Toxic Metabolic Encephalopathy in Hospitalized Patients with COVID-19

Abstract

Background Toxic metabolic encephalopathy (TME) has been reported in 7–31% of hospitalized patients with coronavirus disease 2019 (COVID-19); however, some reports include sedation-related delirium and few data exist on the etiology of TME. We aimed to identify the prevalence, etiologies, and mortality rates associated with TME in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive patients. Methods We conducted a retrospective, multicenter, observational cohort study among patients with reverse transcriptase–polymerase chain reaction-confirmed SARS-CoV-2 infection hospitalized at four New York City hospitals in the same health network between March 1, 2020, and May 20, 2020. TME was diagnosed in patients with altered mental status off sedation or after an adequate sedation washout. Patients with structural brain disease, seizures, or primary neurological diagnoses were excluded. The coprimary outcomes were the prevalence of TME stratified by etiology and in-hospital mortality (excluding comfort care only patients) assessed by using a multivariable time-dependent Cox proportional hazards models with adjustment for age, race, sex, intubation, intensive care unit requirement, Sequential Organ Failure Assessment scores, hospital location, and date of admission. Results Among 4491 patients with COVID-19, 559 (12%) were diagnosed with TME, of whom 435 of 559 (78%) developed encephalopathy immediately prior to hospital admission. The most common etiologies were septic encephalopathy ( n = 247 of 559 [62%]), hypoxic-ischemic encephalopathy (HIE) ( n = 331 of 559 [59%]), and uremia ( n = 156 of 559 [28%]). Multiple etiologies were present in 435 (78%) patients. Compared with those without TME ( n = 3932), patients with TME were older (76 vs. 62 years), had dementia (27% vs. 3%) or psychiatric history (20% vs. 10%), were more often intubated (37% vs. 20%), had a longer hospital length of stay (7.9 vs. 6.0 days), and were less often discharged home (25% vs. 66% [all P < 0.001]). Excluding comfort care patients ( n = 267 of 4491 [6%]) and after adjustment for confounders, TME remained associated with increased risk of in-hospital death ( n = 128 of 425 [30%] patients with TME died, compared with n = 600 of 3799 [16%] patients without TME; adjusted hazard ratio [aHR] 1.24, 95% confidence interval [CI] 1.02–1.52, P = 0.031), and TME due to hypoxemia conferred the highest risk ( n = 97 of 233 [42%] patients with HIE died, compared with n = 631 of 3991 [16%] patients without HIE; aHR 1.56, 95% CI 1.21–2.00, P = 0.001). Conclusions TME occurred in one in eight hospitalized patients with COV...

Post-infection cognitive impairments in a cohort of elderly patients with COVID-19

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COVID-19-associated myoclonus in a series of five critically ill patients

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“…This theory is supported by the fact that the symptoms were reversible in all cases and intrathecal immunoglobulins were detected. Furthermore, the onset of symptoms with some latency after a viral infection is typical [ 14 , 15 ].…”

Elevation of Neurodegenerative Serum Biomarkers among Hospitalized COVID-19 Patients

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“…This statistic calculates pairwise rankings for comparable pairs, and accounts for the time needed to have the opportunity to be diagnosed with a specific outcome prior to the occurrence of a All models were adjusted for confounders including age, sex, race, history of neurological disease, admission sequential organ failure assessment (SOFA) score, and admission oxygen saturation. Covariates were selected based on known predictors of in-hospital death, poor discharge disposition, biological plausibility and bivariate associations within our own data(1,3,22). Analyses were conducted using IBM SPSS Statistics for Mac V25 (IBM Corp., Armonk, NY) and R studio V1.1.456.…”