A Prospective Study of Neurologic Disorders in Hospitalized Patients With COVID-19 in New York City

• Published in: Neurology Vol. 96; no. 4; pp. e575 - e586
• Main Authors: Frontera, Jennifer A., Sabadia, Sakinah, Lalchan, Rebecca, Fang, Taolin, Flusty, Brent, Millar-Vernetti, Patricio, Snyder, Thomas, Berger, Stephen, Yang, Dixon, Granger, Andre, Morgan, Nicole, Patel, Palak, Gutman, Josef, Melmed, Kara, Agarwal, Shashank, Bokhari, Matthew, Andino, Andres, Valdes, Eduard, Omari, Mirza, Kvernland, Alexandra, Lillemoe, Kaitlyn, Chou, Sherry H.-Y., McNett, Molly, Helbok, Raimund, Mainali, Shraddha, Fink, Ericka L., Robertson, Courtney, Schober, Michelle, Suarez, Jose I., Ziai, Wendy, Menon, David, Friedman, Daniel, Friedman, David, Holmes, Manisha, Huang, Joshua, Thawani, Sujata, Howard, Jonathan, Abou-Fayssal, Nada, Krieger, Penina, Lewis, Ariane, Lord, Aaron S., Zhou, Ting, Kahn, D. Ethan, Czeisler, Barry M., Torres, Jose, Yaghi, Shadi, Ishida, Koto, Scher, Erica, de Havenon, Adam, Placantonakis, Dimitris, Liu, Mengling, Wisniewski, Thomas, Troxel, Andrea B., Balcer, Laura, Galetta, Steven
• Format: Journal Article
• Language: English
• Published: United States American Academy of Neurology 26-01-2021; Lippincott Williams & Wilkins
• Subjects: Adult; Age Factors; Aged; Brain Diseases - epidemiology; Brain Diseases - etiology; COVID-19 - complications; COVID-19 - epidemiology; COVID-19 - mortality; Female; Hospital Mortality; Hospitalization - statistics & numerical data; Humans; Intubation, Intratracheal - statistics & numerical data; Male; Middle Aged; Nervous System Diseases - epidemiology; Nervous System Diseases - etiology; Nervous System Diseases - mortality; Neurotoxicity Syndromes; New York City - epidemiology; Organ Dysfunction Scores; Patient Discharge - statistics & numerical data; Prospective Studies; Sex Factors; Spinal Cord Diseases - epidemiology; Spinal Cord Diseases - etiology; Young Adult; New York City
• ISSN: 0028-3878; 1526-632X; 1526-632X
• DOI: 10.1212/WNL.0000000000010979

To determine the prevalence and associated mortality of well-defined neurologic diagnoses among patients with coronavirus disease 2019 (COVID-19), we prospectively followed hospitalized severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive patients and recorded new neurologic disorders and hospital outcomes.
We conducted a prospective, multicenter, observational study of consecutive hospitalized adults in the New York City metropolitan area with laboratory-confirmed SARS-CoV-2 infection. The prevalence of new neurologic disorders (as diagnosed by a neurologist) was recorded and in-hospital mortality and discharge disposition were compared between patients with COVID-19 with and without neurologic disorders.
Of 4,491 patients with COVID-19 hospitalized during the study timeframe, 606 (13.5%) developed a new neurologic disorder in a median of 2 days from COVID-19 symptom onset. The most common diagnoses were toxic/metabolic encephalopathy (6.8%), seizure (1.6%), stroke (1.9%), and hypoxic/ischemic injury (1.4%). No patient had meningitis/encephalitis or myelopathy/myelitis referable to SARS-CoV-2 infection and 18/18 CSF specimens were reverse transcriptase PCR negative for SARS-CoV-2. Patients with neurologic disorders were more often older, male, white, hypertensive, diabetic, intubated, and had higher sequential organ failure assessment (SOFA) scores (all
< 0.05). After adjusting for age, sex, SOFA scores, intubation, history, medical complications, medications, and comfort care status, patients with COVID-19 with neurologic disorders had increased risk of in-hospital mortality (hazard ratio [HR] 1.38, 95% confidence interval [CI] 1.17-1.62,
< 0.001) and decreased likelihood of discharge home (HR 0.72, 95% CI 0.63-0.85,
< 0.001).
Neurologic disorders were detected in 13.5% of patients with COVID-19 and were associated with increased risk of in-hospital mortality and decreased likelihood of discharge home. Many observed neurologic disorders may be sequelae of severe systemic illness.