Title:Prevalence of Coronavirus Disease 2019 in the Brain-Dead Candidates for Transplantation and Uncommon Manifestations of the Infection

VOLUME: 17 ISSUE: 4

Author(s):Mohsen Aliakbarian, Rozita Khodashahi *, Atefe Vakilian, Hamid Reza Naderi, Mandana Khodashahi , Ebrahim Khaleghi and Maliheh Dadgar Moghaddam

Affiliation:Department of Surgical Oncology Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Department of Infectious Diseases and Tropical Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Department of Infectious Diseases and Tropical Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Department of Infectious Diseases and Tropical Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Rheumatic Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Organ Procurement & Transplant Center, Montaserieh Hospital, Mashhad University of Medical Sciences, Mashhad, Department of Community Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad

Keywords:Brain death, COVID-19, prevalence, transplantation, infection, manifestations.

Abstract:

Aim: This study aimed to evaluate the prevalence of Coronavirus Disease 2019 (COVID-19) positive cases meeting clinical brain death criteria; moreover, it was attempted to assess the uncommon manifestations of the infection in this study.

Materials and Methods: This retrospective observational study was conducted on all brain-dead patients who were referred to the emergency department of hospitals in Mashhad, Iran, from February to October 2020. The demographic characteristics, clinical information, and laboratory data were collected and recorded in a researcher-made checklist.

Results: In general, 70 patients were entered in this study. The PCR test result was positive for COVID-19 in 54% of the patients, and syncope was reported in 16.1% of the cases (n=10). Furthermore, the majority of the patients (52.9%) showed central nervous system (CNS) hemorrhagic manifestations. A comparison was made between the patients with positive and negative PCR test result in terms of syncope; accordingly, there was a significant difference between them in this regard (χ2=4.5; P=0.03). The CNS hemorrhagic manifestations were significantly higher in patients with positive PCR compared to those with negative PCR (χ2=4.57, P=0.03). Moreover, the grand glass opacity and pleural effusion were the most common findings of the chest computed tomography in brain-dead patients with COVID-19.

Conclusion: Due to the high prevalence of COVID-19 among brain-dead patients, it seems that syncope attack should be regarded as one of the possible symptoms of COVID-19. Moreover, syncope as a result of COVID-19 may itself cause traumatic events. It is worth mentioning that CNS hemorrhagic manifestations have been reported in more than half of the patients with brain death.