Weaker Post-Covid Bold-CSF Coupling Is Associated With Acute Inflammation and Coagulation in Covid-19 Icu Survivors

Motivation: The cerebral waste clearance system may be involved in 'long COVID'. Inflammation and/or hypercoagulation could affect cerebrovascular drivers of cerebrospinal fluid (CSF) (i.e., neurofluid dynamics) and influence the clearance system. Goal(s): To explore the relationship between acute inflammation and coagulation and post-COVID neurofluid dynamics in COVID-19 ICU survivors. Approach: Post-COVID neurofluid dynamics were assessed through BOLD-CSF coupling in COVID-19 ICU survivors using resting-state fMRI and correlated with acute inflammation (C-reactive protein-to-albumin-ratio (CAR) and fibrinogen-to-albumin-ratio (FAR)) and coagulation markers (FAR). Results: Weaker post-COVID BOLD-CSF coupling correlated with higher median FAR and CAR during ICU stay, but not at ICU admission. Impact: Weaker post-COVID BOLD-CSF coupling correlated with increased inflammation and hypercoagulation during ICU stay in COVID-19 ICU survivors. This may affect post-COVID neurofluid dynamics and cerebral waste clearance, possibly contributing to long COVID.