Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Feb;36(1):89-96.
doi: 10.1007/s12028-021-01256-7. Epub 2021 Jun 28.

Disorders of Consciousness in Hospitalized Patients with COVID-19: The Role of the Systemic Inflammatory Response Syndrome

Amelia K Boehme  1 , Kevin Doyle  2 , Kiran T Thakur  3 , David Roh  2 , Soojin Park  2 , Sachin Agarwal  2 , Angela G Velazquez  2 , Jennifer A Egbebike  2 , Caroline Der Nigoghossian  4 , Morgan L Prust  2 , Jon Rosenberg  2 , Daniel Brodie  5 , Katherine N Fishkoff  6 , Beth R Hochmann  6 , Leroy E Rabani  7 , Natalie H Yip  5 , Oliver Panzer  8 , Jan Claassen  9
Affiliations

Disorders of Consciousness in Hospitalized Patients with COVID-19: The Role of the Systemic Inflammatory Response Syndrome

Amelia K Boehme et al. Neurocrit Care. 2022 Feb.

Abstract

Background: Prevalence and etiology of unconsciousness are uncertain in hospitalized patients with coronavirus disease 2019 (COVID-19). We tested the hypothesis that increased inflammation in COVID-19 precedes coma, independent of medications, hypotension, and hypoxia.

Methods: We retrospectively assessed 3203 hospitalized patients with COVID-19 from March 2 through July 30, 2020, in New York City with the Glasgow Coma Scale and systemic inflammatory response syndrome (SIRS) scores. We applied hazard ratio (HR) modeling and mediation analysis to determine the risk of SIRS score elevation to precede coma, accounting for confounders.

Results: We obtained behavioral assessments in 3203 of 10,797 patients admitted to the hospital who tested positive for SARS-CoV-2. Of those patients, 1054 (32.9%) were comatose, which first developed on median hospital day 2 (interquartile range [IQR] 1-9). During their hospital stay, 1538 (48%) had a SIRS score of 2 or above at least once, and the median maximum SIRS score was 2 (IQR 1-2). A fivefold increased risk of coma (HR 5.05, 95% confidence interval 4.27-5.98) was seen for each day that patients with COVID-19 had elevated SIRS scores, independent of medication effects, hypotension, and hypoxia. The overall mortality in this population was 13.8% (n = 441). Coma was associated with death (odds ratio 7.77, 95% confidence interval 6.29-9.65) and increased length of stay (13 days [IQR 11.9-14.1] vs. 11 [IQR 9.6-12.4]), accounting for demographics.

Conclusions: Disorders of consciousness are common in hospitalized patients with severe COVID-19 and are associated with increased mortality and length of hospitalization. The underlying etiology of disorders of consciousness in this population is uncertain but, in addition to medication effects, may in part be linked to systemic inflammation.

Keywords: COVID-19; Coma; Disorders of consciousness; Inflammation; Systemic inflammatory response syndrome.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Fig. 1
Fig. 1
Flowchart. Coma and outcomes of patients with coronavirus disease 2019 (COVID-19)
Fig. 2
Fig. 2
Systemic inflammation and coma. Development of coma over time stratified by the SIRS score (SIRS score 0–1 vs. SIRS score 2–4). SIRS systemic inflammatory response syndrome
See this image and copyright information in PMC

References

    1. Cummings MJ, Baldwin MR, Abrams D, et al. Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York City: a prospective cohort study. Lancet. 2020;395(10239):1763–1770. doi: 10.1016/S0140-6736(20)31189-2. - DOI - PMC - PubMed
    1. Ellul MA, Benjamin L, Singh B, et al. Neurological associations of COVID-19. Lancet Neurol. 2020;19:767–783. doi: 10.1016/S1474-4422(20)30221-0. - DOI - PMC - PubMed
    1. Koralnik IJ, Tyler KL. COVID-19: a global threat to the nervous system. Ann Neurol. 2020;88:1–11. doi: 10.1002/ana.25807. - DOI - PMC - PubMed
    1. Needham EJ, Chou SHY, Coles AJ, Menon DK. Neurological implications of COVID-19 infections. Neurocrit Care. 2020;32:667–671. doi: 10.1007/s12028-020-00978-4. - DOI - PMC - PubMed
    1. Paterson RW, Brown RL, Benjamin L, et al. The emerging spectrum of COVID-19 neurology: clinical, radiological and laboratory findings. Brain. 2020;143(10):3104–3120. doi: 10.1093/brain/awaa240. - DOI - PMC - PubMed

Publication types