Potential Prognostic Predictors for Coronavirus Disease-2019-related Impaired Consciousness in Patients with Critical Illnesses

Abstract

Objective:Central nervous system involvement in patients with coronavirus disease-2019 (COVID-19) is associated with increased morbidity and mortality. The assessment of neurological symptoms in patients with critical illnesses, who are mechanically ventilated under deep sedation is challenging, which means doctors could be unaware of such symptoms until patients reach the weaning stage. Thus, this study aimed to identify potential prognostic predictors for COVID-19-related impaired consciousness in patients with critical illnesses.Materials and Methods:This retrospective, multicenter, and observational cohort study was conducted among patients with COVID-19 who were admitted to the intensive care units of five hospitals between March 11, 2020, and September 18, 2020. The patient population was analyzed in two groups-cases with impaired consciousness and cases without impaired consciousness.Results:Patients with impaired consciousness were found to be significantly younger (p=0.001) and to exhibit significantly more laboratory abnormalities, such as high ferritin (p=0.003), C-reactive protein (p=0.001), procalcitonin (p=0.019), and D-dimer (p=0.001) levels. Additionally, pathological magnetic resonance imaging findings were detected in 14 of 29 (48%) patients with impaired consciousness.Conclusion:All patients with severe COVID-19 should be screened for signs of hyperinflammation due to the associated risk of neurological complications. The early detection of at-risk cases and the prompt initiation of specific treatment should result in better disease outcomes.

Keywords

• covid-19
• neurological complications
• inflammatory markers
• hyperinflammation