Abstract
BackgroundThe objective of the study was to assess the cerebrospinal fluid (CSF) findings in COVID-19 patients.AimsThis was an observational retrospective cohort from electronic medical records of hospitalized patients (n = 2655) with confirmed COVID-19 between February 15, 2020, and April 15, 2020, in 182 hospitals from a large health system in the USA. The review of data yielded to a total of 79 patients in 20 hospitals who had CSF analysis.MethodsOutcomes during hospitalization, including hospital length of stay, disease severity, ventilator time, and in-hospital death were recorded. Independent variables collected included patient demographics, diagnoses, laboratory values, and procedures.ResultsA total of 79 patients underwent CSF analysis. Of these, antigen testing was performed in 73 patients. Ten patients had CSF analysis for general markers such as total protein, cell count, glucose, clarity, and color. Seven of the 10 cases (70%) had normal total cell count and normal white blood cell count in CSF. Sixty-three percent (5/8) had elevated total protein. Two patients had normal levels of lactate dehydrogenase (LDH) and 1 patient had significantly elevated (fourfold) neuron-specific enolase (NSE) level in CSF.ConclusionUnlike bacterial infections, viral infections are less likely to cause remarkable changes in CSF glucose, cell count, or protein. Our observations showed no pleocytosis, but mild increase in protein in the CSF of the COVID-19 patients. The fourfold elevation of NSE may have diagnostic/prognostic value as a biomarker in CSF for COVID-19 patients who have altered mental status.Graphical abstract
Highlights
The coronaviruses are RNA viruses that are responsible for zoonotic infections
Coronavirus disease 2019 (COVID-19) is an infectious disease caused by a new strain of coronavirus type 2, Severe acute respiratory syndrome (SARS)-COV-2 [2]
In addition to the analysis of general components of CSF, antigen, antibody, and other biomarker tests can be valuable for prognosis. Several biomarkers such as S100B, neuron-specific enolase (NSE), and glial fibrillary acid protein (GFAP) were shown to be associated with the clinical outcome in patients with head concussion trauma, ischemic stroke, intracerebral hemorrhage, cardiac arrest, anoxic encephalopathy, encephalitis, brain metastasis, and status epilepticus [16,17,18,19,20]. In this observational cohort study, we evaluated the cerebrospinal fluid findings in hospitalized patients with confirmed COVID-19
Summary
The strains of coronaviruses that have caused outbreaks in recent history include the systemic acute respiratory syndrome by SARS-CoV and the Middle East respiratory syndrome by MERS-CoV. SARSCoV was the causal agent of the severe acute respiratory syndrome outbreaks in 2002 and 2003 in China, while. MERS-CoV was the responsible agent for the outbreak in 2012 in Saudi Arabia [1]. COVID-19 presents with various symptoms ranging from mild to acute respiratory distress syndrome (ARDS), as well as gastrointestinal symptoms, cardiovascular, and neurologic symptoms. There are worldwide reports of neurological symptoms associated with COVID-19 [3,4,5,6,7,8,9,10,11,12,13,14]. The objective of the study was to assess the cerebrospinal fluid (CSF) findings in COVID-19 patients
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