Open AccessEncephalopathy at admission predicts adverse outcomes in patients with SARS‐CoV‐2 infection
Author(s) -
Tang Lei,
Liu Shixin,
Xiao Yanhe,
Tran Thi My Linh,
Choi Ji Whae,
Wu Jing,
Halsey Kasey,
Huang Raymond Y.,
Boxerman Jerrold,
Patel Sohil H,
Kung David,
Liu Renyu,
Feldman Michael D.,
Danoski Daniel D,
Liao Weihua,
Kasner Scott E.,
Liu Tao,
Xiao Bo,
Zhang Paul J.,
Reznik Michael,
Bai Harrison X.,
Yang Li
Publication year - 2021
Publication title -
cns neuroscience and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.403
H-Index - 69
eISSN - 1755-5949
pISSN - 1755-5930
DOI - 10.1111/cns.13687
Subject(s) - medicine , encephalopathy , hazard ratio , intensive care unit , proportional hazards model , confidence interval , glasgow coma scale , mechanical ventilation , surgery
Aims To determine if neurologic symptoms at admission can predict adverse outcomes in patients with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). Methods Electronic medical records of 1053 consecutively hospitalized patients with laboratory‐confirmed infection of SARS‐CoV‐2 from one large medical center in the USA were retrospectively analyzed. Univariable and multivariable Cox regression analyses were performed with the calculation of areas under the curve (AUC) and concordance index (C‐index). Patients were stratified into subgroups based on the presence of encephalopathy and its severity using survival statistics. In sensitivity analyses, patients with mild/moderate and severe encephalopathy (defined as coma) were separately considered. Results Of 1053 patients (mean age 52.4 years, 48.0% men [ n = 505]), 35.1% ( n = 370) had neurologic manifestations at admission, including 10.3% ( n = 108) with encephalopathy. Encephalopathy was an independent predictor for death (hazard ratio [HR] 2.617, 95% confidence interval [CI] 1.481–4.625) in multivariable Cox regression. The addition of encephalopathy to multivariable models comprising other predictors for adverse outcomes increased AUCs (mortality: 0.84–0.86, ventilation/ intensive care unit [ICU]: 0.76–0.78) and C‐index (mortality: 0.78 to 0.81, ventilation/ICU: 0.85–0.86). In sensitivity analyses, risk stratification survival curves for mortality and ventilation/ICU based on severe encephalopathy ( n = 15) versus mild/moderate encephalopathy ( n = 93) versus no encephalopathy ( n = 945) at admission were discriminative ( p < 0.001). Conclusions Encephalopathy at admission predicts later progression to death in SARS‐CoV‐2 infection, which may have important implications for risk stratification in clinical practice.