Neurological Manifestations in Critically Ill Patients With COVID-19: A Retrospective Study
Siyuan Fan, Meng Xiao, Fei Han, Peng Xia, Xiaoyin Bai, Huan Chen, Hongmin Zhang, Xin Ding, Hua Zhao, Jing Zhao, Xuefeng Sun, Wei Jiang, Chunyao Wang, Wei Cao, Fan Guo, Ran Tian, Peng Gao, Wei Wu, Jie Ma, Dong Wu, Zhengyin Liu, Xiang Zhou, Jinglan Wang, Tianjia Guan, Yan Qin, Taisheng Li, Yingchun Xu, Dong Zhang, Yú Chen, Jing Xie, Yongzhe Li, Xiaowei Yan, Yicheng Zhu, Bin Peng, Liying Cui, Yuanqiang Zhang, Hongzhi Guan
Abstract
Background: The complications of coronavirus disease 2019 (COVID-19) involved multiple organs or systems, especially in critically ill patients. We aim to investigate the neurological complications in critically ill patients with COVID-19. Methods: This retrospective single-center case series analyzed critically ill patients with COVID-19 at the intensive care unit of Tongji Hospital, Wuhan, China from February 5 to April 2, 2020. Demographic data, clinical and laboratory findings, comorbidities and treatments were collected and analyzed. Results: Among 86 patients with confirmed COVID-19, 54 patients (62.8%) were male, and the mean (SD) age was 66.6 (11.1) years. Overall, 65% patients presented with at least one neurological symptom. Twenty patients (23.3%) had symptoms involving the central nervous system, including delirium, cerebrovascular diseases and hypoxic-ischemic brain injury, while 6 patients (7%) had neuromuscular involvement. Seven of 86 patients exhibited new stroke and 6 (7%) cases were ischemic. A significantly higher prevalence of antiphospholipid antibodies was observed in patients with ischemic stroke than in those without stroke (83.3% vs 26.9%, p<0.05). Patients with ischemic stroke were more likely to have a higher myoglobulin level, and a lower hemoglobin level. Conclusions: The clinical spectrum of neurological complications in critically ill patients with COVID-19 was broad. Stroke, delirium and neuromuscular diseases are common neurological complications of COVID-19. Physicians should pay close attention to neurological complications in critically ill patients with COVID-19.