☆ 4.4 Article

Disorders of Consciousness in Hospitalized Patients with COVID-19: The Role of the Systemic Inflammatory Response Syndrome

NEUROCRITICAL CARE (2022)

Journal

NEUROCRITICAL CARE

Volume 36, Issue 1, Pages 89-96

Publisher

HUMANA PRESS INC

DOI: 10.1007/s12028-021-01256-7

Keywords

COVID-19; Disorders of consciousness; Coma; Inflammation; Systemic inflammatory response syndrome

Funding

National Institute of Neurological Disorders and Stroke [R01 NS106014, NS106014-S0201, R01 NS106014-S0202, R03 NS112760]
James McDonnel Foundation

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Abstract

The prevalence and etiology of unconsciousness in hospitalized patients with severe COVID-19 are uncertain. Increased inflammation in COVID-19 may precede coma, and is associated with higher mortality and longer hospital stays.

Background Prevalence and etiology of unconsciousness are uncertain in hospitalized patients with coronavirus disease 2019 (COVID-19). We tested the hypothesis that increased inflammation in COVID-19 precedes coma, independent of medications, hypotension, and hypoxia. Methods We retrospectively assessed 3203 hospitalized patients with COVID-19 from March 2 through July 30, 2020, in New York City with the Glasgow Coma Scale and systemic inflammatory response syndrome (SIRS) scores. We applied hazard ratio (HR) modeling and mediation analysis to determine the risk of SIRS score elevation to precede coma, accounting for confounders. Results We obtained behavioral assessments in 3203 of 10,797 patients admitted to the hospital who tested positive for SARS-CoV-2. Of those patients, 1054 (32.9%) were comatose, which first developed on median hospital day 2 (interquartile range [IQR] 1-9). During their hospital stay, 1538 (48%) had a SIRS score of 2 or above at least once, and the median maximum SIRS score was 2 (IQR 1-2). A fivefold increased risk of coma (HR 5.05, 95% confidence interval 4.27-5.98) was seen for each day that patients with COVID-19 had elevated SIRS scores, independent of medication effects, hypotension, and hypoxia. The overall mortality in this population was 13.8% (n = 441). Coma was associated with death (odds ratio 7.77, 95% confidence interval 6.29-9.65) and increased length of stay (13 days [IQR 11.9-14.1] vs. 11 [IQR 9.6-12.4]), accounting for demographics. Conclusions Disorders of consciousness are common in hospitalized patients with severe COVID-19 and are associated with increased mortality and length of hospitalization. The underlying etiology of disorders of consciousness in this population is uncertain but, in addition to medication effects, may in part be linked to systemic inflammation.

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The systemic pro-inflammatory response: targeting the dangerous liaison between COVID-19 and cancer

G. M. Dettorre, M. Patel, A. Gennari, G. Pentheroudakis, E. Romano, A. Cortellini, D. J. Pinato

Summary: Inflammation plays a crucial role in severe SARS-CoV-2 infection in cancer patients, leading to increased susceptibility to fatal COVID-19. Targeted and non-targeted anti-inflammatory therapies, including selective interleukin inhibition and tyrosine kinase modulation, may help prevent end-organ damage and decrease mortality in these vulnerable patients. Further investigation of therapeutic approaches is needed to develop tailored treatments for this patient population.

ESMO OPEN (2021)