Abstract
Background: Acute confusional state (ACS) in COVID-19 is shown to be associated with poor clinical outcomes.Methods: We assessed the impact of ACS - defined as a documented deterioration of mental status from baseline on the alertness and orientation to time, place, and person - on inpatient mortality and the need for intensive care unit (ICU) transfer in inpatient admissions with active COVID-19 infection in a single-center retrospective cohort of inpatient admissions from a designated COVID-19 tertiary care center using an electronic health record system. Furthermore, we developed and validated a neurological history and symptom-based predictive score of developing ACS.Results: Thirty seven out of 245 (15%) patients demonstrated ACS. Nineteen (51%) patients had multifactorial ACS, followed by 11 (30%) patients because of hypoxemia. ACS patients were significantly older (80 [70-85] years vs 50.5 [38-69] years, p < 0.001) and demonstrated more frequent history of dementia (43% vs 9%, p < 0.001) and epilepsy (16% vs 2%, p = 0.001). ACS patients observed significantly higher in-hospital mortality (45.9% vs 1.9%, aOR [adjusted odds ratio]: 15.7, 95% CI = 3.6-68.0, p < 0.001) and need for ICU transfer (64.9% vs 35.1%, aOR: 2.7, 95% CI = 1.2-6.1, p = 0.015). In patients who survived hospitalization, ACS was associated with longer hospital stay (6 [3.5-10.5] days vs 3 [2-7] day, p = 0.012) and numerically longer ICU stay (6 [4-10] days vs 3 [2-6] days, p = 0.078). A score to predict ACS demonstrated 75.68% sensitivity and 81.73% specificity at a cutoff of ≥3.Conclusion: A high prevalence of ACS was found in patients with COVID-19 in our study cohort. Patients with ACS demonstrated increased mortality and need for ICU care. An internally validated score to predict ACS demonstrated high sensitivity and specificity in our cohort.
Highlights
Acute confusional state (ACS) patients observed significantly higher in-hospital mortality (45.9% vs 1.9%, an independent predictor of in-hospital mortality (aOR) [adjusted odds ratio]: 15.7, 95% CI = 3.668.0, p < 0.001) and need for intensive care unit (ICU) transfer (64.9% vs 35.1%, aOR: 2.7, 95% CI = 1.2-6.1, p = 0.015)
In patients who survived hospitalization, ACS was associated with longer hospital stay (6 [3.5-10.5] days vs 3 [2,3,4,5,6,7] day, p = 0.012) and numerically longer ICU stay (6 [4,5,6,7,8,9,10] days vs 3 [2,3,4,5,6] days, p = 0.078)
The COVID-19 pandemic that initially presented as a cluster of unexplained pneumonia cases in Wuhan, China, in December 2019 [1] and rapidly spread across the world has reached more than 170 million confirmed cases as of June 1, 2021 [2], with South-East Asia and Americas leading in the total new cases (May 24, 2021-May 31, 2021)
Summary
The COVID-19 pandemic that initially presented as a cluster of unexplained pneumonia cases in Wuhan, China, in December 2019 [1] and rapidly spread across the world has reached more than 170 million confirmed cases as of June 1, 2021 [2], with South-East Asia and Americas leading in the total new cases (May 24, 2021-May 31, 2021). Strict confinement protocols combined with enhanced vaccination efforts have led to some degree of control in disease transmission in the United States, Europe, and Australia; failure to curb the spread in South-East Asia and South America ascertains continued propagation of the disease resulting in high mortality [2]. Until better control and effective vaccination measures are available worldwide, better strategies for risk stratification and prognostication, as well as early identification of patients who may need enhanced care, may help reduce the care burden and improve outcomes [3]. Acute confusional state (ACS) is one such symptom that has been shown to be frequently present in COVID-19 patients. Acute confusional state (ACS) in COVID-19 is shown to be associated with poor clinical outcomes
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