COVID-19-Associated Acute Brain Dysfunction Related to Sepsis

Area of Science:

• Neurology
• Infectious Diseases
• Critical Care Medicine

Background:

• The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a global pandemic, with millions infected and significant mortality from organ failure.
• Severe cases of coronavirus disease 2019 (COVID-19), particularly those with pneumonia and acute respiratory distress syndrome (ARDS), are associated with life-threatening acute brain dysfunction (ABD).

Purpose of the Study:

• To review the manifestations, diagnosis, and treatment of acute brain dysfunction (ABD) in patients with COVID-19.
• To highlight the association between severe COVID-19, ARDS, altered mental status, and sepsis.
• To emphasize the importance of recognizing COVID-19-associated ABD related to sepsis for timely empirical combination therapy.

Main Methods:

• Review of existing literature on COVID-19 patients with pneumonia and ARDS.
• Analysis of reported cases of acute brain dysfunction (ABD) in COVID-19.
• Application of Sepsis-3 criteria to understand the relationship between severe COVID-19, ARDS, and sepsis.

Main Results:

• Altered mental status and/or delirium were the most common manifestations of ABD, with prevalence up to 79.5%.
• Coma occurred in 10% of severe COVID-19 patients.
• The most frequent types of COVID-19-associated ABD included acute stroke (ischemic and hemorrhagic), encephalopathy, and central nervous system (CNS) infections.

Conclusions:

• Severe COVID-19-associated ABD with ARDS and altered mental status meets the criteria for sepsis.
• Recognizing COVID-19-associated ABD as sepsis is crucial for initiating early empirical combination therapy.
• Prompt recognition and treatment of sepsis-related brain dysfunction in COVID-19 are vital for improving patient survival rates.