Mental confusion an early warning sign of severe COVID-19

COVID-19 patients with mental confusion are at increased risk for a severe form of the illness, a new study finds.

25 jun 2021--Researchers analyzed the electronic health records of more than 36,000 COVID-19 patients at five Florida hospitals. Of those, 12% developed severe COVID-19.

Patients with mental confusion were three times more likely to develop severe illness than those without such symptoms, according to the study published in the June issue of Critical Care Explorations.

"One of the key things in treating COVID-19 is looking for signs that you might have an aggressive or severe disease course," said lead study author David Marra. He is a postdoctoral researcher in the department of clinical and health psychology at the University of Florida's (UF) College of Public Health and Health Professions.

"What we found was that certain brain symptoms, specifically a condition known as encephalopathy, may be an early marker of more severe COVID-19," Marra said in a university news release. "We hope this might equip front-line workers and other health care providers with information to help them be on the lookout for a more severe disease course."

Encephalopathy is characterized by general disorientation and confusion, and "the person just doesn't seem right," Marra explained.

"They might not know where they are or be confused about the people around them," he said. "They might not know the date or recent events. If there is a lot of general confusion that's atypical for that person, that would be suggestive of some type of acute brain dysfunction."

Encephalopathy symptoms typically appeared a few days before or concurrent with the progression of COVID-19 to a serious stage requiring intensive treatment, such as admission to the intensive care unit or ventilation, the study found.

Watching for signs of encephalopathy in patients with COVID-19 could help doctors begin treatment much earlier and potentially prevent severe disease, the researchers said.

Consistent with previous research, the study found that COVID-19 patients with loss of smell and loss of taste were less likely to develop severe illness.

Study co-author Chris Robinson said, "I know we're starting to open up and we're getting vaccinated, but COVID will be with us for a while, so we need to be smarter than the virus and try to find things that we as physicians and families can identify early on to allow patients to combat the illness much more effectively."

Robinson, who is a neurointensivist and an assistant professor of neurology at the UF College of Medicine, added, "If we become complacent with what we know at this point, we'll still continue to lose people."