Abstract Details

Title Recovery from Disorders of Consciousness after Severe COVID-19

Topic Neuro Trauma and Critical Care

Presentation(s) N4 - Neuroscience in the Clinic: Neuroscience of Coma and Consciousness in the Clinic (2:25 PM-2:35 PM)

Poster/Presentation
Number 002

Background Some patients with severe COVID-19 experience persistently impaired arousal and/or awareness after discontinuation of sedation, consistent with DoC. In our recently published analysis of 21 such patients, 12 (57%) recovered to minimally conscious state (MCS) or better before hospital discharge. Recovery to MCS—especially within 8 weeks of injury—is an important prognostic indicator in DoC of other etiologies, but its significance in COVID-19 remains unknown.

Objective

To examine long-term outcomes of disorders of consciousness (DoC) after severe COVID-19.

Design/Methods All 21 patients were included in a prospectively followed cohort involving telephonic assessment 6 and 12 months after discharge. We examined relationships between recovery to MCS and survival. For patients completing telephone assessments, we report functional outcomes including Barthel Index, extended Glasgow Outcome Scale (E-GOS), and modified Rankin Scale (mRS); and psychological outcomes using Quality of Life in Neurological Disorders (Neuro-QOL) anxiety, depression, fatigue, and sleep disturbance inventories.

Results Recovery to MCS within 8 weeks of illness onset—but not later—was associated with 12-month survival (6/8 versus 2/9, p=0.024). Six patients completed both assessments. Of these, 2 were in DoC at 6 months and died by 12 months; 1 recovered consciousness after 6 months but remained severely disabled; 1 was moderately disabled; and 2 achieved functional independence (Barthel Index 100; E-GOS 5-7; mRS 1-2). Neuro-QOL scores were elevated at 6 but not 12 months.

Conclusions Ten percent (2/21) of our original cohort achieved functional independence by 12 months, demonstrating that recovery is possible after COVID-19-associated DoC. Consistent with the literature on non-COVID DoC, recovery to MCS within 8 weeks of illness onset may be prognostically favorable. Psychological symptoms in this severely ill group were less common than in patients with neurologic sequelae of COVID-19 generally. More work is needed to understand the natural history of long-term recovery from severe COVID-19.

Authors/Disclosures
Lindsey Gurin, MD (Langone Orthopedic Hospital) PRESENTER	Dr. Gurin has received personal compensation in the range of $0-$499 for serving as a physician reviewer with Healthcare Quality Strategies, Inc. Dr. Gurin has received personal compensation in the range of $500-$4,999 for serving as a consultant with Human Services Research Institute.
	No disclosure on file
Ariane Lewis, MD, FAAN (NYU Langone Medical Center)	Dr. Lewis has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Seminars in Neurology. Dr. Lewis has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Journal of Clinical Neuroscience.