Incidence, clinical characteristics, risk factors and outcomes of meningoencephalitis in patients with COVID-19
Por:
Fragiel, M, Miro, O, Llorens, P, Jimenez, S, Salmeron, P, Burillo-Putze, G, Martin, A, Martin-Sanchez, F, Lamberechts, E, Jacob, J, Alquezar-Arbe, A, Llopis-Roca, F, Garcia, J, Lopez, R, Vera, M, Lucas-Imbernon, F, Martinez, F, Juarez, R, Rodriguez, M, Bautista, B, Valdes, A, Nicolas, J, Amez, J, Porta-Etessam, J, Calvo, E, del Castillo, J and Spanish Investigators Emergency Si
Publicada:
1 ago 2021
Ahead of Print:
1 mar 2021
Resumen:
We investigated the incidence, clinical characteristics, risk factors, and outcome of meningoencephalitis (ME) in patients with COVID-19 attending emergency departments (ED), before hospitalization. We retrospectively reviewed all COVID patients diagnosed with ME in 61 Spanish EDs (20% of Spanish EDs, COVID-ME) during the COVID pandemic. We formed two control groups: non-COVID patients with ME (non-COVID-ME) and COVID patients without ME (COVID-non-ME). Unadjusted comparisons between cases and controls were performed regarding 57 baseline and clinical characteristics and 4 outcomes. Cerebrospinal fluid (CSF) biochemical and serologic findings of COVID-ME and non-COVID-ME were also investigated. We identified 29 ME in 71,904 patients with COVID-19 attending EDs (0.40 parts per thousand, 95%CI=0.27-0.58). This incidence was higher than that observed in non-COVID patients (150/1,358,134, 0.11 parts per thousand, 95%CI=0.09-0.13; OR=3.65, 95%CI=2.45-5.44). With respect to non-COVID-ME, COVID-ME more frequently had dyspnea and chest X-ray abnormalities, and neck stiffness was less frequent (OR=0.3, 95%CI=0.1-0.9). In 69.0% of COVID-ME, CSF cells were predominantly lymphocytes, and SARS-CoV-2 antigen was detected by RT-PCR in 1 patient. The clinical characteristics associated with a higher risk of presenting ME in COVID patients were vomiting (OR=3.7, 95%CI=1.4-10.2), headache (OR=24.7, 95%CI=10.2-60.1), and altered mental status (OR=12.9, 95%CI=6.6-25.0). COVID-ME patients had a higher in-hospital mortality than non-COVID-ME patients (OR=2.26; 95%CI=1.04-4.48), and a higher need for hospitalization (OR=8.02; 95%CI=1.19-66.7) and intensive care admission (OR=5.89; 95%CI=3.12-11.14) than COVID-non-ME patients. ME is an unusual form of COVID presentation (<0.5 parts per thousand cases), but is more than 4-fold more frequent than in non-COVID patients attending the ED. As the majority of these MEs had lymphocytic predominance and in one patient SARS-CoV-2 antigen was detected in CSF, SARS-CoV-2 could be the cause of most of the cases observed. COVID-ME patients had a higher unadjusted in-hospital mortality than non-COVID-ME patients.
Filiaciones:
Fragiel, M:
Univ Complutense, IDISSC, Hosp Clin San Carlos, Emergency Dept, Prof Martin Lagos S-N, Marid 28040, Spain
Miro, O:
Univ Barcelona, IDIBAPS, Hosp Clin, Emergency Dept, Barcelona, Catalonia, Spain
:
Univ Miguel Hernandez, Hosp Gen Alicante, Emergency Dept, Alicante, Spain
Jimenez, S:
Univ Barcelona, IDIBAPS, Hosp Clin, Emergency Dept, Barcelona, Catalonia, Spain
Salmeron, P:
Hosp Reina Sofia, Emergency Dept, Murcia, Spain
Burillo-Putze, G:
Hosp Univ Canarias, Emergency Dept, Tenerife, Spain
Martin, A:
Hosp Severo Ochoa, Emergency Dept, Madrid, Spain
Martin-Sanchez, F:
Univ Complutense, IDISSC, Hosp Clin San Carlos, Emergency Dept, Prof Martin Lagos S-N, Marid 28040, Spain
Lamberechts, E:
Univ Complutense, IDISSC, Hosp Clin San Carlos, Emergency Dept, Prof Martin Lagos S-N, Marid 28040, Spain
Jacob, J:
Hosp Univ Bellvitge, Emergency Dept, Barcelona, Catalonia, Spain
Alquezar-Arbe, A:
Hosp Santa Creu & Sant Pau, Emergency Dept, Barcelona, Catalonia, Spain
Llopis-Roca, F:
Hosp Univ Bellvitge, Emergency Dept, Barcelona, Catalonia, Spain
Garcia, J:
Hosp Valle Los Pedroches Pozoblanco Cordoba, Emergency Dept, Pozoblanco, Spain
Lopez, R:
Complejo Hosp Univ A Coruna, La Coruna, Spain
Vera, M:
Complejo Hosp Univ Vigo, Hosp Alvaro Cunqueiro, Vigo, Spain
Lucas-Imbernon, F:
Hosp Univ Gen Albacete, Albacete, Spain
Martinez, F:
Hosp Virgen Luz Cuenca, Cuenca, Spain
Juarez, R:
Hosp Nuestra Senora Prado Talavera Reina Toledo, Emergency Dept, Talavera De La Reina, Spain
Rodriguez, M:
Hosp Univ Canarias, Emergency Dept, Tenerife, Spain
Bautista, B:
Hosp Univ Cent Asturias, Oviedo, Spain
Valdes, A:
Hosp Univ Cabuenes Gijon, Gijon, Spain
Nicolas, J:
Hosp Reina Sofia, Emergency Dept, Murcia, Spain
Univ Lozano Blesa, Hosp Clin, Zaragoza, Spain
Amez, J:
Univ Lozano Blesa, Hosp Clin, Zaragoza, Spain
Porta-Etessam, J:
Hosp Clin San Carlos, Neurol Dept, Madrid, Spain
Calvo, E:
Univ Complutense, IDISSC, Hosp Clin San Carlos, Internal Med Dept, Madrid, Spain
del Castillo, J:
Univ Complutense, IDISSC, Hosp Clin San Carlos, Emergency Dept, Prof Martin Lagos S-N, Marid 28040, Spain
Green Published, Bronze
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