Acute encephalopathy is associated with worse outcomes in COVID-19 patients

Objective: To determine prevalence of acute encephalopathy in hospitalized COVID-19 patients and to determine outcomes compared to those without acute encephalopathy. Background: Acute encephalopathy in the setting of any infection is associated with severity of the disease process. With this COVID-19 pandemic, we did not find any studies to associate the development of acute encephalopathy with outcomes in hospitalized COVID-19 patients. Design/Methods: This was a retrospective cohort study where we examined clinical outcome parameters comprising 'need for critical care services', 'intubation' and '30-day mortality' among hospitalized COVID-19 patients with and without acute encephalopathy, before and after propensity-score matching. TriNetX, which is a large global COVID-19 database was used to obtain medical record data and their analytics function was used for statistical analysis. Results: Of 12,601 hospitalized COVID-19 patients, 1092 (8.7%) developed acute encephalopathy. Patients in the acute encephalopathy group were older (67 vs. 61 years) and had higher prevalence of medical co-morbidities including obesity, hypertension, diabetes, heart disease, COPD, chronic kidney and liver disease among others. Before and after propensity score matching for co-morbidities, patients with acute encephalopathy were more likely to need critical care services (35.6% vs. 16.9%, p < 0.0001), intubation (19.5% vs. 6.0%, p < 0.0001) and had a higher 30-day mortality (24.3% vs. 17.9%, p 0.0002). Conclusions: Among hospitalized COVID-19 patients, acute encephalopathy is common and more likely to occur in patients with medical co-morbidities and are more likely to need critical care, intubation and have a higher 30-day mortality even after adjusting for age and underlying medical co-morbidities.