portugal

Palavras¹,

Faria²,

Fernandes³

et al. 2022

Cureus

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Background: COVID-19 poses a significantly more serious threat to adults aged 65 and above, with a higher mortality rate. This study aims to describe the outcome of COVID-19 patients in the elderly and very elderly population admitted to a tertiary care Portuguese hospital. The authors defined the elderly population (65 to 79 years) and the very elderly population (≥ 80 years).Methods: We conducted a retrospective observational single center study in the internal medicine ward of a tertiary hospital from November 1, 2020 to January 31, 2021. All COVID-19 patients aged over 65 years were enrolled.Results: Of the 824 patients with SARS-CoV-2 infection, 586 (71%) were aged above 65 years. Of them, 61.7% were very elderly and 32.9% were elderly. The hospital recorded 53 (27.5%) deaths in the elderly group and 182 (46.3%) in the over-80 group. In the elderly population, only 32 patients had critical illness compared to the 79 in the very elderly group. In addition to respiratory complications, acute kidney failure and liver dysfunction were noted. In both groups, mortality was higher when there was acute kidney injury (AKI). With respect to treatment, dexamethasone and azithromycin did not show a statistically significant difference between the groups. The need for oxygen therapy over 4L/min, high-flow therapy, and mechanical invasive ventilation was related to higher mortality in both groups. Conclusion:The very elderly group had a higher number of deaths compared to the elderly group due to multiple comorbidities. Respiratory failure was the most frequently occurring complication. Surprisingly, dexamethasone and azithromycin therapy did not show a statistically significant effect in both age groups despite their current widespread usage in COVID-19 treatment worldwide.

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“…These factors included: advanced age and the presence of comorbidities like DM and cardiac diseases (13,17,18). Other documented associated factors for poor outcomes are gender, altered sensorium, and human immunodeficiency virus infection (19,20). Li et al in a systemic review and meta-analysis found that male gender, old age, obesity, DM, and chronic kidney disease were associated with poor outcomes.…”

Section: Introductionmentioning

confidence: 99%

COVID-19 Infection in A Dedicated Regional ICU In Saudi Arabia: Patients` Characteristics and Outcome of Management

AlMutairi¹,

Etonyeaku²,

Alriyaee³

et al. 2022

JOHS

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Background: Coronavirus infection disease 2019 (COVID-19) is a novel viral respiratory tract infection that caused a global pandemic. It can be associated with many complications including acute respiratory failure which can lead to intensive care unit (ICU) admission. This study evaluates the characteristic of patients with COVID-19 admitted for ICU care, and determine factors associated with poor outcome of care. Methodology: This is a retrospective review of patients admitted into the ICU of Buraidah Central Hospital on account of COVID-19 complications between March 2020 and October 2021. Records on patients` age, gender, body mass index (BMI), smoking habit, co-morbidities, ventilatory support type, the occurrence of pneumothorax, duration of ICU stay, and outcome of treatment of disease were extracted and analyzed for descriptive statistics, and the Chi-square test using SPSS version 28. Results: A total of 1035 patients were admitted into the ICU due to COVID-19 infection. The mean age of the patients was 59.95±21.10 years (range = 5-104 years). There were more males (N=695, 67.1%) than females (340, 32.9%). The majority of the patients (545; 52.7%) were elderly, followed by middle-aged adults (360; 34.8%); and were either overweight or obese (N= 849, 82%). More patients (568, 54.9%) were admitted in the year 2020, compared to the year 2021(467; 45.1%). Similarly, mortality rates were higher in the year 2020 (252, 44.4%) than in 2021 (219; 46.9%). There was a significant association between hospital course and patients who had higher BMI, endotracheal intubation, pneumothorax, emphysema, and co-morbidities such as hypertension and diabetes mellitus (p < .001). Also, there is a significant association between hospital course and the patient’s age, gender, and month of admission (p < .001). Also, there is a significant association between hospital course and the patient’s age, gender, and month of admission (p<.001). Conclusion: COVID-19 was an indication for ICU admission. Most patients were middle-aged or elderly and were predominantly male. Most admissions occurred during summer, and there has been a steady decline in admission rates and mortality. The male gender, obesity, and other co-morbidities are associated with worse outcomes.

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Altered mental status is a predictor of poor outcomes in COVID-19 patients: A cohort study

Cited by 9 publications

References 33 publications

Neurological complications of critically ill COVID-19 patients

Neurological complications of critically ill COVID-19 patients

The Impact of the Third Wave of the COVID-19 Pandemic on the Elderly and Very Elderly Population in a Tertiary Care Hospital in Portugal

COVID-19 Infection in A Dedicated Regional ICU In Saudi Arabia: Patients` Characteristics and Outcome of Management

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