Critical COVID-19 and neurological dysfunction - a direct comparative analysis between SARS-CoV-2 and other infectious pathogens

Abstract

Objective To evaluate whether critical SARS-CoV-2 infection is more frequently associated with signs of corticospinal tract dysfunction and other neurological signs, symptoms, and syndromes, than other infectious pathogens. Methods This was a prospective cohort study with consecutive inclusion of patients admitted to intensive care units due to primary infectious acute respiratory distress syndrome requiring invasive mechanical ventilation > 48 hours. Eligible patients were randomly assigned to three investigators for clinical evaluation, which encompassed the examination of signs of corticospinal tract dysfunction. Clinical data, including other neurological complications and possible predictors, were independently obtained from clinical records. Results We consecutively included 54 patients with acute respiratory distress syndrome, 27 due to SARS-CoV-2 and 27 due to other infectious pathogens. The groups were comparable in most characteristics. COVID-19 patients presented a significantly higher risk of neurological complications (RR = 1.98; 95%CI 1.23 - 3.26). Signs of corticospinal tract dysfunction tended to be more prevalent in COVID-19 patients (RR = 1.62; 95%CI 0.72 - 3.44). Conclusion Our study is the first comparative analysis between SARS-CoV-2 and other infectious pathogens, in an intensive care unit setting, assessing neurological dysfunction. We report a significantly higher risk of neurological dysfunction among COVID-19 patients. As such, we suggest systematic screening for neurological complications in severe COVID-19 patients.

To: Critical COVID-19 and neurological dysfunction - a direct comparative analysis between SARS-CoV-2 and other infectious pathogens

“…With interest, we read the article by Teixeira-Vaz et al on a prospective, single-center cohort study among 27 coronavirus disease 2019 (COVID-19) patients requiring mechanical ventilation > 48 hours for acute respiratory distress syndrome (ARDS). ( 1 ) Compared to a disease control cohort, COVID-19 ARDS patients had an increased risk of neurological complications and corticospinal tract dysfunction. ( 1 ) It was concluded that patients with severe COVID-19 should be systematically examined neurologically.…”

“…( 1 ) Compared to a disease control cohort, COVID-19 ARDS patients had an increased risk of neurological complications and corticospinal tract dysfunction. ( 1 ) It was concluded that patients with severe COVID-19 should be systematically examined neurologically. ( 1 ) The study is excellent but has limitations that are a cause for concern and should be discussed.…”

“…( 1 ) It was concluded that patients with severe COVID-19 should be systematically examined neurologically. ( 1 ) The study is excellent but has limitations that are a cause for concern and should be discussed.…”

“…The main limitation of the study is that the clinical neurological examination was incomplete. ( 1 ) The exam included only assessment of the sedation level, excitability of tendon reflexes, and presence/absence of Babinski’s sign. ( 1 ) By evaluating only these three points, it is impossible to decide whether an individual patient has developed central nervous system or peripheral nervous system complications.…”

“…( 1 ) The exam included only assessment of the sedation level, excitability of tendon reflexes, and presence/absence of Babinski’s sign. ( 1 ) By evaluating only these three points, it is impossible to decide whether an individual patient has developed central nervous system or peripheral nervous system complications. A comprehensive clinical neurological examination is required to assess whether COVID-19 is complicated by neurological impairment.…”