Outcomes in Patients With COVID-19 With Acute Encephalopathy and Coma: An International Prospective Study.
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Legriel Stephane, Badenes Rafael, Engrand Nicolas, Mendoza-Trujillo Rocio, Soulier Pauline, Benghanem Sarah, Pizzi Michael, Maciel Carolina, Chelly Jonathan, Zuber Benjamin, Labruyere Marie, Plantefeve Gaetan, Jacq Gwenaëlle, Galbois Arnaud, Launey Yoann, Argaud Laurent, Lesieur Olivier, Ferre Alexis, Paul Marine, Guillon Antoine, Bailly Pierre, Beuret Pascal, de-Carne Marie-Charlotte, Siami Shidasp, Benzekri Dalila, Colin Gwenhael, Gaviria Leidy, Aldana Jose Luis, Bruel Cedric, Stoclin Annabelle, Sedillot Nicholas, Geri Guillaume, Samano Daniel, Sobczak Evie, Swafford Emily, O'Phelan Kristine, Meffert Arnaud, Holleville Mathilde, Silva Stein, Alves da Costa Manoel José, Mejia Jorge, Alkhachroum Ayham, for NeuroCovid19
Аннотация
METHODS: 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 intensive care units in 6 countries (France, United States, Colombia, Spain, Mexico, and 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 (GOS-E) score of 1-4 was considered a poor outcome (indicating death, vegetative state, or severe disability).
RESULTS: Of 4,060 patients admitted with COVID-19, 374 (9.2%) experienced acute encephalopathy at or before the intensive care unit (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 older than 70 years (odds ratio [OR] 4.01, 95% CI 2.25-7.15), presumed fatal comorbidity (OR 3.98, 95% CI 1.68-9.44), Glasgow coma scale score <9 before/at ICU admission (OR 2.20, 95% CI 1.22-3.98), vasopressor/inotrope support during ICU stay (OR 3.91, 95% CI 1.97-7.76), renal replacement therapy during ICU stay (OR 2.31, 95% CI 1.21-4.50), and CNS ischemic or hemorrhagic complications as acute encephalopathy etiology (OR 3.22, 95% CI 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).
DISCUSSION: In this observational study, we found a low prevalence of acute encephalopathy at ICU admission in patients with COVID-19. More than 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.
TRIAL REGISTRATION INFORMATION: The study is registered with ClinicalTrials.gov, number NCT04320472.