Impact of Acute Confusional State in Patients With COVID-19 and a Predictive Score.

• Authors: Bhanu Gogia, Neurology/Vascular Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA.; Deep Pujara, Neurology, Case Western Reserve University, Cleveland, USA.; Neeharika Thottempudi, Neurology, University of Texas Medical Branch at Galveston, Galveston, USA.; Tamer Ghanayem, Neurology, Vanderbilt University Medical Center, Nashville, USA.; Yousaf Ajam, Neurology, University of Texas Medical Branch at Galveston, Galveston, USA.; Ayush Singh, Neurology, Emory University School of Medicine, Atlanta, USA.; Alok Dabi, Neurology, University of Texas Medical Branch at Galveston, Galveston, USA.; Shekhar Patil, Internal Medicine, Northeast Internal Medical Associates, Fort Wayne, USA.; Kyra Curtis, Neurology, University of Texas Medical Branch at Galveston, Galveston, USA.; Xiang Fang, Neurology, University of Texas Medical Branch at Galveston, Galveston, USA.; Kamakshi Patel, Neurology, University of Texas Medical Branch at Galveston, Galveston, USA.; Anish Bhardwaj, Neurology, University of Texas Medical Branch at Galveston, Galveston, USA.; Prashant Rai, Neurology, University of Texas Medical Branch at Galveston, Galveston, USA.
• Journal Title: Cureus
• Volume: Volume 13, Number 9
• Publisher: Cureus | 2021-09, Pages e18360-e18360
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.7759/cureus.18360
• Subjects: Health Sciences, Medicine and Surgery
• Keywords: acute confusional state; covid-19; predictive score; receiver operating characteristic (roc) analysis; retrospective cohort

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.