Neurologic manifestations are increasingly reported in patients with coronavirus disease 2019 (COVID-19). Yet, data on prevalence, predictors and relevance for outcome of neurological manifestations in patients requiring intensive care are scarce. We aimed to characterize prevalence, risk factors and impact on outcome of neurologic manifestations in critically ill COVID-19 patients. In the prospective, multicenter, observational registry study PANDEMIC (Pooled Analysis of Neurologic DisordErs Manifesting in Intensive care of COVID-19), we enrolled COVID-19 patients with neurologic manifestations admitted to 19 German intensive care units (ICU) between April 2020 and September 2021. We performed descriptive and explorative statistical analyses. Multivariable models were used to investigate factors associated with disorder categories and their underlying diagnoses as well as to identify predictors of outcome. Of the 392 patients included in the analysis, 70.7% (277/392) were male and the mean age was 65.3 (SD ± 3.1) years. During the study period, a total of 2681 patients with COVID-19 were treated at the ICUs of 15 participating centers. New neurologic disorders were identified in 350 patients, reported by these centers, suggesting a prevalence of COVID-19-associated neurologic disorders of 12.7% among COVID-19 ICU patients. Encephalopathy (46.2%; 181/392), cerebrovascular (41.0%; 161/392) and neuromuscular disorders (20.4%; 80/392) were the most frequent categories identified. Out of 35 cerebrospinal fluid analyses with reverse transcriptase PCR for SARS-COV-2, only 3 were positive. In-hospital mortality was 36.0% (140/389), and functional outcome (mRS 3 to 5) of surviving patients was poor at hospital discharge in 70.9% (161/227). Intracerebral hemorrhage (OR 6.2, 95% CI 2.5–14.9, p < 0.001) and acute ischemic stroke (OR 3.9, 95% CI 1.9–8.2, p < 0.001) were the strongest predictors of poor outcome among the included patients. Based on this well-characterized COVID-19 ICU cohort, that comprised 12.7% of all severe ill COVID-19 patients, neurologic manifestations increase mortality and morbidity. Since no reliable evidence of direct viral affection of the nervous system by COVID-19 could be found, these neurologic manifestations may for a great part be indirect para- or postinfectious sequelae of the infection or severe critical illness. Neurologic ICU complications should be actively searched for and treated.

中文翻译：

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重症患者 COVID-19 的神经系统表现：前瞻性多中心登记大流行的结果

2019 年冠状病毒病 (COVID-19) 患者的神经系统表现越来越多。然而，关于需要重症监护的患者神经系统表现的患病率、预测因素和相关性的数据很少。我们旨在描述危重 COVID-19 患者的患病率、风险因素和对神经系统表现结果的影响。在前瞻性、多中心、观察性注册研究 PANDEMIC（COVID-19 重症监护中表现出的神经系统疾病的汇总分析）中，我们招募了 2020 年 4 月至 9 月期间在 19 个德国重症监护病房 (ICU) 收治的具有神经系统表现的 COVID-19 患者2021. 我们进行了描述性和探索性统计分析。多变量模型用于研究与疾病类别及其潜在诊断相关的因素，并确定结果的预测因子。在纳入分析的 392 名患者中，70.7% (277/392) 为男性，平均年龄为 65.3 (SD ± 3.1) 岁。在研究期间，共有 2681 名 COVID-19 患者在 15 个参与中心的 ICU 接受了治疗。这些中心报告说，在 350 名患者中发现了新的神经系统疾病，这表明 COVID-19 相关的神经系统疾病在 COVID-19 ICU 患者中的患病率为 12.7%。脑病 (46.2%; 181/392)、脑血管 (41.0%; 161/392) 和神经肌肉疾病 (20.4%; 80/392) 是最常见的类别。在对 SARS-COV-2 进行逆转录酶 PCR 的 35 次脑脊液分析中，只有 3 次是阳性的。住院死亡率为 36.0% (140/389)，70.9% (161/227) 的存活患者出院时功能结果（mRS 3 至 5）较差。脑出血（OR 6.2, 95% CI 2.5-14.9, p < 0.001）和急性缺血性卒中（OR 3.9, 95% CI 1.9-8.2, p < 0.001）是纳入患者预后不良的最强预测因素。基于这个特征明确的 COVID-19 ICU 队列（占所有重症 COVID-19 患者的 12.7%），神经系统表现会增加死亡率和发病率。由于无法找到 COVID-19 直接病毒影响神经系统的可靠证据，这些神经系统表现在很大程度上可能是感染或严重危重病的间接感染后遗症或感染后后遗症。应积极寻找和治疗神经系统ICU并发症。