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Disorders of Consciousness in Hospitalized Patients with COVID-19: The Role of the Systemic Inflammatory Response Syndrome.
Boehme, Amelia K; Doyle, Kevin; Thakur, Kiran T; Roh, David; Park, Soojin; Agarwal, Sachin; Velazquez, Angela G; Egbebike, Jennifer A; Der Nigoghossian, Caroline; Prust, Morgan L; Rosenberg, Jon; Brodie, Daniel; Fishkoff, Katherine N; Hochmann, Beth R; Rabani, Leroy E; Yip, Natalie H; Panzer, Oliver; Claassen, Jan.
  • Boehme AK; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
  • Doyle K; Division of Critical Care Neurology, Department of Neurology, Columbia University Irving Medical Center, New York-Presbyterian Hospital, 177 Fort Washington Avenue, MHB 8 Center, Room 300, New York, NY, 10032, USA.
  • Thakur KT; Division of Hospitalist Neurology, Department of Neurology, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York, NY, USA.
  • Roh D; Division of Critical Care Neurology, Department of Neurology, Columbia University Irving Medical Center, New York-Presbyterian Hospital, 177 Fort Washington Avenue, MHB 8 Center, Room 300, New York, NY, 10032, USA.
  • Park S; Division of Critical Care Neurology, Department of Neurology, Columbia University Irving Medical Center, New York-Presbyterian Hospital, 177 Fort Washington Avenue, MHB 8 Center, Room 300, New York, NY, 10032, USA.
  • Agarwal S; Division of Critical Care Neurology, Department of Neurology, Columbia University Irving Medical Center, New York-Presbyterian Hospital, 177 Fort Washington Avenue, MHB 8 Center, Room 300, New York, NY, 10032, USA.
  • Velazquez AG; Division of Critical Care Neurology, Department of Neurology, Columbia University Irving Medical Center, New York-Presbyterian Hospital, 177 Fort Washington Avenue, MHB 8 Center, Room 300, New York, NY, 10032, USA.
  • Egbebike JA; Division of Critical Care Neurology, Department of Neurology, Columbia University Irving Medical Center, New York-Presbyterian Hospital, 177 Fort Washington Avenue, MHB 8 Center, Room 300, New York, NY, 10032, USA.
  • Der Nigoghossian C; Pharmacy, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York, NY, USA.
  • Prust ML; Division of Critical Care Neurology, Department of Neurology, Columbia University Irving Medical Center, New York-Presbyterian Hospital, 177 Fort Washington Avenue, MHB 8 Center, Room 300, New York, NY, 10032, USA.
  • Rosenberg J; Division of Critical Care Neurology, Department of Neurology, Columbia University Irving Medical Center, New York-Presbyterian Hospital, 177 Fort Washington Avenue, MHB 8 Center, Room 300, New York, NY, 10032, USA.
  • Brodie D; Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University Irving Medical Center, New York-Presbyterian Hospital and Columbia University, New York, NY, USA.
  • Fishkoff KN; Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA.
  • Hochmann BR; Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA.
  • Rabani LE; Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA.
  • Yip NH; Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University Irving Medical Center, New York-Presbyterian Hospital and Columbia University, New York, NY, USA.
  • Panzer O; Division of Critical Care Medicine, Department of Anesthesiology, Columbia University Irving Medical Center, New York, NY, USA.
  • Claassen J; Division of Critical Care Neurology, Department of Neurology, Columbia University Irving Medical Center, New York-Presbyterian Hospital, 177 Fort Washington Avenue, MHB 8 Center, Room 300, New York, NY, 10032, USA. jc1439@cumc.columbia.edu.
Neurocrit Care ; 36(1): 89-96, 2022 02.
Article in English | MEDLINE | ID: covidwho-1286190
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.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 Type of study: Etiology study / Observational study / Prognostic study Limits: Humans Language: English Journal: Neurocrit Care Journal subject: Neurology / Critical Care Year: 2022 Document Type: Article Affiliation country: S12028-021-01256-7

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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 Type of study: Etiology study / Observational study / Prognostic study Limits: Humans Language: English Journal: Neurocrit Care Journal subject: Neurology / Critical Care Year: 2022 Document Type: Article Affiliation country: S12028-021-01256-7