Table 2.
Patient characteristics at the time of COVID-19 onset and COVID-19 acute encephalopathy
| variables | Total (n = 97) | High risk of OSA (n = 79, 81.4%) | no OSA (n = 18, 18.6%) | p-value |
|---|---|---|---|---|
| General examination and parameter at COVID-19 onset | ||||
| dyspnea | 54 (55.7%) | 42 (53.2%) | 12 (66.7%) | 0.4311 |
| cough | 60 (63.2%) | 50 (64.9%) | 10 (55.6%) | 0.5881 |
| fever | 80 (82.5%) | 67 (84.8%) | 13 (72.2%) | 0.2991 |
| FiO2 | 32.31 (± 17.30) | 33.35 (± 18.31) | 27.84 (± 11.38) | 0.1132 |
| Percentage of lung parenchyma with COVID-19 lesions (pulmonary CT scan) | 0.5832 | |||
| 0–30% | 13 (20.0%) | 11 (20.4%) | 2 (18.2%) | |
| 30–50% | 22 (33.8%) | 19 (35.2%) | 3 (27.3%) | |
| 50–70% | 17 (26.2%) | 14 (25.9%) | 3 (27.3%) | |
| > 70% | 13 (20.0%) | 10 (18.5%) | 3 (27.3%) | |
| Neurological signs at COVID-19 acute encephalopathy | ||||
| fluctuation | 87 (89.7%) | 73 (92.4%) | 14 (77.8%) | 0.0851 |
| inattention | 86 (88.7%) | 74 (93.7%) | 12 (66.7%) | 0.0051 |
| thought disturbance | 68 (74.7%) | 61 (82.4%) | 7 (41.2%) | 0.0011 |
| alertness trouble | 48 (48.5%) | 44 (54.4%) | 4 (22.2%) | 0.0261 |
| drowsiness | 51 (52.6%) | 42 (53.2%) | 9 (50.0%) | 0.9991 |
| agitation | 33 (34.0%) | 29 (36.7%) | 4 (22.2%) | 0.2831 |
| psychomotor slowdown | 63 (65.6%) | 55 (70.5%) | 8 (44.4%) | 0.0531 |
| obnubilation | 32 (34.4%) | 28 (36.8%) | 4 (23.5%) | 0.4011 |
| perseveration | 53 (58.2%) | 47 (64.4%) | 6 (33.3%) | 0.0311 |
| disorientation | 48 (54.5%) | 43 (60.6%) | 5 (29.4%) | 0.0301 |
| hallucination | 17 (19.3%) | 14 (19.4%) | 3 (18.8%) | 0.9991 |
| focal neurological sign | 27 (27.8%) | 23 (29.1%) | 4 (22.2%) | 0.7721 |
| COVID-19 acute encephalopathy features | ||||
| CAM | 2.97 (± 1.05) | 3.18 (± 0.89) | 2.06 (± 1.21) | 0.0013 |
| RASS ≤ -3 | 8 (8.2%) | 7 (8.9%) | 1 (5.6%) | 0.1681 |
| mutism | 14 (14.4%) | 12 (15.2%) | 2 (11.1%) | 0.9991 |
| severe encephalopathya | 72 (74.2%) | 67 (84.8%) | 5 (27.8%) | < 0.0011 |
| duration of encephalopathy (days) | 25.8 (± 59.3) | 27.9 (± 65.5) | 16.9 (± 12.4) | 0.0183 |
| Biological results in the blood | ||||
| C-reactive protein (mg/l) | 89.85 (39.2–163.4) | 89.6 (41.9—163.6) | 90.1 (9.7—159.3) | 0,5042 |
| leucocytes (/mm3) | 9.88 (7.3–12.2) | 9.84 (7.2—12) | 11.35 (8.5—14.2) | 0,2152 |
| lymphocytes (/mm3) | 0.82 (0.5–1.1) | 0.79 (0.5—1) | 0.97 (0.7—1.2) | 0,2302 |
| segmented neutrophils (/mm3) | 7.47 (5.5–10.4) | 7.35 (5.1—10) | 9.09 (6.4—11.7) | 0,2722 |
| monocytes (/mm3) | 0.53 (0.3–0.8) | 0.52 (0.3—0.8) | 0.58 (0.4—0.7) | 0,9982 |
| thrombocytes (/mm3) | 298 (232–354.5) | 307 (241—356.8) | 264 (167—319) | 0,3452 |
| Brain MRI | ||||
| missing valuesb | 35 | 27 | 8 | |
| leucoencephalopathy | 0.0501 | |||
| 0 | 23 (31.5%) | 17 (28.3%) | 6 (46.2%) | |
| 1 | 32 (43.8%) | 30 (50.0%) | 2 (15.4%) | |
| 2 | 7 (9.6%) | 6 (10.0%) | 1 (7.7%) | |
| 3 | 11 (15.1%) | 7 (11.7%) | 4 (30.8%) | |
| stroke (DWI lesion) | 34 (47.2%) | 26 (44.1%) | 8 (61.5%) | 0.3591 |
| hyperT2 lesion (number) | 7.12 (± 6.22%) | 7.3 (± 6.2) | 6.31 (± 6.54) | 0.6233 |
| microbleed (number) | 3.03 (± 7.43%) | 2.9 (± 7.75) | 3.62 (± 5.92) | 0.7143 |
| number of vessels with endotheliitisc | < 0.0011 | |||
| 0 | 9 (14.5%) | 1 (1.9%) | 8 (80.0%) | |
| 1 | 18 (29.0%) | 16 (30.8%) | 2 (20.0%) | |
| 2 | 16 (25.8%) | 16 (30.8%) | 0 | |
| 3 | 19 (30.6%) | 19 (36.5%) | 0 | |
| circumferential endotheliitisc | 48 (77.4%) | 48 (92.3%) | 0 | < 0.0011 |
| endotheliitisc | < 0.0011 | |||
| unilateral | 26 (41.9%) | 24 (46.2%) | 2 (20.0%) | |
| bilateral | 27 (43.5%) | 27 (51.9%) | 0 | |
| stenosis | 3 (4.1%) | 3 (5.0%) | 0 | |
| EEG slowing | 47 (53.4%) | 40 (55.6%) | 7 (43.8%) | 0.4201 |
| Epidemiological features | ||||
| intensive care unit | 62 (63.9%) | 50 (63.3%) | 12 (66.7%) | 0.9993 |
| hospitalization time | 43.5 [25.0–61.5] | 43.5 [25.0–61.0] | 42.5 [28.0–66.0] | 0.7962 |
| mRS at discharge | 0.0081 | |||
| 0 | 9 (9.3%) | 8 (10.1%) | 1 (5.6%) | |
| 1 | 23 (23.7%) | 13 (16.5%) | 10 (55.6%) | |
| 2 | 16 (16.5%) | 12 (15.2%) | 4 (22.2%) | |
| 3 | 22 (22.7%) | 21 (26.6%) | 1 (5.6%) | |
| 4 | 14 (14.4%) | 13 (16.5%) | 1 (5.6%) | |
| 5 | 1 (1.0%) | 1 (1.3%) | 0 (0.0%) | |
| 6 (death) | 12 (12.4%) | 11 (13.9%) | 1 (5.6%) | |
| mRS at discharge ≥ 3 | 49 (50.5%) | 46 (58.2%) | 3 (16.7%) | 0.0021 |
This table presents patient characteristics at the time of COVID-19 onset (general examination data and COVID-19 pulmonary imaging status) and at COVID-19 acute encephalopathy paroxysm (neurological signs, encephalopathy features, epidemiological features, biological data from blood and CSF, brain MRI data and EEG results)
Abbreviations: CAM Confusion Assessment Method, COVID-19 AE COVID-19 acute encephalopathy, DWI Diffusion-weighted imaging, OSA Obstructive sleep apnea, mRS modified Rankin Scale, RASS Richmond Agitation Sedation Scale
1Fisher's exact test. Table results were given in number of patients (percentage of total number of patients per group)
2Mann-Whitney u test. Table results were given in median (± interquartile ratio)
3t-test. Table results were given in median (± interquartile ratio)
asevere encephalopathy was defined on a RASS < − 3 at worst presentation ─ meaning deep sedation, no response to voice but possible movement or eye, opening to physical stimulation; or on a CAM score ≥ 3 among patients with a RASS ≥ -3 ─ meaning displaying 3 out of 4 items among symptoms fluctuation, inattention, thought disturbance, and altered alertness
bMissing value. Brain MRI were missing in many patients because of the inability to perform these tests due to patient compliance at the acute phase of COVID-19 encephalopathy
cThe term “endotheliitis” referred to homogeneous gadolinium contrast enhancement of the inner part of the vessel wall (injected brain MRI) without stenosis. Circumferential endotheliitis referred to contrast enhancement of the vessel wall greater than 50% of the circumference