Background And Objectives: To report the prevalence of acute encephalopathy and outcomes in patients with severe coronavirus disease 2019 (COVID-19) and to identify determinants of 90-day outcomes.
Methods: Data from adults with severe COVID-19 and acute encephalopathy were prospectively collected for patients requiring intensive care unit management in 31 university or university-affiliated intensive care units in 6 countries (France, United States, Colombia, Spain, Mexico, and Brazil) between March and September of 2020. Acute encephalopathy was defined, as recently recommended, as subsyndromal delirium or delirium or as a comatose state in case of severely decreased level of consciousness. Logistic multivariable regression was performed to identify factors associated with 90-day outcomes. A Glasgow Outcome Scale-Extended (GOS-E) score of 1-4 was considered a poor outcome (indicating death, vegetative state, or severe disability).
Results: Of 4,060 patients admitted with COVID-19, 374 (9.2%) experienced acute encephalopathy at or before the intensive care unit (ICU) admission. A total of 199/345 (57.7%) patients had a poor outcome at 90-day follow-up as evaluated by the GOS-E (29 patients were lost to follow-up). On multivariable analysis, age older than 70 years (odds ratio [OR] 4.01, 95% CI 2.25-7.15), presumed fatal comorbidity (OR 3.98, 95% CI 1.68-9.44), Glasgow coma scale score <9 before/at ICU admission (OR 2.20, 95% CI 1.22-3.98), vasopressor/inotrope support during ICU stay (OR 3.91, 95% CI 1.97-7.76), renal replacement therapy during ICU stay (OR 2.31, 95% CI 1.21-4.50), and CNS ischemic or hemorrhagic complications as acute encephalopathy etiology (OR 3.22, 95% CI 1.41-7.82) were independently associated with higher odds of poor 90-day outcome. Status epilepticus, posterior reversible encephalopathy syndrome, and reversible cerebral vasoconstriction syndrome were associated with lower odds of poor 90-day outcome (OR 0.15, 95% CI 0.03-0.83).
Discussion: In this observational study, we found a low prevalence of acute encephalopathy at ICU admission in patients with COVID-19. More than half of patients with COVID-19 presenting with acute encephalopathy had poor outcomes as evaluated by GOS-E. Determinants of poor 90-day outcome were dominated by older age, comorbidities, degree of impairment of consciousness before/at ICU admission, association with other organ failures, and acute encephalopathy etiology.
Trial Registration Information: The study is registered with ClinicalTrials.gov, number NCT04320472.
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http://dx.doi.org/10.1212/WNL.0000000000207263 | DOI Listing |
Pan Afr Med J
September 2024
Infectious Diseases Department, Ibn Al Jazzar University Hospital, Kairouan, Tunisia.
Pneumococcal meningitis is the most severe bacterial meningitis rarely complicated by acute myelitis. We report a case of a 54-year-old female who presented with pneumococcal meningoencephalitis. After eight days of hospitalization, the patient presented a sudden onset of bilateral lower leg weakness and bladder and bowel sphincter dysfunction.
View Article and Find Full Text PDFCase Rep Gastrointest Med
December 2024
Department of Cardiology, Medical College of Georgia, Augusta University, Augusta, Georgia, USA.
Acute colonic pseudo-obstruction (ACPO), or Ogilvie syndrome, is a rare condition marked by significant colon distention without mechanical obstruction. Symptoms include abdominal pain, bloating, nausea, vomiting, and an inability to pass gas or stool. Although common in males over 60, we report a challenging case of a 44-year-old man from Africa with recurrent abdominal distention and discomfort.
View Article and Find Full Text PDFBrain Behav
December 2024
Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA.
Purpose/objective: This study examined (a) differences in demographic and injury-related characteristics following traumatic brain injury (TBI) between Native American and White individuals; (b) differences in community participation between Native American and White individuals with TBI at 1, 2, and 5 years after TBI; and (c) whether demographic or injury-related characteristics account for community participation disparities.
Research Method/design: A sample of 63 Native American individuals demographically matched to 63 White individuals (n = 126) was enrolled while on acute rehabilitation for moderate or severe TBI. Baseline demographic and injury-related characteristics were collected at this time and the Participation Assessment with Recombined Tools (PART-O) measure of community participation at 1, 2, and 5 years after TBI.
Brain Behav
December 2024
Department of Neurology, Sakarya University Faculty of Medicine, Sakarya, Türkiye.
Objective: The current research was carried out to test the validity and reliability of the Turkish version of the Acute Stroke Management Questionnaire (ASMaQ), developed to determine the acute stroke management awareness of health-care professionals.
Methods: This methodological study was performed in a training and research hospital. Data were collected using the "Participant Interview Form" and the Acute Stroke Management Questionnaire.
Brain Behav
December 2024
Department of Medical Affairs, Otsuka Pharmaceutical Co. Ltd, Tokyo, Japan.
Objective: This study aimed to investigate seasonal differences in migraine onset in Japan and associated trends in the prescription of triptan.
Background: The relationship between seasonal changes and the onset of migraine remains largely unknown.
Methods: We combined the large-scale medical claims data in Japan with city-level meteorological data presented by the Japan Weather Association.
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