Neurologic manifestations of COVID-19 in critically ill patients: results of the prospective multicenter registry PANDEMIC
Abstract Background Neurologic manifestations are increasingly reported in patients with coronavirus disease 2019 (COVID-19). Yet, data on prevalence, predictors and relevance for outcome of neurological manifestations in patients requiring intensive care are scarce. We aimed to characterize prevale...
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| Format: | Article |
| Language: | English |
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BMC
2022-07-01
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| Series: | Critical Care |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13054-022-04080-3 |
| _version_ | 1818474183792787456 |
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| author | Konstantinos Dimitriadis Jan Meis Hermann Neugebauer Kristian Barlinn Bernhard Neumann Georg Gahn Piergiorgio Lochner Benjamin Knier Sarah Lindemann Kurt Wolfram Sühs Kristina Szabo Thomas Pfefferkorn Ingo Schirotzek Tobias Freilinger Bassa Burc Albrecht Günther Matthias Wittstock Patrick Schramm Gernot Reimann Jana Godau Gabor Nagy Fatima B. Koenig Fabian Essig Hartwig Klinker Christian Hartmann Moritz L. Schmidbauer Tim Steinberg Lora Lefterova Christina Klose Julian Bösel for the IGNITE study group |
| author_facet | Konstantinos Dimitriadis Jan Meis Hermann Neugebauer Kristian Barlinn Bernhard Neumann Georg Gahn Piergiorgio Lochner Benjamin Knier Sarah Lindemann Kurt Wolfram Sühs Kristina Szabo Thomas Pfefferkorn Ingo Schirotzek Tobias Freilinger Bassa Burc Albrecht Günther Matthias Wittstock Patrick Schramm Gernot Reimann Jana Godau Gabor Nagy Fatima B. Koenig Fabian Essig Hartwig Klinker Christian Hartmann Moritz L. Schmidbauer Tim Steinberg Lora Lefterova Christina Klose Julian Bösel for the IGNITE study group |
| author_sort | Konstantinos Dimitriadis |
| collection | DOAJ |
| description | Abstract Background Neurologic manifestations are increasingly reported in patients with coronavirus disease 2019 (COVID-19). Yet, data on prevalence, predictors and relevance for outcome of neurological manifestations in patients requiring intensive care are scarce. We aimed to characterize prevalence, risk factors and impact on outcome of neurologic manifestations in critically ill COVID-19 patients. Methods In the prospective, multicenter, observational registry study PANDEMIC (Pooled Analysis of Neurologic DisordErs Manifesting in Intensive care of COVID-19), we enrolled COVID-19 patients with neurologic manifestations admitted to 19 German intensive care units (ICU) between April 2020 and September 2021. We performed descriptive and explorative statistical analyses. Multivariable models were used to investigate factors associated with disorder categories and their underlying diagnoses as well as to identify predictors of outcome. Results Of the 392 patients included in the analysis, 70.7% (277/392) were male and the mean age was 65.3 (SD ± 3.1) years. During the study period, a total of 2681 patients with COVID-19 were treated at the ICUs of 15 participating centers. New neurologic disorders were identified in 350 patients, reported by these centers, suggesting a prevalence of COVID-19-associated neurologic disorders of 12.7% among COVID-19 ICU patients. Encephalopathy (46.2%; 181/392), cerebrovascular (41.0%; 161/392) and neuromuscular disorders (20.4%; 80/392) were the most frequent categories identified. Out of 35 cerebrospinal fluid analyses with reverse transcriptase PCR for SARS-COV-2, only 3 were positive. In-hospital mortality was 36.0% (140/389), and functional outcome (mRS 3 to 5) of surviving patients was poor at hospital discharge in 70.9% (161/227). Intracerebral hemorrhage (OR 6.2, 95% CI 2.5–14.9, p < 0.001) and acute ischemic stroke (OR 3.9, 95% CI 1.9–8.2, p < 0.001) were the strongest predictors of poor outcome among the included patients. Conclusions Based on this well-characterized COVID-19 ICU cohort, that comprised 12.7% of all severe ill COVID-19 patients, neurologic manifestations increase mortality and morbidity. Since no reliable evidence of direct viral affection of the nervous system by COVID-19 could be found, these neurologic manifestations may for a great part be indirect para- or postinfectious sequelae of the infection or severe critical illness. Neurologic ICU complications should be actively searched for and treated. |
| first_indexed | 2024-04-14T04:34:35Z |
| format | Article |
| id | doaj.art-010404c81c5943d08ffa6f23d888dce5 |
| institution | Directory Open Access Journal |
| issn | 1364-8535 |
| language | English |
| last_indexed | 2024-04-14T04:34:35Z |
| publishDate | 2022-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Critical Care |
| spelling | doaj.art-010404c81c5943d08ffa6f23d888dce52022-12-22T02:11:55ZengBMCCritical Care1364-85352022-07-0126111210.1186/s13054-022-04080-3Neurologic manifestations of COVID-19 in critically ill patients: results of the prospective multicenter registry PANDEMICKonstantinos Dimitriadis0Jan Meis1Hermann Neugebauer2Kristian Barlinn3Bernhard Neumann4Georg Gahn5Piergiorgio Lochner6Benjamin Knier7Sarah Lindemann8Kurt Wolfram Sühs9Kristina Szabo10Thomas Pfefferkorn11Ingo Schirotzek12Tobias Freilinger13Bassa Burc14Albrecht Günther15Matthias Wittstock16Patrick Schramm17Gernot Reimann18Jana Godau19Gabor Nagy20Fatima B. Koenig21Fabian Essig22Hartwig Klinker23Christian Hartmann24Moritz L. Schmidbauer25Tim Steinberg26Lora Lefterova27Christina Klose28Julian Bösel29for the IGNITE study groupDepartment of Neurology, University Hospital LMU MunichInstitute of Medical Biometry, University of HeidelbergDepartment of Neurology, University Hospital WürzburgDepartment of Neurology, University Hospital Carl Gustav Carus, Technische Universität DresdenDepartment of Neurology, Donau-Isar-Klinikum DeggendorfDepartment of Neurology, Klinikum KarlsruheDepartment of Neurology, Saarland University Medical CenterDepartment of Neurology, Klinikum rechts der Isar, Technical University of MunichSRH-Waldklinikum GeraDepartment of Neurology, Medical School HannoverDepartment of Neurology, Medical Faculty Mannheim and Mannheim Center for Translational Neurosciences (MCTN), Heidelberg UniversityDepartment of Neurology, Klinikum IngolstadtDepartment of Neurology, Klinikum DarmstadtKlinik für Neurologie, Klinikum PassauDepartment of Neurology, Krankenhaus NordwestDepartment of Neurology, Jena University HospitalDepartment of Neurology, University Medicine RostockDepartment of Neurology, Universitätätsklinikum Giessen und Marburg, Standort Giessen, Justus-Liebig-UniversityDepartment of Neurology, Klinikum Dortmund gGmbHDepartment of Neurology, Klinikum KasselDepartment of Neurology, Klinikum KasselDepartment of Neurology, Klinikum KasselDepartment of Neurology, University Hospital WürzburgDepartment of Internal Medicine II, Division of Infectious Diseases, University Hospital WürzburgDepartment of Neurology, University Hospital Carl Gustav Carus, Technische Universität DresdenDepartment of Neurology, University Hospital LMU MunichDepartment of Neurology, University of Regensburg, Bezirksklinikum RegensburgDepartment of Neurology, Klinikum KarlsruheInstitute of Medical Biometry, University of HeidelbergDepartment of Neurology, Klinikum KasselAbstract Background Neurologic manifestations are increasingly reported in patients with coronavirus disease 2019 (COVID-19). Yet, data on prevalence, predictors and relevance for outcome of neurological manifestations in patients requiring intensive care are scarce. We aimed to characterize prevalence, risk factors and impact on outcome of neurologic manifestations in critically ill COVID-19 patients. Methods In the prospective, multicenter, observational registry study PANDEMIC (Pooled Analysis of Neurologic DisordErs Manifesting in Intensive care of COVID-19), we enrolled COVID-19 patients with neurologic manifestations admitted to 19 German intensive care units (ICU) between April 2020 and September 2021. We performed descriptive and explorative statistical analyses. Multivariable models were used to investigate factors associated with disorder categories and their underlying diagnoses as well as to identify predictors of outcome. Results Of the 392 patients included in the analysis, 70.7% (277/392) were male and the mean age was 65.3 (SD ± 3.1) years. During the study period, a total of 2681 patients with COVID-19 were treated at the ICUs of 15 participating centers. New neurologic disorders were identified in 350 patients, reported by these centers, suggesting a prevalence of COVID-19-associated neurologic disorders of 12.7% among COVID-19 ICU patients. Encephalopathy (46.2%; 181/392), cerebrovascular (41.0%; 161/392) and neuromuscular disorders (20.4%; 80/392) were the most frequent categories identified. Out of 35 cerebrospinal fluid analyses with reverse transcriptase PCR for SARS-COV-2, only 3 were positive. In-hospital mortality was 36.0% (140/389), and functional outcome (mRS 3 to 5) of surviving patients was poor at hospital discharge in 70.9% (161/227). Intracerebral hemorrhage (OR 6.2, 95% CI 2.5–14.9, p < 0.001) and acute ischemic stroke (OR 3.9, 95% CI 1.9–8.2, p < 0.001) were the strongest predictors of poor outcome among the included patients. Conclusions Based on this well-characterized COVID-19 ICU cohort, that comprised 12.7% of all severe ill COVID-19 patients, neurologic manifestations increase mortality and morbidity. Since no reliable evidence of direct viral affection of the nervous system by COVID-19 could be found, these neurologic manifestations may for a great part be indirect para- or postinfectious sequelae of the infection or severe critical illness. Neurologic ICU complications should be actively searched for and treated.https://doi.org/10.1186/s13054-022-04080-3COVID-19Neurologic manifestationsIntensive careCritically ill |
| spellingShingle | Konstantinos Dimitriadis Jan Meis Hermann Neugebauer Kristian Barlinn Bernhard Neumann Georg Gahn Piergiorgio Lochner Benjamin Knier Sarah Lindemann Kurt Wolfram Sühs Kristina Szabo Thomas Pfefferkorn Ingo Schirotzek Tobias Freilinger Bassa Burc Albrecht Günther Matthias Wittstock Patrick Schramm Gernot Reimann Jana Godau Gabor Nagy Fatima B. Koenig Fabian Essig Hartwig Klinker Christian Hartmann Moritz L. Schmidbauer Tim Steinberg Lora Lefterova Christina Klose Julian Bösel for the IGNITE study group Neurologic manifestations of COVID-19 in critically ill patients: results of the prospective multicenter registry PANDEMIC Critical Care COVID-19 Neurologic manifestations Intensive care Critically ill |
| title | Neurologic manifestations of COVID-19 in critically ill patients: results of the prospective multicenter registry PANDEMIC |
| title_full | Neurologic manifestations of COVID-19 in critically ill patients: results of the prospective multicenter registry PANDEMIC |
| title_fullStr | Neurologic manifestations of COVID-19 in critically ill patients: results of the prospective multicenter registry PANDEMIC |
| title_full_unstemmed | Neurologic manifestations of COVID-19 in critically ill patients: results of the prospective multicenter registry PANDEMIC |
| title_short | Neurologic manifestations of COVID-19 in critically ill patients: results of the prospective multicenter registry PANDEMIC |
| title_sort | neurologic manifestations of covid 19 in critically ill patients results of the prospective multicenter registry pandemic |
| topic | COVID-19 Neurologic manifestations Intensive care Critically ill |
| url | https://doi.org/10.1186/s13054-022-04080-3 |
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