Association of consciousness impairment and mortality in people with COVID-19
Weixi Xiong
Department of Neurology, West China Hospital of Sichuan University, Chengdu, China
Institute of Brain Science and Brain-inspired technology of West China Hospital, Sichuan University, Chengdu, China
Search for more papers by this authorLu Lu
Department of Neurology, West China Hospital of Sichuan University, Chengdu, China
Institute of Brain Science and Brain-inspired technology of West China Hospital, Sichuan University, Chengdu, China
Search for more papers by this authorBaiyang Zhang
West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
Search for more papers by this authorJianfei Luo
Department of Gastrointestinal Surgery, Renmin Hospital of Wuhan University, Wuhan, China
Search for more papers by this authorWeimin Li
Department of Pulmonary & Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, China
Search for more papers by this authorLi He
Department of Neurology, West China Hospital of Sichuan University, Chengdu, China
Institute of Brain Science and Brain-inspired technology of West China Hospital, Sichuan University, Chengdu, China
Search for more papers by this authorJosemir W. Sander
Department of Neurology, West China Hospital of Sichuan University, Chengdu, China
Institute of Brain Science and Brain-inspired technology of West China Hospital, Sichuan University, Chengdu, China
UCL Queen Square Institute of Neurology, NIHR University College London Hospitals Biomedical Research Centre, London, UK
Chalfont Centre for Epilepsy, Chalfont St Peter, UK
Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, Netherlands
Search for more papers by this authorCorresponding Author
Jie Mu
Department of Neurology, West China Hospital of Sichuan University, Chengdu, China
Institute of Brain Science and Brain-inspired technology of West China Hospital, Sichuan University, Chengdu, China
Correspondence
Jie Mu and Dong Zhou, Department of Neurology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China.
Emails: [email protected] (JM); [email protected] (DZ)
Cairong Zhu, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China.
Email: [email protected]
Search for more papers by this authorCorresponding Author
Cairong Zhu
West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
Correspondence
Jie Mu and Dong Zhou, Department of Neurology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China.
Emails: [email protected] (JM); [email protected] (DZ)
Cairong Zhu, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China.
Email: [email protected]
Search for more papers by this authorCorresponding Author
Dong Zhou
Department of Neurology, West China Hospital of Sichuan University, Chengdu, China
Institute of Brain Science and Brain-inspired technology of West China Hospital, Sichuan University, Chengdu, China
Correspondence
Jie Mu and Dong Zhou, Department of Neurology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China.
Emails: [email protected] (JM); [email protected] (DZ)
Cairong Zhu, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China.
Email: [email protected]
Search for more papers by this authorWeixi Xiong
Department of Neurology, West China Hospital of Sichuan University, Chengdu, China
Institute of Brain Science and Brain-inspired technology of West China Hospital, Sichuan University, Chengdu, China
Search for more papers by this authorLu Lu
Department of Neurology, West China Hospital of Sichuan University, Chengdu, China
Institute of Brain Science and Brain-inspired technology of West China Hospital, Sichuan University, Chengdu, China
Search for more papers by this authorBaiyang Zhang
West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
Search for more papers by this authorJianfei Luo
Department of Gastrointestinal Surgery, Renmin Hospital of Wuhan University, Wuhan, China
Search for more papers by this authorWeimin Li
Department of Pulmonary & Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, China
Search for more papers by this authorLi He
Department of Neurology, West China Hospital of Sichuan University, Chengdu, China
Institute of Brain Science and Brain-inspired technology of West China Hospital, Sichuan University, Chengdu, China
Search for more papers by this authorJosemir W. Sander
Department of Neurology, West China Hospital of Sichuan University, Chengdu, China
Institute of Brain Science and Brain-inspired technology of West China Hospital, Sichuan University, Chengdu, China
UCL Queen Square Institute of Neurology, NIHR University College London Hospitals Biomedical Research Centre, London, UK
Chalfont Centre for Epilepsy, Chalfont St Peter, UK
Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, Netherlands
Search for more papers by this authorCorresponding Author
Jie Mu
Department of Neurology, West China Hospital of Sichuan University, Chengdu, China
Institute of Brain Science and Brain-inspired technology of West China Hospital, Sichuan University, Chengdu, China
Correspondence
Jie Mu and Dong Zhou, Department of Neurology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China.
Emails: [email protected] (JM); [email protected] (DZ)
Cairong Zhu, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China.
Email: [email protected]
Search for more papers by this authorCorresponding Author
Cairong Zhu
West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
Correspondence
Jie Mu and Dong Zhou, Department of Neurology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China.
Emails: [email protected] (JM); [email protected] (DZ)
Cairong Zhu, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China.
Email: [email protected]
Search for more papers by this authorCorresponding Author
Dong Zhou
Department of Neurology, West China Hospital of Sichuan University, Chengdu, China
Institute of Brain Science and Brain-inspired technology of West China Hospital, Sichuan University, Chengdu, China
Correspondence
Jie Mu and Dong Zhou, Department of Neurology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China.
Emails: [email protected] (JM); [email protected] (DZ)
Cairong Zhu, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China.
Email: [email protected]
Search for more papers by this authorWeixi Xiong, Lu Lu and Baiyang Zhang, authors equally contributed do this work.
Funding information
This work was supported by grants from the National Natural Science Foundation of China (81801294, 81871017 and 81420108014), and the 1.3.5 project for disciplines of excellence, West China Hospital, Sichuan University (ZY2017305, ZYGD20011).
Abstract
Background
To investigate the association between impairment of consciousness and risk of death in people with COVID-19.
Methods
In this multicentre retrospective study, we enrolled people with confirmed COVID-19 from 44 hospitals in Wuhan and Sichuan, China, between 18 January and 30 March 2020. We extracted demographics, clinical, laboratory data and consciousness level (as measured by the Glasgow Coma Scale (GCS) score) from medical records. We used Cox proportional hazards regression, structural equation modelling and survival time analysis to compare people with different progressions of impaired consciousness.
Results
We enrolled 1,143 people (average age 51.3 ± standard deviation 17.1-year-old; 50.3% males), of whom 76 died. Increased mortality risk was identified in people with GCS score between 9 and 14 (hazard ratio (HR) 46.76, p < .001) and below 9 (HR 65.86, p < .001). Pathway analysis suggested a significant direct association between consciousness level and death. Other factors, including age, oxygen saturation level and pH, had indirect associations with death mediated by GCS scores. People who developed impaired consciousness more rapidly either from symptoms onset (<10 days vs. 10–19 days, p = .025, <10 days vs. ≥20 days and 10–19 days vs. ≥20 days, <.001) or deterioration of oxygen saturation (≤2 days vs.>2 days, p = .028) had shorter survival times.
Conclusion
Altered consciousness and its progression had a direct link with death in COVID-19. Interactions with age, oxygen saturation level and pH suggest possible pathophysiology. Further work to confirm these findings explore prevention strategies and interventions to decrease mortality is warranted.
CONFLICT OF INTEREST
None concerning this work.
Open Research
DATA AVAILABILITY STATEMENT
Anonymized data will be shared by reasonable requests from any qualified investigator to the corresponding author.
Supporting Information
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| ane13471-sup-0001-FigS1.jpgJPEG image, 202.4 KB | Figure S1 |
| ane13471-sup-0002-TableS1.docxWord document, 26.4 KB | Table S1 |
| ane13471-sup-0003-TableS2.docxWord document, 26.6 KB | Table S2 |
| ane13471-sup-0004-TableS3.docxWord document, 24.2 KB | Table S3 |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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