Incidence of Neurological Manifestations in Critically Ill COVID-19 Patients: A Low-Resource Setting Experience

Introduction Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is not primarily a neurotropic virus. However, since angiotensin-converting enzyme 2 (ACE2) receptors are present in the brain, spinal cord, and nerves, the involvement of the nervous system, which could potentially influence the final outcome, cannot be ruled out. This study aimed to assess the incidence and significance of specific neurological manifestations and/or neurological disorders in critically ill COVID-19 patients treated in low-resource settings (LRS), as well as to determine their impact on the clinical outcomes of these patients. Subjects and methods The research was designed as a retrospective observational study conducted between October 2020 and February 2021, during the second wave of the COVID-19 pandemic. The incidence of specific neurological manifestations and/or neurological disorders in patients treated at the Medical Intensive Care Unit (MICU) of the University Clinical Centre (UCC) of the Republic of Srpska, Bosnia and Herzegovina, was monitored, and relevant demographic and clinical data were collected. The results were analyzed using methods from descriptive statistics and statistical testing. Results Among the 262 patients who met the inclusion criteria, 154 (58.5%) exhibited at least one of the monitored neurological manifestations or neurological disorders. The most frequently observed were impaired consciousness (19.5%), headache (10.2%), myalgia (8%), loss of taste and smell (7.6%), lower back pain (3.4%), and ischemic cerebrovascular stroke (3.4%). All other recorded had an incidence of less than 2%. In terms of clinical outcomes, 128 patients (48.9%) died, 81 (30.9%) were transferred to a step-down unit, and 53 (20.2%) were discharged home. Using Fisher's exact test, impaired consciousness was found to be significantly associated with a fatal outcome (p = 0.01; OR = 0.33; 95% CI = 0.17-0.64), while acute polyradiculoneuritis was associated with a favorable clinical outcome in the form of discharge home (p = 0.04; OR = 0.96; 95% CI = 0.91-1.01). Headache was more frequently reported in female patients (p = 0.03; OR = 2.51; 95% CI = 1.10-5.80). Impaired consciousness was significantly more frequent in patients aged 51-60 years (p = 0.02; OR = 2.61; 95% CI = 1.12-6.12) and those aged ≥71 years (p = 0.01; OR = 0.36; 95% CI = 0.18-0.73), while epileptic seizures were most commonly observed in the 31-40 age group (p = 0.01; OR = 0.36; 95% CI = 0.18-0.73). Conclusion The incidence and significant associations between specific neurological presentations and/or disorders and clinical outcomes, along with observed demographic variations, highlight the importance of comprehensive monitoring of extrapulmonary manifestations (including neurological) in critically ill COVID-19 patients.