Neurological Complications and Outcomes in Critically Ill Patients with COVID-19: Results from International Neurological Study Group from the COVID-19 Critical Care Consortium

Abstract

Abstract Abstract (300/300) Background: In this COVID-19 Critical Care Consortium (CCCC) sub-study, we qualified neurological complications associated with COVID-19 infection, including incidence and outcomes across many countries. Methods: The CCCC is an international, multicenter study. Eligible patients were COVID-19 patients admitted to intensive care units (ICU) in hospitals across 23 centers between January 7th, 2020, to June 23rd, 2022. Incidence of neurological complications was estimated as the number of events per hospital days and per admission using Poisson regression. Associations between neurological complications and clinical risk factors were assessed using multivariable Poisson regression. Results: 713 patients were included, with a median age of 56 years (interquartile range (IQR)=45-65), of which 272 (38.1%) were female. Median ICU days was 14 (IQR=7-25). Neurological complications were reported in 61/480 patients (12.7%) with the most common being ischemic stroke (2.9%), intracranial hemorrhage (ICH) (2.8%), and seizures (2.6%). After adjusting for sex, age, pandemic era, country income status, comorbid neurological conditions, and mechanical ventilation or extracorporeal membrane oxygenation (ECMO), multivariable analysis for neurological complications per admitted days showed comorbid neurological conditions (incidence rate ratio (IRR)=6.35, 2.57-15.7) were an independent risk factor for ischemic stroke. ECMO (IRR=5.32, 1.52-18.6), low-middle income countries (LMIC) vs high income countries (HIC) (IRR=4.70, 1.62-13.7), and age >55 (IRR=3.66, 1.23-10.9) were independent risk factors for ICH. Co-morbid neurological conditions (IRR=3.43, 1.11-10.6), LMIC vs HIC (IRR=8.69, 2.15-35.2), July-December 2020 vs January-June 2020 (IRR=0.17, 0.04-0.69) and age >55 (IRR=4.05, 1.15-14.3) were independent risk factors for seizure. 6.8% of patients with neurological complications had favorable outcomes (modified Rankin Score (mRS) < 3) at discharge compared to 13.2% of patients without complications. Conclusions: Neurological complications were not uncommon in patients with COVID-19 infection. Being from an LMIC was an independent risk factor for neurological complications. Decision-making should incorporate salient risk factors to inform the management of severe COVID-19 infection.