Acute confusional state, more commonly known as delirium or brain fog, in COVID-19 patients is linked to longer hospital stays, higher likelihood of needing intensive care and higher likelihood of death, according to new research from the University of Texas Medical Branch.

The research, which was published in the Cureus Journal of Medical Science, looked at the impact of ACS on patient outcomes and on how medical providers could better identify patients who needed higher levels of care.

“We wanted to have a better way for risk stratification in inpatient COVID admissions,” said Dr. Prashant Rai, Department of Neurology assistant professor and the study’s corresponding author. “We also wanted to address the impact of potential history of neurological diseases may have on COVID outcomes.”

The study reviewed the UTMB electronic health system to identify hospital inpatients with a confirmed diagnosis of COVID-19 between March 1 and July 13, 2020 – 245 patients were identified, with 37 demonstrating ACS.

Patients who demonstrated ACS were significantly older, had higher comorbidities and exhibited more frequent history of at least one neurological diagnosis, such as dementia, when compared to COVID-19 patients who did not demonstrate ACS.

“Prior history of neurological conditions such as dementia and epilepsy were associated with higher likelihood of developing ACS, which in turn was associated with higher mortality,” Rai said. “These patients should be aware of their higher risks for COVID associated poor outcomes.”

ACS patients also experienced a significantly higher need for ICU transfer and often had a longer hospital stay compared to non-ACS patients, the study showed.

By understanding the overall impact of ACS in COVID-19 patients, the study aimed to evaluate the use of ACS at presentation or during hospitalization in determining a patient’s prognosis. The study proposed a scoring system that can help identify patients with ACS who may require ICU level care earlier in the course of their illness. This scoring system is based on neurological history and age of the patient.

“Not only could this study help with better risk stratification of COVID patients, in resource poor conditions it may also help guide candidates who are more likely to develop poor outcomes and thus may benefit from aggressive management,” Rai said.

While there are several studies that delve into neurological symptoms of COVID-19 and a handful of studies that suggest worse outcomes with neurological comorbidities, this particular study highlights the importance of the use of ACS in predicting overall outcomes for hospitalized patients.