Medical College of Georgia, Southwest Clinical Campus, Albany, GA, USA.
Department of Cardiology, Phoebe Putney Memorial Hospital, Albany, GA, USA.
Ir J Med Sci. 2022 Feb;191(1):21-26. doi: 10.1007/s11845-021-02515-4. Epub 2021 Feb 10.
BACKGROUND/AIMS: Limited data exists on the outcomes of COVID-19 patients presenting with altered mental status (AMS). Hence, we studied the characteristics and outcomes of hospitalized COVID-19 patients who presented with AMS at our hospital in rural southwest Georgia.
Data from electronic medical records of all hospitalized COVID-19 patients from March 2, 2020, to June 17, 2020, were analyzed. Patients were divided in 2 groups, those presenting with and without AMS. Primary outcome of interest was in-hospital mortality. Secondary outcomes were needed for mechanical ventilation, need for intensive care unit (ICU) care, need for dialysis, and length of stay. All analyses were performed using SAS 9.4 and R 3.6.0.
Out of 710 patients, 73 (10.3%) presented with AMS. Majority of the population was African American (83.4%). Patients with AMS were older and more likely to have hypertension, chronic kidney disease (CKD), cerebrovascular disease, and dementia. Patients with AMS were less likely to present with typical COVID-19 symptoms, including dyspnea, cough, fever, and gastrointestinal symptoms. Predictors of AMS included age ≥ 70 years, CKD, cerebrovascular disease, and dementia. After multivariable adjustment, patients with AMS had higher rates of in-hospital mortality (30.1% vs 14.8%, odds ratio (OR) 2.139, p = 0.019), ICU admission (43.8% vs 40.2%, OR 2.59, p < 0.001), and need for mechanical ventilation (27.4% vs 18.5%, OR 2.06, p = 0.023). Patients presenting with AMS had increased length of stay.
Patients with COVID-19 presenting with AMS are less likely to have typical COVID-19 symptoms, and AMS is an independent predictor of in-hospital mortality, need for ICU admission, and need for mechanical ventilation.
背景/目的：关于出现精神状态改变（AMS）的 COVID-19 患者的结局，目前仅有有限的数据。因此，我们研究了佐治亚州西南部农村地区我院住院 COVID-19 患者中出现 AMS 的特征和结局。
分析 2020 年 3 月 2 日至 2020 年 6 月 17 日期间所有住院 COVID-19 患者的电子病历数据。患者分为出现 AMS 组和未出现 AMS 组。主要观察指标是住院死亡率。次要观察指标为机械通气、入住重症监护病房（ICU）、需要透析和住院时间。所有分析均使用 SAS 9.4 和 R 3.6.0 进行。
在 710 例患者中，73 例（10.3%）出现 AMS。大多数患者为非裔美国人（83.4%）。出现 AMS 的患者年龄更大，更有可能患有高血压、慢性肾脏病（CKD）、脑血管疾病和痴呆。出现 AMS 的患者出现 COVID-19 典型症状（包括呼吸困难、咳嗽、发热和胃肠道症状）的可能性较小。AMS 的预测因素包括年龄≥70 岁、CKD、脑血管疾病和痴呆。经多变量调整后，出现 AMS 的患者住院死亡率更高（30.1%比 14.8%，比值比[OR] 2.139，p=0.019），入住 ICU 的比例更高（43.8%比 40.2%，OR 2.59，p<0.001），需要机械通气的比例更高（27.4%比 18.5%，OR 2.06，p=0.023）。出现 AMS 的患者住院时间更长。
出现 AMS 的 COVID-19 患者出现 COVID-19 典型症状的可能性较小，AMS 是住院死亡率、入住 ICU 以及需要机械通气的独立预测因素。
