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Heart failure (HF) manifests primarily as dyspnea, fatigue, and fluid retention, resulting in peripheral and pulmonary edema. Symptoms may vary depending on which ventricle is more affected, left or right.Left-Sided Heart FailureAlso known as left ventricular failure, this condition results from the left ventricle's inability to fill or eject sufficient blood into the systemic circulation. It leads to pulmonary congestion, which occurs when the left ventricle fails to eject blood effectively...
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Neurologic Syndromes Predict Higher In-Hospital Mortality in COVID-19.

Emad Nader Eskandar1, David J Altschul2, Rafael de la Garza Ramos1

  • 1From the Departments of Neurological Surgery (E.N.E., D.J.A., R.d.l.G.R., P.C., S.R.U., J. Benton, J.D., A.T., J.F.-T., J.L., R.H., E.B.), Neurology (N.P., A. Malaviya, D.F., D.A., D.L., J.G., V.F., J.R., C.E., M.M., A.B., M.F.M.), Radiology (R.Z., K.H., A. McClelland, J. Burns, A.E.), and Critical Care Medicine (R.M., M.G.), Albert Einstein College of Medicine, Montefiore Medical Center (P.S., V.F., J.R.), Bronx, NY.

Neurology
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Summary

Neurologic syndromes in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) increase the risk of inpatient mortality. Identifying and treating altered mentation or stroke in COVID-19 patients may reduce mortality.

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Area of Science:

  • Neurology
  • Infectious Diseases
  • Critical Care Medicine

Background:

  • Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) affects multiple organ systems, but nervous system involvement and its impact on outcomes are not fully understood.
  • Neurologic manifestations in COVID-19 patients can range widely, complicating disease characterization and prognosis.

Purpose of the Study:

  • To investigate the association between neurologic syndromes and inpatient mortality in hospitalized patients with confirmed SARS-CoV-2 infection.
  • To identify specific neurologic manifestations that predict a higher risk of death.

Main Methods:

  • A cohort study comparing 581 hospitalized COVID-19 patients with neurologic involvement and brain imaging to 1,743 non-neurologic COVID-19 patients.
  • Patients were matched for age and disease severity. Four patterns of neurologic manifestations were identified: acute stroke, seizures, altered mentation with normal imaging, and neuro-COVID-19 complex.
  • Statistical analysis was performed to identify predictors of in-hospital mortality.

Main Results:

  • Of 4,711 admitted patients, 581 (12%) had neurologic issues requiring neuroimaging.
  • Patients with altered mentation (OR 1.39) or radiologically confirmed stroke (OR 3.1) showed a significantly higher risk of mortality compared to matched controls.
  • These findings were independent of overall disease severity.

Conclusions:

  • Altered mentation and stroke on admission are independent predictors of increased inpatient mortality in COVID-19 patients.
  • Early identification and management of neurologic complications in COVID-19 are crucial for improving patient outcomes and reducing overall mortality.