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Observational Study
. 2023 May 30;100(22):e2247-e2258.
doi: 10.1212/WNL.0000000000207263. Epub 2023 Apr 11.

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

Stephane Legriel  1 , Rafael Badenes  2 , Nicolas Engrand  2 , Rocio Mendoza-Trujillo  2 , Pauline Soulier  2 , Sarah Benghanem  2 , Michael Pizzi  2 , Carolina Maciel  2 , Jonathan Chelly  2 , Benjamin Zuber  2 , Marie Labruyere  2 , Gaetan Plantefeve  2 , Gwenaëlle Jacq  2 , Arnaud Galbois  2 , Yoann Launey  2 , Laurent Argaud  2 , Olivier Lesieur  2 , Alexis Ferre  2 , Marine Paul  2 , Antoine Guillon  2 , Pierre Bailly  2 , Pascal Beuret  2 , Marie-Charlotte de-Carne  2 , Shidasp Siami  2 , Dalila Benzekri  2 , Gwenhael Colin  2 , Leidy Gaviria  2 , Jose Luis Aldana  2 , Cedric Bruel  2 , Annabelle Stoclin  2 , Nicholas Sedillot  2 , Guillaume Geri  2 , Daniel Samano  2 , Evie Sobczak  2 , Emily Swafford  2 , Kristine O'Phelan  2 , Arnaud Meffert  2 , Mathilde Holleville  2 , Stein Silva  2 , Manoel José Alves da Costa  2 , Jorge Mejia  2 , Ayham Alkhachroum  2 ; for NeuroCovid19
Collaborators, Affiliations
Observational Study

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

Stephane Legriel et al. Neurology. .

Abstract

Background and objectives: To report the prevalence of acute encephalopathy and outcomes in patients with severe coronavirus disease 2019 (COVID-19) and to identify determinants of 90-day outcomes.

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.

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Conflict of interest statement

The authors report no relevant disclosures. Go to Neurology.org/N for full disclosures.

Figures

Figure
Figure. Patient Flowchart
GOS-E = Glasgow Outcome Scale–Extended; SARS-CoV-2 = severe acute respiratory syndrome coronavirus 2.
See this image and copyright information in PMC

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