Fragiel, MarcosMiró i Andreu, ÒscarLlorens, PereJiménez, SòniaPiñera Salmerón, PascualBurillo Putze, GuillermoMartín, AlfonsoMartín Sánchez, Francisco JavierGarcía Lamberechts, Eric JorgeJacob, JavierAlquézar Arbé, AitorLlopis Roca, FerranPedraza García, JorgeCalvo López, RicardoMaza Vera, María TeresaLucas Imbernón, Francisco JavierGonzález Martinez, FélixJuárez, RicardoExpósito Rodriguez, MarcosMartinez Bautista, Beatriz MariaNiembro Valdés, Ana PatriciaSanchez Nicolas, Jose AndresFerreras Amez, José MaríaPorta-Etessam, JesúsCalvo, ElpidioGonzález del Castillo, JuanSpanish Investigators on Emergency Situations TeAm (SIESTA) network2021-04-062021-04-062021-03-09https://hdl.handle.net/2445/176032We investigated the incidence, clinical characteristics, risk factors, and outcome of meningoencephalitis (ME) in patients with COVID-19 attending emergency departments (ED), before hospitalization. We retrospectively reviewed all COVID patients diagnosed with ME in 61 Spanish EDs (20% of Spanish EDs, COVID-ME) during the COVID pandemic. We formed two control groups: non-COVID patients with ME (non-COVID-ME) and COVID patients without ME (COVID-non-ME). Unadjusted comparisons between cases and controls were performed regarding 57 baseline and clinical characteristics and 4 outcomes. Cerebrospinal fluid (CSF) biochemical and serologic findings of COVID-ME and non-COVID-ME were also investigated. We identified 29 ME in 71,904 patients with COVID-19 attending EDs (0.40‰, 95%CI=0.27-0.58). This incidence was higher than that observed in non-COVID patients (150/1,358,134, 0.11‰, 95%CI=0.09-0.13; OR=3.65, 95%CI=2.45-5.44). With respect to non-COVID-ME, COVID-ME more frequently had dyspnea and chest X-ray abnormalities, and neck stiffness was less frequent (OR=0.3, 95%CI=0.1-0.9). In 69.0% of COVID-ME, CSF cells were predominantly lymphocytes, and SARS-CoV-2 antigen was detected by RT-PCR in 1 patient. The clinical characteristics associated with a higher risk of presenting ME in COVID patients were vomiting (OR=3.7, 95%CI=1.4-10.2), headache (OR=24.7, 95%CI=10.2-60.1), and altered mental status (OR=12.9, 95%CI=6.6-25.0). COVID-ME patients had a higher in-hospital mortality than non-COVID-ME patients (OR=2.26; 95%CI=1.04-4.48), and a higher need for hospitalization (OR=8.02; 95%CI=1.19-66.7) and intensive care admission (OR=5.89; 95%CI=3.12-11.14) than COVID-non-ME patients. ME is an unusual form of COVID presentation (<0.5‰ cases), but is more than 4-fold more frequent than in non-COVID patients attending the ED. As the majority of these MEs had lymphocytic predominance and in one patient SARS-CoV-2 antigen was detected in CSF, SARS-CoV-2 could be the cause of most of the cases observed. COVID-ME patients had a higher unadjusted in-hospital mortality than non-COVID-ME patients.12 p.application/pdfeng(c) Fragiel et al., 2021COVID-19Malalties cerebralsSARS-CoV-2COVID-19Brain diseasesSARS-CoV-2info:eu-repo/semantics/article2021-03-25info:eu-repo/semantics/openAccess33686558