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  1. Article ; Online: Altered mental status is an independent predictor of mortality in hospitalized COVID-19 patients.

    Kenerly, Marjorie J / Shah, Priyank / Patel, Hiten / Racine, Rilee / Jani, Yash / Owens, Caroline / George, Varghese / Linder, Daniel / Owens, Jack / Hess, David C

    Irish journal of medical science

    2021  Volume 191, Issue 1, Page(s) 21–26

    Abstract: ... mental status (AMS). Hence, we studied the characteristics and outcomes of hospitalized COVID-19 patients ... and AMS is an independent predictor of in-hospital mortality, need for ICU admission, and need ... Background/aims: Limited data exists on the outcomes of COVID-19 patients presenting with altered ...

    Abstract Background/aims: Limited data exists on the outcomes of COVID-19 patients presenting with altered mental status (AMS). Hence, we studied the characteristics and outcomes of hospitalized COVID-19 patients who presented with AMS at our hospital in rural southwest Georgia.
    Methods: Data from electronic medical records of all hospitalized COVID-19 patients from March 2, 2020, to June 17, 2020, were analyzed. Patients were divided in 2 groups, those presenting with and without AMS. Primary outcome of interest was in-hospital mortality. Secondary outcomes were needed for mechanical ventilation, need for intensive care unit (ICU) care, need for dialysis, and length of stay. All analyses were performed using SAS 9.4 and R 3.6.0.
    Results: Out of 710 patients, 73 (10.3%) presented with AMS. Majority of the population was African American (83.4%). Patients with AMS were older and more likely to have hypertension, chronic kidney disease (CKD), cerebrovascular disease, and dementia. Patients with AMS were less likely to present with typical COVID-19 symptoms, including dyspnea, cough, fever, and gastrointestinal symptoms. Predictors of AMS included age ≥ 70 years, CKD, cerebrovascular disease, and dementia. After multivariable adjustment, patients with AMS had higher rates of in-hospital mortality (30.1% vs 14.8%, odds ratio (OR) 2.139, p = 0.019), ICU admission (43.8% vs 40.2%, OR 2.59, p < 0.001), and need for mechanical ventilation (27.4% vs 18.5%, OR 2.06, p = 0.023). Patients presenting with AMS had increased length of stay.
    Conclusions: Patients with COVID-19 presenting with AMS are less likely to have typical COVID-19 symptoms, and AMS is an independent predictor of in-hospital mortality, need for ICU admission, and need for mechanical ventilation.
    MeSH term(s) Aged ; COVID-19 ; Hospital Mortality ; Hospitalization ; Humans ; Intensive Care Units ; Respiration, Artificial ; Retrospective Studies ; SARS-CoV-2
    Language English
    Publishing date 2021-02-10
    Publishing country Ireland
    Document type Journal Article
    ZDB-ID 390895-1
    ISSN 1863-4362 ; 0021-1265
    ISSN (online) 1863-4362
    ISSN 0021-1265
    DOI 10.1007/s11845-021-02515-4
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Zs.B 323: Show issues Location:
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    bis Jg. 2021: Bestellungen von Artikeln über das Online-Bestellformular
    ab Jg. 2022: Lesesaal (EG)

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  2. Article ; Online: Altered mental status predicts length of stay but not death in a community-based cohort of hospitalized COVID-19 patients.

    Chachkhiani, David / Isakadze, Marine / Villemarette-Pittman, Nicole R / Devier, Deidre J / Lovera, Jesus F

    Clinical neurology and neurosurgery

    2021  Volume 210, Page(s) 106977

    Abstract: ... mental status is an independent predictor of prolonged hospital stay, but not death. Further studies are ... Introduction: Altered Mental Status (AMS) is a common neurological complication in patients ... needed to evaluate the causes of AMS in patients with COVID-19. ...

    Abstract Introduction: Altered Mental Status (AMS) is a common neurological complication in patients hospitalized with the diagnosis of COVID-19 (Umapathi et al., 2020; Liotta et al., 2020). Studies show that AMS is associated with death and prolonged hospital stay. In addition to respiratory insufficiency, COVID-19 causes multi-organ failure and multiple metabolic derangements, which can cause AMS, and the multi-system involvement could account for the prolonged hospital stay and increased mortality. In this study, we built on our previous publication (Chachkhiani et al., 2020) using a new, larger cohort to investigate whether we could reproduce our previous findings while addressing some of the prior study's limitations. Most notably, we sought to determine whether AMS still predicted prolonged hospital stay and increased mortality after controlling for systemic complications such as sepsis, liver failure, kidney failure, and electrolyte abnormalities.
    Objectives: The primary purpose was to document the frequency of AMS in patients with COVID-19 at the time of presentation to the emergency room. Secondary aims were to determine: 1) if AMS at presentation was associated with worse outcomes as measured by prolonged hospitalization and death; and 2) if AMS remained a predictor of worse outcome after adjusting for concomitant organ failure and metabolic derangements.
    Results: Out of 367 patients, 95 (26%) had AMS as a main or one of the presenting symptoms. Our sample has a higher representation of African Americans (53%) than the US average and a high frequency of comorbidities, such as obesity (average BMI 29.1), hypertension (53%), and diabetes (30%). Similar to our previous report, AMS was the most frequent neurological chief complaint. At their admission, out of 95 patients with AMS, 83 (88%) had organ failure or one of the systemic problems that could have caused AMS. However, a similar proportion (86%) of patients without AMS had one or more of these same problems. Age, race, and ethnicity were the main demographic predictors. African Americans had shorter hospital stay [HR1.3(1.0,1.7),p = 0.02] than Caucasians. Hispanics also had shorter hospital stay than non-Hispanics [HR1.6(1.2,2.1), p = 0.001]. Hypoxia, liver failure, hypernatremia, and kidney failure were also predictors of prolonged hospital stay. In the multivariate model, hypoxia, liver failure, and acute kidney injury were the remaining predictors of longer hospital stay, as well as people with AMS at baseline [HR0.7(0.6,0.9), p < 0.02] after adjusting for the demographic characteristics and clinical predictors. AMS at baseline predicted death, but not after adjusting for demographics and clinical variables in the multivariate model. Hypoxia and hyperglycemia at baseline were the strongest predictors of death.
    Conclusion: Altered mental status is an independent predictor of prolonged hospital stay, but not death. Further studies are needed to evaluate the causes of AMS in patients with COVID-19.
    MeSH term(s) Academic Medical Centers/trends ; Adult ; Aged ; Aged, 80 and over ; COVID-19/diagnosis ; COVID-19/mortality ; COVID-19/therapy ; Cohort Studies ; Community Health Centers/trends ; Female ; Hospitalization/trends ; Humans ; Length of Stay/trends ; Male ; Mental Disorders/diagnosis ; Mental Disorders/mortality ; Mental Disorders/therapy ; Middle Aged ; Mortality/trends ; Predictive Value of Tests ; Retrospective Studies ; Young Adult
    Language English
    Publishing date 2021-10-07
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 193107-6
    ISSN 1872-6968 ; 0303-8467
    ISSN (online) 1872-6968
    ISSN 0303-8467
    DOI 10.1016/j.clineuro.2021.106977
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Ui I Zs.53: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
    bis Jg. 2021: Bestellungen von Artikeln über das Online-Bestellformular
    ab Jg. 2022: Lesesaal (EG)

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