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. 2024 Oct 15:19418744241292487.
doi: 10.1177/19418744241292487. Online ahead of print.

Neurological Complications and Outcomes in Critically Ill Patients With COVID-19: Results From International Neurological Study Group From the COVID-19 Critical Care Consortium

Syed Ameen Ahmad  1 , Yunis Mayasi  1 , Thu-Lan Kelly  2 , Nicole White  2 , Jacky Suen  3   4 , Denise Battaglini  5   6 , Gianluigi Li Bassi  3   4   7   8 , John F Fraser  3   4   7   9 , Lavien Premraj  3   10 , Rakesh C Arora  11   12 , Diego Bastos  13 , Glenn Whitman  1 , Matthew Griffee  14 , Jonathon P Fanning  3   4   9 , Chiara Robba  5   15 , Sung-Min Cho  1 ; COVID-19 Critical Care Consortium
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Neurological Complications and Outcomes in Critically Ill Patients With COVID-19: Results From International Neurological Study Group From the COVID-19 Critical Care Consortium

Syed Ameen Ahmad et al. Neurohospitalist. .

Abstract

Background: In this COVID-19 Critical Care Consortium (CCCC) sub-study, we qualified neurological complications associated with SARS-CoV2 infection.

Methods: The CCCC is an international, multicenter study. Eligible patients were COVID-19 patients admitted to intensive care units (ICU) across 23 centers between 1/7/2020 to 6/23/2022. Incidence of neurological complications was estimated as number of events per hospital days and per admission using Poisson regression. Associations between neurological complications and risk factors were assessed using multivariable Poisson regression.

Results: 713 patients were included. Median age = 56 years (interquartile range (IQR) = 45-65). Neurological complications reported in 61/480 patients (12.7%) with the majority being ischemic stroke (2.9%), intracranial hemorrhage (ICH) (2.8%), and seizures (2.6%). Multivariable analysis for neurological complications per admitted days showed comorbid neurological conditions (incidence rate ratio (IRR) = 6.35, 2.57-15.7) were an independent risk factor for ischemic stroke. Extracorporeal membrane oxygenation (IRR = 5.32, 1.52-18.6), low-middle income countries (LMIC) vs high income countries (HIC) (IRR = 4.70, 1.62-13.7), and age >55 (IRR = 3.66, 1.23-10.9) were independent risk factors for ICH. Co-morbid neurological conditions (IRR = 3.43, 1.11-10.6), LMIC vs HIC (IRR = 8.69, 2.15-35.2), July-December 2020 vs January-June 2020 (IRR = 0.17, 0.04-0.69) and age >55 (IRR = 4.05, 1.15-14.3) were independent risk factors for seizure.

Conclusions: Decision-making should incorporate salient risk factors to inform management of SARS-CoV2 infection and avoid neurological complications.

Keywords: COVID-19; disability; income countries; neurological complications; neurological outcome; stroke.

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Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Multivariable adjusted rate ratios (RR) for length of stay and incidence rate ratios (IRR) for mortality. Abbreviations: 1. RR, rate ratio; 2. CI, confidence interval; 3. HIC, high income country; 4. LMIC, low-middle income country; 5. IRR, incidence rate ratio. Legend: multivariable adjusted rate ratios (RR) for length of stay and incidence rate ratios (IRR) for mortality.
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