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?:abstract
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Abstract Background Multiple neurological manifestations of COVID-19 have been reported such as headache, anosmia, ischemic stroke, and cerebral hemorrhages Objective characterization of the acute neurological damage in critically ill patients with COVID-19 has not yet been reported Method We performed a prospective observational study of plasma brain biomarkers in critically ill patients with respiratory failure that were diagnosed with (COVID-19) or without (ICU control) COVID-19 Demographics, co-morbidities, daily clinical physiologic and laboratory data were collected Plasma samples were drawn for measurement of neurofilament-light chain (NF-L), total tau (t-tau), ubiquitin carboxy-terminal hydrolase L1 (UCH-L1), and glial fibrillary acidic protein (GFAP) The primary neurological outcome was delirium as defined by the intensive care delirium screening checklist (ICDSC, scale 1 - 8) Associations between brain biomarkers and markers of respiratory failure of COVID-19 were analyzed Result 27 patients with COVID-19 and 19 ICU controls were enrolled The concentration of plasma GFAP, UCH-L1 and NF-L levels was higher in both groups compared to healthy controls Compared to ICU controls, patients with COVID-19 had significantly higher GFAP (272 [150-555] pg/ml vs 118 [78 5-168] pg/ml, p=0 0009) In patients with COVID-19, GFAP (rho=0 5115, p=0 0064), UCH-L1 (rho=0 4056, p=0 0358) and NF-L (rho=0 6223, p=0 0005) were positively correlated with the ICDSC score and were higher in patients diagnosed with delirium (ICDSC ≥4) in the COVID-19 group but not ICU controls There were no associations between PaO2/FiO2 or diagnosis of ARDS and plasma concentration of GFAP, t-tau, UCH-L1, or NF-L in patients with COVID-19 Conclusion Plasma GFAP is 2-fold higher in critically ill patients with COVID-19 compared to ICU controls, and higher concentrations of GFAP, UCH-L1 and NF-L are associated with delirium specifically in patients with COVID-19
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