Altered mental status is a predictor of poor outcomes in COVID-19 patients: A cohort study

• Published in: PloS one Vol. 16; no. 10; p. e0258095
• Main Authors: Attia, Abdallah S, Hussein, Mohammad, Aboueisha, Mohamed A, Omar, Mahmoud, Youssef, Mohanad R, Mankowski, Nicholas, Miller, Michael, Munshi, Ruhul, Swinford, Aubrey, Kline, Adam, Nguyen, Therese, Toraih, Eman, Duchesne, Juan, Kandil, Emad
• Format: Journal Article
• Language: English
• Published: San Francisco Public Library of Science 05-10-2021; Public Library of Science (PLoS)
• Subjects: Adverse events; Analysis; Biology and Life Sciences; Blood pressure; Body mass index; China; Cohort analysis; Coma; Complications; Control; Coronaviruses; Cough; COVID-19; Diarrhea; Epidemics; Fever; Guillain-Barre syndrome; Health risk assessment; Health risks; Intubation; Laboratories; Mechanical ventilation; Medicine; Medicine and Health Sciences; Mental illness; Mortality; Obesity; Pandemics; Patients; People and places; Research and Analysis Methods; Risk factors; Severe acute respiratory syndrome coronavirus 2; Statistical analysis; Surgery; Ventilation; Ventilators; Viral diseases; China; Louisiana; Suez Canal; United States > US; Egypt
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0258095

Several studies have described typical clinical manifestations, including fever, cough, diarrhea, and fatigue with COVID-19 infection. However, there are limited data on the association between the presence of neurological manifestations on hospital admission, disease severity, and outcomes. We sought to investigate this correlation to help understand the disease burden. We delivered a multi-center retrospective study of positive laboratory-confirmed COVID-19 patients. Clinical presentation, laboratory values, complications, and outcomes data were reported. Our findings of interest were Intensive Care Unit (ICU) admission, intubation, mechanical ventilation, and in-hospital mortality. A total of 502 patients with a mean age of 60.83 ± 15.5 years, of them 71 patients (14.14%) presented with altered mental status, these patients showed higher odds of ICU admission (OR = 2.06, 95%CI = 1.18 to 3.59, p = 0.01), mechanical ventilation (OR = 3.28, 95%CI = 1.86 to 5.78, p 4 days) mechanical ventilation (OR = 4.35, 95%CI = 1.89 to 10, p = 0.001), acute kidney injury (OR = 2.18, 95%CI = 1.28 to 3.74, p = 0.004), and mortality (HR = 2.82, 95%CI = 1.49 to 5.29, p = 0.01). This cohort study found that neurological presentations are associated with higher odds of adverse events. When examining patients with neurological manifestations, clinicians should suspect COVID-19 to avoid delayed diagnosis or misdiagnosis and lose the chance to treat and prevent further transmission.