Acquired agitation in acute respiratory distress syndrome with COVID-19 compared to influenza patients: a propensity score matching observational study
Abstract Background A growing body of evidence reports that agitation and encephalopathy are frequent in critically ill Covid-19 patients. We aimed to assess agitation’s incidence and risk factors in critically ill ARDS patients with Covid-19. For that purpose, we compared SARS-CoV-2 acute respirato...
| Main Authors: | , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2022-09-01
|
| Series: | Virology Journal |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12985-022-01868-1 |
| _version_ | 1798003033442877440 |
|---|---|
| author | Adel Maamar Clémence Liard Willelm Doucet Florian Reizine Benoit Painvin Flora Delamaire Valentin Coirier Quentin Quelven Pauline Guillot Mathieu Lesouhaitier Jean Marc Tadié Arnaud Gacouin |
| author_facet | Adel Maamar Clémence Liard Willelm Doucet Florian Reizine Benoit Painvin Flora Delamaire Valentin Coirier Quentin Quelven Pauline Guillot Mathieu Lesouhaitier Jean Marc Tadié Arnaud Gacouin |
| author_sort | Adel Maamar |
| collection | DOAJ |
| description | Abstract Background A growing body of evidence reports that agitation and encephalopathy are frequent in critically ill Covid-19 patients. We aimed to assess agitation’s incidence and risk factors in critically ill ARDS patients with Covid-19. For that purpose, we compared SARS-CoV-2 acute respiratory distress syndrome (ARDS) patients with a population of influenza ARDS patients, given that the influenza virus is also known for its neurotropism and ability to induce encephalopathy. Methods We included all the patients with laboratory-confirmed Covid-19 infection and ARDS admitted to our medical intensive care unit (ICU) between March 10th, 2020 and April 16th, 2021, and all the patients with laboratory-confirmed influenza infection and ARDS admitted to our ICU between April 10th, 2006 and February 8th, 2020. Clinical and biological data were prospectively collected and retrospectively analyzed. We also recorded previously known factors associated with agitation (ICU length of stay, length of invasive ventilation, SOFA score and SAPS II at admission, sedative and opioids consumption, time to defecation). Agitation was defined as a day with Richmond Agitation Sedation Scale greater than 0 after exclusion of other causes of delirium and pain. We compared the prevalence of agitation among Covid-19 patients during their ICU stay and in those with influenza patients. Results We included 241 patients (median age 62 years [53–70], 158 males (65.5%)), including 146 patients with Covid-19 and 95 patients with Influenza. One hundred eleven (46.1%) patients had agitation during their ICU stay. Patients with Covid-19 had significantly more agitation than patients with influenza (respectively 80 patients (54.8%) and 31 patients (32.6%), p < 0.01). After matching with a propensity score, Covid-19 patients remained more agitated than influenza patients (49 (51.6% vs 32 (33.7%), p = 0.006). Agitation remained independently associated with mortality after adjustment for other factors (HR = 1.85, 95% CI 1.37–2.49, p < 0.001). Conclusion Agitation in ARDS Covid-19 patients was more frequent than in ARDS influenza patients and was not associated with common risk factors, such as severity of illness or sedation. Systemic hyperinflammation might be responsible for these neurological manifestations, but there is no specific management to our knowledge. |
| first_indexed | 2024-04-11T12:01:36Z |
| format | Article |
| id | doaj.art-2976cc561199481d90dc34e512770a8e |
| institution | Directory Open Access Journal |
| issn | 1743-422X |
| language | English |
| last_indexed | 2024-04-11T12:01:36Z |
| publishDate | 2022-09-01 |
| publisher | BMC |
| record_format | Article |
| series | Virology Journal |
| spelling | doaj.art-2976cc561199481d90dc34e512770a8e2022-12-22T04:24:50ZengBMCVirology Journal1743-422X2022-09-011911910.1186/s12985-022-01868-1Acquired agitation in acute respiratory distress syndrome with COVID-19 compared to influenza patients: a propensity score matching observational studyAdel Maamar0Clémence Liard1Willelm Doucet2Florian Reizine3Benoit Painvin4Flora Delamaire5Valentin Coirier6Quentin Quelven7Pauline Guillot8Mathieu Lesouhaitier9Jean Marc Tadié10Arnaud Gacouin11CHU Rennes, Service de Maladies Infectieuses et Réanimation Médicale, Hôpital Pontchaillou, Université de Rennes 1CHU Rennes, Service de Maladies Infectieuses et Réanimation Médicale, Hôpital Pontchaillou, Université de Rennes 1CHU Rennes, Service de Maladies Infectieuses et Réanimation Médicale, Hôpital Pontchaillou, Université de Rennes 1CHU Rennes, Service de Maladies Infectieuses et Réanimation Médicale, Hôpital Pontchaillou, Université de Rennes 1CHU Rennes, Service de Maladies Infectieuses et Réanimation Médicale, Hôpital Pontchaillou, Université de Rennes 1CHU Rennes, Service de Maladies Infectieuses et Réanimation Médicale, Hôpital Pontchaillou, Université de Rennes 1CHU Rennes, Service de Maladies Infectieuses et Réanimation Médicale, Hôpital Pontchaillou, Université de Rennes 1CHU Rennes, Service de Maladies Infectieuses et Réanimation Médicale, Hôpital Pontchaillou, Université de Rennes 1CHU Rennes, Service de Maladies Infectieuses et Réanimation Médicale, Hôpital Pontchaillou, Université de Rennes 1CHU Rennes, Service de Maladies Infectieuses et Réanimation Médicale, Hôpital Pontchaillou, Université de Rennes 1CHU Rennes, Service de Maladies Infectieuses et Réanimation Médicale, Hôpital Pontchaillou, Université de Rennes 1CHU Rennes, Service de Maladies Infectieuses et Réanimation Médicale, Hôpital Pontchaillou, Université de Rennes 1Abstract Background A growing body of evidence reports that agitation and encephalopathy are frequent in critically ill Covid-19 patients. We aimed to assess agitation’s incidence and risk factors in critically ill ARDS patients with Covid-19. For that purpose, we compared SARS-CoV-2 acute respiratory distress syndrome (ARDS) patients with a population of influenza ARDS patients, given that the influenza virus is also known for its neurotropism and ability to induce encephalopathy. Methods We included all the patients with laboratory-confirmed Covid-19 infection and ARDS admitted to our medical intensive care unit (ICU) between March 10th, 2020 and April 16th, 2021, and all the patients with laboratory-confirmed influenza infection and ARDS admitted to our ICU between April 10th, 2006 and February 8th, 2020. Clinical and biological data were prospectively collected and retrospectively analyzed. We also recorded previously known factors associated with agitation (ICU length of stay, length of invasive ventilation, SOFA score and SAPS II at admission, sedative and opioids consumption, time to defecation). Agitation was defined as a day with Richmond Agitation Sedation Scale greater than 0 after exclusion of other causes of delirium and pain. We compared the prevalence of agitation among Covid-19 patients during their ICU stay and in those with influenza patients. Results We included 241 patients (median age 62 years [53–70], 158 males (65.5%)), including 146 patients with Covid-19 and 95 patients with Influenza. One hundred eleven (46.1%) patients had agitation during their ICU stay. Patients with Covid-19 had significantly more agitation than patients with influenza (respectively 80 patients (54.8%) and 31 patients (32.6%), p < 0.01). After matching with a propensity score, Covid-19 patients remained more agitated than influenza patients (49 (51.6% vs 32 (33.7%), p = 0.006). Agitation remained independently associated with mortality after adjustment for other factors (HR = 1.85, 95% CI 1.37–2.49, p < 0.001). Conclusion Agitation in ARDS Covid-19 patients was more frequent than in ARDS influenza patients and was not associated with common risk factors, such as severity of illness or sedation. Systemic hyperinflammation might be responsible for these neurological manifestations, but there is no specific management to our knowledge.https://doi.org/10.1186/s12985-022-01868-1Covid-19InfluenzaARDSICUAgitationEncephalopathy |
| spellingShingle | Adel Maamar Clémence Liard Willelm Doucet Florian Reizine Benoit Painvin Flora Delamaire Valentin Coirier Quentin Quelven Pauline Guillot Mathieu Lesouhaitier Jean Marc Tadié Arnaud Gacouin Acquired agitation in acute respiratory distress syndrome with COVID-19 compared to influenza patients: a propensity score matching observational study Virology Journal Covid-19 Influenza ARDS ICU Agitation Encephalopathy |
| title | Acquired agitation in acute respiratory distress syndrome with COVID-19 compared to influenza patients: a propensity score matching observational study |
| title_full | Acquired agitation in acute respiratory distress syndrome with COVID-19 compared to influenza patients: a propensity score matching observational study |
| title_fullStr | Acquired agitation in acute respiratory distress syndrome with COVID-19 compared to influenza patients: a propensity score matching observational study |
| title_full_unstemmed | Acquired agitation in acute respiratory distress syndrome with COVID-19 compared to influenza patients: a propensity score matching observational study |
| title_short | Acquired agitation in acute respiratory distress syndrome with COVID-19 compared to influenza patients: a propensity score matching observational study |
| title_sort | acquired agitation in acute respiratory distress syndrome with covid 19 compared to influenza patients a propensity score matching observational study |
| topic | Covid-19 Influenza ARDS ICU Agitation Encephalopathy |
| url | https://doi.org/10.1186/s12985-022-01868-1 |
| work_keys_str_mv | AT adelmaamar acquiredagitationinacuterespiratorydistresssyndromewithcovid19comparedtoinfluenzapatientsapropensityscorematchingobservationalstudy AT clemenceliard acquiredagitationinacuterespiratorydistresssyndromewithcovid19comparedtoinfluenzapatientsapropensityscorematchingobservationalstudy AT willelmdoucet acquiredagitationinacuterespiratorydistresssyndromewithcovid19comparedtoinfluenzapatientsapropensityscorematchingobservationalstudy AT florianreizine acquiredagitationinacuterespiratorydistresssyndromewithcovid19comparedtoinfluenzapatientsapropensityscorematchingobservationalstudy AT benoitpainvin acquiredagitationinacuterespiratorydistresssyndromewithcovid19comparedtoinfluenzapatientsapropensityscorematchingobservationalstudy AT floradelamaire acquiredagitationinacuterespiratorydistresssyndromewithcovid19comparedtoinfluenzapatientsapropensityscorematchingobservationalstudy AT valentincoirier acquiredagitationinacuterespiratorydistresssyndromewithcovid19comparedtoinfluenzapatientsapropensityscorematchingobservationalstudy AT quentinquelven acquiredagitationinacuterespiratorydistresssyndromewithcovid19comparedtoinfluenzapatientsapropensityscorematchingobservationalstudy AT paulineguillot acquiredagitationinacuterespiratorydistresssyndromewithcovid19comparedtoinfluenzapatientsapropensityscorematchingobservationalstudy AT mathieulesouhaitier acquiredagitationinacuterespiratorydistresssyndromewithcovid19comparedtoinfluenzapatientsapropensityscorematchingobservationalstudy AT jeanmarctadie acquiredagitationinacuterespiratorydistresssyndromewithcovid19comparedtoinfluenzapatientsapropensityscorematchingobservationalstudy AT arnaudgacouin acquiredagitationinacuterespiratorydistresssyndromewithcovid19comparedtoinfluenzapatientsapropensityscorematchingobservationalstudy |