CHSJ

Curr Health Sci J, vol. 52, no. 2, 2026

Admission Acute Brain Dysfunction and In-ICU Mortality in a Single-Center Pre-Vaccination Romanian COVID-19 Cohort: A Retrospective Observational Analysis

[Original Paper]

A.I. NEACSU(1), A.D. ROTARU-ZAVALEANU(2), M.B. NOVAC(3), L. RADU(4), E. OSIAC(5)


(1)Doctoral School, University of Medicine and Pharmacy of Craiova, Romania;
(2)Department of Epidemiology, University of Medicine and Pharmacy of Craiova, Romania;
(3)Department of Anesthesiology and Intensive Care, University of Medicine and Pharmacy of Craiova, Romania;
(4)Department of Hygiene, University of Medicine and Pharmacy of Craiova, Romania;
(5)Department of Biophysics, University of Medicine and Pharmacy of Craiova, Romania


Abstract:

Background: Critically ill COVID-19 patients frequently develop organ dysfunction and acute brain dysfunction with features overlapping sepsis-associated encephalopathy (SAE). Real-world cohorts from Eastern European intensive care during the pre-vaccination period are scarce. Methods: We retrospectively analysed 389 consecutive adults with RT-PCR-confirmed SARS-CoV-2 admitted to a single regional Romanian tertiary ICU during 2020-2021, entirely preceding population-level vaccination. Organ dysfunction was defined as admission SOFA?2, and acute brain dysfunction was op-erationalised from admission Glasgow Coma Scale and neurological SOFA (the acute brain dysfunction [ABD] proxy). Associations with in-ICU mortality were examined descriptively, with pre-specified sensitivity analyses restricted to non-ventilated pa-tients to address sedation confounding. Results: In-ICU mortality was 65.8%. The ABD proxy was present in 49.6% of the cohort; mortality was 96.9% in ABD-proxy-positive patients versus 45.9% in those with preserved consciousness, an absolute difference of 51.0 percentage points, which was of similar magnitude (49.4 points) in non-ventilated patients, arguing against sedation as the sole explanation. Higher inflammatory markers accompanied the ABD proxy, and the association between admission acute brain dys-function and mortality was consistent across analyses. Conclusions: Admission acute brain dysfunction was strongly associated with in-ICU mortality, and this association persisted in non-ventilated patients. The findings are descriptive associations within an extreme, single-center pre-vaccination cohort under surge conditions; they are not causal, and should not be generalised to vaccinated or contemporary critical care.


Keywords: COVID-19, critical care, multiple organ dysfunction syndrome, sepsis-associated encephalopathy, acute brain dysfunction, intensive care epidemiology



Corresponding: Alexandra Daniela Rotaru Zavaleanu, Department of Epidemiology, University of Medicine and Pharmacy of Craiova, e-mail: alexandra.rotaru@umfcv.ro


DOI 10.12865/CHSJ.52.02.05 - Download PDF
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