Incidence and Nature of Neurological Complications among Coronavirus Disease 2019 Intensive Care Unit Patients in Saudi Arabia: A Retrospective Analysis

Abstract

Introduction: Coronavirus disease 2019 (COVID-19) represents a global health challenge. Neurological complications arising due to SARS-CoV-2 infection or its systemic manifestations complicate clinical course and prognosis. This study characterised the incidence and impact of neurological complications on outcomes among critically ill COVID-19 patients in Saudi Arabia. Methods: This retrospective study examined data from 1086 adult COVID-19 patients admitted to intensive care units (ICUs) of tertiary hospitals between 22 June 2020 and 22 October 2020. Patient demographics, comorbidities, neurological complications, lengths of stay, need for mechanical ventilation (MV) and outcomes were retrieved. Neurological outcomes studied included stroke, seizures and intracerebral haemorrhage. The study utilised IBM SPSS Statistics version 27 for statistical analysis, focusing on clinical features, neurological complications, demographics and patient outcomes. Categorical variables were expressed as frequencies and percentages, whereas continuous variables were shown as means and standard deviations. Neurological complication incidence rates were computed, and associations were determined using Chi-square tests. Comparisons between groups were performed using one-way analysis of variance with post hoc tests. Multiple logistic regression assessed the impact of neurological complications on outcomes, whereas Kaplan–Meier curves and log-rank tests were used for survival analysis. Results: The mean age was 55 years with male preponderance. Overall neurological complication incidence was 2.6% for stroke, 1.8% for seizures and 2.8% for intracerebral haemorrhage. Lengths of stay and ventilation duration were significantly prolonged among patients with the above complications compared to those without. Stroke influenced microbiological cure rates, with more patients achieving cure without stroke. Patients with stroke, seizures or intracerebral haemorrhage had lower rates of ICU discharge within 28 days and higher mortality. Conclusion: Neurological involvement independently impacted the clinical course and survival in critically ill COVID-19 patients. Stroke, seizures and intracerebral haemorrhage acted as risk factors for adverse outcomes by prolonging recovery, MV requirement and increasing mortality. Longer stays incurred by neurological issues reinforce the need for vigilant monitoring, multidisciplinary care and resource allocation. Strategies accounting for neurological involvement can help optimise care pathways and improve prognosis.