Read on for our pick of Covid-related cross-sectional case control studies from the scientific press for October 2022:
- Delirium in Adults With COVID-19–related ARDS: Comparison With Other Etiologies
- Neurological manifestations of COVID-19 in adults and children
Delirium in Adults With COVID-19–related ARDS: Comparison With Other Etiologies
Neurological complications have been associated with COVID-19, including delirium. Such complications have been reported to be frequent among ICU admitted patients. In this article the authors hypothesized that the rate of neurological complications would be higher in COVID-19 associated acute respiratory distress syndrome (ARDS) than those who develop ARDS from a different cause. They conducted a retrospective cohort study in the adult intensive care unit (ICU) of their hospital, including all consecutive patients fulfilling Berlin criteria for ARDS hospitalized between December 2017 and June 2021, stratifying exposure between COVID-19 or not. The primary outcome was delirium onset during ICU stay, defined by the confusion assessment method (CAM-ICU). Exploratory outcomes included development of neurological complications of the central (stroke, hemmorhage, vasculitis) or critical illness weakness, and 30 and 180 days all-cause mortality.
311 patients were included in the study (253 with COVID-19 and 58 with other causes); CAM-ICU was assessed in 231 (74.3% in COVID-19 vs. 74,1% in non-COVID-19). The proportion of patients developing delirium was similar in patients with COVID-19 and controls in univariate comparison (69.1% vs 60.5%, P=0.246). Yet, COVID-19 patients had higher body mass index, lower ICU severity, longer mechanical ventilation, and higher sedation doses (propofol, dexmedetomidine). After adjusting for these factors in COVID-19 patients in a multivariable analysis, the risk of delirium remained comparable across groups (adjusted odds ratio (OR) (95% CI): 0.86 (0.35-2.1)). Similarly, COVID-19 related ARDS had no impact on all-cause mortality at 30 days (adjusted OR: 0.87 (0.39-1.92)) and 180 days (adjusted OR: 0.67 (0.33-1.35)). Finally, neurological complications affecting the central nervous system (adjusted OR: 1.15 (0.25-5.29)) and critical illness weakness (adjusted OR: 2.99 (0.97-9.1)) were not higher in the COVID-19 group. The authors concluded that compared to other etiologies, patients with COVID-19 did not have higher incidence of delirium and other neurological complications, after accounting for underlying disease severity in ARDS patients. Management of COVID-19 associated ARDS needed longer invasive ventilation and higher sedation, which could explain higher rates of delirium in uncontrolled studies.
Bernard-Valnet R, Favre E, Bernini A, Oddo M, Chiche JD, Du Pasquier RA, Rossetti A; CORO-NEURO-ICU study group. Delirium in Adults With COVID-19-related ARDS: Comparison With Other Etiologies. Neurology. 2022 Aug 25:10.1212/WNL.0000000000201162. doi: 10.1212/WNL.0000000000201162.
Neurological manifestations of COVID-19 in adults and children
Different neurological manifestations of COVID-19 in adults and children and their impact have not been well characterized. In this article the authors aimed to determine the prevalence of neurological manifestations and in-hospital complications among hospitalized COVID-19 patients and ascertain differences between adults and children. They conducted a prospective multicenter observational study using the International Severe Acute Respiratory and emerging Infection Consortium cohort across 1507 sites worldwide from January/30th/2020 to May/25th/2021. Analyses of neurological manifestations and neurological complications considered unadjusted prevalence estimates for predefined patient subgroups, and adjusted estimates as a function of patient age and time of hospitalization using generalized linear models. Overall, 161,239 patients (158,267 adults; 2,972 children) hospitalized with COVID-19 and assessed for neurological manifestations and complications were included. In adults and children, the most frequent neurological manifestations at admission were fatigue (adults: 37.4%; children: 20.4%), altered consciousness (20.9%; 6.8%), myalgia (16.9%; 7.6%), dysgeusia (7.4%; 1.9%), anosmia (6.0%; 2.2%), and seizure (1.1%; 5.2%). In adults, the most frequent in-hospital neurological complications were stroke (1.5%), seizure (1%), and central nervous system (CNS) infection (0.2%). Each occurred more frequently in ICU than in non-ICU patients. In children, seizure was the only neurological complication to occur more frequently in ICU vs. non-ICU (7.1% vs. 2.3%, P < .001). Stroke prevalence increased with increasing age, while CNS infection and seizure steadily decreased with age. There was a dramatic decrease in stroke over time during the pandemic. Hypertension, chronic neurological disease, and the use of extracorporeal membrane oxygenation were associated with increased risk of stroke. Altered consciousness was associated with CNS infection, seizure, and stroke. All in-hospital neurological complications were associated with increased odds of death. The likelihood of death rose with increasing age, especially after 25 years of age. The authors concluded that adults and children have different neurological manifestations and in-hospital complications associated with COVID-19. Stroke risk increased with increasing age, while CNS infection and seizure risk decreased with age.
Cho SM, White N, Premraj L, Battaglini D, Fanning J, Suen J, Bassi GL, Fraser J, Robba C, Griffee M, Singh B, Citarella BW, Merson L, Solomon T, Thomson D; ISARIC Clinical Characterisation Group. Neurological manifestations of COVID-19 in adults and children. Brain. 2022 Sep 10:awac332. doi: 10.1093/brain/awac332.