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Neurological manifestations in COVID-19 patients and their application in predicting fatal disease: A retrospective cohort study
Journal of Microbiology, Immunology and Infection ( IF 4.5 ) Pub Date : 2021-08-25 , DOI: 10.1016/j.jmii.2021.07.010
Tian-Shuo Zhao 1 , Hao-Long Zeng 2 , Xin Zhang 3 , Xi Chen 4 , Wan-Li Jiang 5 , Juan Du 1 , Han-Yu Liu 1 , Jing Zhao 6 , Yang Yuan 6 , Xue-Fang Peng 6 , Jia-Chen Li 6 , Tong Yang 6 , Bao-Cheng Liu 6 , Hui-Jun Li 2 , Xiao-Ai Zhang 6 , Li-Qun Fang 6 , Qing-Bin Lu 1 , Fuqiang Cui 1 , Wei Liu 7
Affiliation  

Background

To explore the development of central nervous system (CNS) symptoms and clinical application in predicting the clinical outcomes of SARS-COV-2 patients.

Methods

A retrospective cohort study was performed on the hospitalized patients with SARS-COV-2 recruited from four hospitals in Hubei Province, China from 18 January to 10 March 2020. The patients with CNS symptoms were determined. Data regarding clinical symptoms and laboratory tests were collected from medical records.

Results

Of 1268 patients studied, 162 (12.8%) had CNS symptoms, manifested as unconsciousness (71, 5.6%), coma (69, 5.4%), dysphoria (50, 3.9%), somnolence (34, 2.7%) and convulsion (3, 0.2%), which were observed at median of 14 (interquartile range 9–18) days after symptom onset and significantly associated with older age (OR = 5.71, 95% confidence interval [CI] 2.78–11.73), male (OR = 1.73, 95% CI 1.22–2.47) and preexisting hypertension (OR = 1.78, 95% CI 1.23–2.57). The presence of CNS symptoms could be predicted by abnormal laboratory tests across various clinical stages, including by lymphocyte counts of <0.93 × 109/L, LDH≥435 U/L and IL-6≥28.83 pg/L at 0–10 days post disease; by lymphocyte count<0.86 × 109/L, IL-2R ≥ 949 U/L, LDH≥382 U/L and WBC≥8.06 × 109/L at 11–20 days post disease. More patients with CNS symptoms developed fatal outcome compared with patients without CNS symptoms (HR = 33.96, 95% CI 20.87–55.16).

Conclusion

Neurological symptoms of COVID-19 were related to increased odds of developing poor prognosis and even fatal infection.

更新日期:2021-08-25
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