Outcomes in COVID-19 Patients With Acute Encephalopathy and Coma: An International Prospective Study

11.04.2023 | Cross-sectional case-control studies

The objective of this study was to report the prevalence of acute encephalopathy and outcomes in patients with severe COVID-19, and to identify determinants of 90-day outcomes. Data from adults with severe COVID-19 and acute encephalopathy were prospectively collected for patients requiring intensive care unit management in 31 university or university-affiliated in six countries (France, USA, Colombia, Spain, Mexico, Brazil) between March and September of 2020. Acute encephalopathy was defined, as recently recommended, as subsyndromal delirium or delirium, or as a comatose state in case of severely decreased level of consciousness. Logistic multivariable regression was performed to identify factors associated with 90-day outcomes. A Glasgow Outcome Scale-Extended score (GOS-E) of 1-4 was considered a poor outcome (indicating death, vegetative state, or severe disability).

Of 4060 patients admitted with COVID-19, 374 (9.2%) experienced acute encephalopathy at or prior to the ICU admission. A total of 199/345 (57.7%) patients had a poor outcome at 90-day follow-up as evaluated by the GOS-E (29 patients were lost to follow-up). On multivariable analysis, age >70 years (odds ratio [OR] 4.01, 95% confidence interval [CI], 2.25-7.15), presumed fatal comorbidity (3.98, 1.68-9.44), Glasgow Coma Scale score <9 before/at ICU admission ICU admission (2.20, 1.22-3.98), vasopressor/inotrope support during ICU stay (3.91, 1.97-7.76), renal replacement therapy during ICU stay (2.31, 1.21-4.50), and CNS ischemic or hemorrhagic complications as acute encephalopathy etiology (3.22, 1.41-7.82) were independently associated with higher odds of poor 90-day outcome. Status epilepticus, posterior reversible encephalopathy syndrome, and reversible cerebral vasoconstriction syndrome were associated with lower odds of poor 90-day outcome (OR 0.15, 95% CI 0.03-0.83). The authors concluded that in this observational study, they found a low prevalence of acute encephalopathy at ICU admission in COVID-19 patients. Over a half of patients with COVID-19 presenting with acute encephalopathy had poor outcomes as evaluated by GOS-E. Determinants of poor 90-day outcome were dominated by older age, comorbidities, degree of impairment of consciousness before/at ICU admission, association with other organ failures, and acute encephalopathy etiology.

Legriel S, Badenes R, Engrand N, Mendoza-Trujillo R, Soulier P, Benghanem S, Pizzi M, Maciel C, Chelly J, Zuber B, Labruyere M, Plantefeve G, Jacq G, Galbois A, Launey Y, Argaud L, Lesieur O, Ferre A, Paul M, Guillon A, Bailly P, Beuret P, de-Carne MC, Siami S, Benzekri D, Colin G, Gaviria L, Aldana JL, Bruel C, Stoclin A, Sedillot N, Geri G, Samano D, Sobczak E, Swafford E, O'Phelan K, Meffert A, Holleville M, Silva S, Alves da Costa MJ, Mejia J, Alkhachroum A. Outcomes in COVID-19 Patients With Acute Encephalopathy and Coma: An International Prospective Study. Neurology. 2023 Apr 11:10.1212/WNL.0000000000207263.

doi: 10.1212/WNL.0000000000207263

Back