ArticleCurrent health sciences journal
Admission Acute Brain Dysfunction and In-ICU Mortality in a Single-Center Pre-Vaccination Romanian COVID-19 Cohort:A Retrospective Observational Analysis.
Article in Current health sciences journal. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundCritically ill COVID-19 patients frequently develop organ dysfunction and acute brain dysfunction with features overlapping sepsis-associated encephalopathy (SAE). Real-world cohorts from Eastern European intensive care during the pre-vaccination period are scarce.
methodsWe retrospectively analysed 389 consecutive adults with RT-PCR-confirmed SARS-CoV-2 admitted to a single regional Romanian tertiary ICU during 2020-2021, entirely preceding population-level vaccination. Organ dysfunction was defined as admission SOFA≥2, and acute brain dysfunction was op-erationalised from admission Glasgow Coma Scale and neurological SOFA (the acute brain dysfunction [ABD] proxy). Associations with in-ICU mortality were examined descriptively, with pre-specified sensitivity analyses restricted to non-ventilated pa-tients to address sedation confounding.
resultsIn-ICU mortality was 65.8%. The ABD proxy was present in 49.6% of the cohort; mortality was 96.9% in ABD-proxy-positive patients versus 45.9% in those with preserved consciousness, an absolute difference of 51.0 percentage points, which was of similar magnitude (49.4 points) in non-ventilated patients, arguing against sedation as the sole explanation. Higher inflammatory markers accompanied the ABD proxy, and the association between admission acute brain dys-function and mortality was consistent across analyses.
conclusionsAdmission acute brain dysfunction was strongly associated with in-ICU mortality, and this association persisted in non-ventilated patients. The findings are descriptive associations within an extreme, single-center pre-vaccination cohort under surge conditions; they are not causal, and should not be generalised to vaccinated or contemporary critical care.
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