Hospital course and outcomes of COVID-19 patients presenting with altered sensorium

Abstract Purpose Numerous studies have shown that fever, cough, diarrhea, and lethargy are typical signs of COVID-19. There is, however, a paucity of information on the relationship between hospital admission, disease severity, prognosis, and the existence of neurological symptoms. Therefore, it was essential for us to look into this correlation to get a better idea of illness burden. Methods This retrospective cohort study was conducted over a period of forty months in a tertiary care hospital, Dr. Ziauddin Hospital, in Karachi, Pakistan. Results Of 1,185 patients, 203 (17.1%) presented with altered mental status (AMS). Patients with altered mental status were older ( P < 0.001), more likely to have hypertension ( P 0 .006), and chronic kidney disease ( P 0.006) . The most common documented neurological manifestations included anosmia 141 (11.9%), headache 84 (7.1%), and irritability 51 (4.3%). The most frequently reported causes of altered mental status (AMS) were encephalopathy, hyponatremia, and stroke. Patients with altered mental status had higher mortality (34.5% vs. 21.9), more likely to need intensive care unit admission (30.5% vs. 9.7%), and mechanical ventilation (19.2% vs. 5.1%). In multivariable analysis, older age and higher urea levels were independently associated with AMS at presentation, while fever, cough, and shortness of breath were inversely associated with AMS. In an adjusted Cox proportional hazards model for in-hospital mortality, AMS remained independently associated with increased mortality (aHR 1.560, 95% CI 1.166–2.087; P 0.003 ), with higher urea and lower serum bicarbonate also associated with mortality ( P < 0.001 for both). Conclusions Altered mental status in COVID-19 patients is associated with higher mortality, need for intensive care unit admission, and mechanical ventilation.