Infectious Disease

Neurological symptoms are common with COVID-19 and increase hospital mortality

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Neurological manifestations were common in patients hospitalized with COVID-19 and correlated with increased hospital mortality, according to a multi-cohort study published on JAMA Network Open.

The study also showed an association between pre-existing neurological conditions and a higher risk of developing neurological signs and / or symptoms in COVID-19.

“This study is the first report from the Global Consortium Study on Neurological Dysfunction in COVID-19 (GCS-NeuroCOVID), an international, multicenter study of neurological dysfunction in COVID-19.” Sherry HY Chou, MD, MMSC, FNCS, Associate professor of intensive care medicine, neurology and neurosurgery in the department of intensive care medicine at the University of Pittsburgh, said Healio Neurology. “In this particular study, we looked at three cohorts of COVID-19 patients sick enough to require hospitalization, systematically determined the frequency of their neurological symptoms and signs, and looked at how these factors increase the patient’s risk of death during an acute one Affect hospitalization. “

Study results

Chou and colleagues conducted a cohort study of patients with clinically diagnosed or laboratory-confirmed COVID-19 from 28 centers in 13 countries. The study included the GCS-NeuroCOVID group, which conducted research from March 1, 2020 to September 30, 2020, and the Neuro-COVID Register (ENGERY) of the European Academy of Neurology (EAN), which conducted research from March to October 2020 . The researchers divided the patients into three groups: the GCS-NeuroCOVID all COVID-19 cohort (n = 3,055), which included consecutive hospitalized patients with COVID-19 with and without neurological manifestations; the GCS-NeuroCOVID COVID-19 neurological cohort (n = 475), which included consecutive patients hospitalized with COVID-19 who had confirmed neurological manifestations; and the ENERGY cohort (n = 214), which included patients with COVID-19 who received formal neurological counseling.

The researchers categorized neurological phenotypes as self-reported symptoms or neurological signs and / or syndromes according to the clinical evaluation. They reported the composite incidence for groups with at least one neurological manifestation. According to the results of the study, hospital mortality was the main finding.

The entire COVID-19 cohort included 1,742 men (57%) and the mean age of the patients was 59.9 years (95% CI, 59.3-60.6 years). The COVID-19 neurological cohort included 262 men (55%) and the mean age of the patients was 62.6 years (95% CI, 61.1-64.1 years). The ENERGY cohort consisted of 133 men (62%) and the mean age of the patients was 67 years (95% CI, 52-78 years).

A total of 3,083 patients (82%) in all groups (n = 3,743) had neurological manifestations of COVID-19, either those that were self-reported and / or clinically identified. The most common self-reported symptoms were headache (37%) and anosmia or ageusia (26%) according to the study results. The most common neurological symptoms and / or syndromes were acute encephalopathy (49%), coma (17%), and stroke (6%). Meningitis and / or encephalitis were rare (0.5%), noted Chou and colleagues.

The incidence of clinically identified neurological symptoms and / or syndromes in COVID-19 correlated with a higher risk of in-hospital mortality after adjusting for study location, age, gender, race, and ethnicity (adjusted OR = 5.99; 95% CI, 4th , 33-). 8.28). Chou and colleagues also identified a link between the presence of pre-existing neurological disorders and a higher risk of developing neurological symptoms and / or syndromes with COVID-19 (aOR = 2.23; 95% CI, 1.8-2.75) .

‘Important’ takeaway news, future research

The first report by the GCS-NeuroCOVID group showed several “important takeaway messages”, according to Chou. This included the fact that neurological symptoms and syndromes were common in patients with COVID-19 who were sick enough to require hospitalization.

“More than every second patient hospitalized with COVID-19 has neurological symptoms or dysfunction,” Chou said. “By far the most common neurological syndrome in hospitalized patients with COVID-19 is acute encephalopathy, which means that the patient is not themselves, confused, insane, aroused, or has altered the senses. The least common or rarest neurological syndromes are meningitis / encephalitis. “

In addition, patients with COVID-19 and clinically verified neurological syndromes had a “much higher risk of death during an acute hospital stay,” even after taking into account the effects of age, gender, differences in race and ethnicity, and differences in death rates in different hospitals, it said Chou. In particular, patients with acute encephalopathy in this study died more than five times more often during an acute hospital stay due to COVID-19 than patients without encephalopathy.

The first report by the GCS-NeuroCOVID group showed that the effects of neurological problems with COVDI-19 are “significant,” she continued.

“For the medical community, the first step is to become more vigilant and look out for neurological issues in patients hospitalized with COVID-19 so that we can identify and diagnose these conditions as early as possible,” Chou said. “Patients who have had neurological problems in the past are particularly susceptible to new neurological problems that we now know are associated with a higher risk of death. Doctors and healthcare systems may need to consider allocating the resources available to provide additional care and support to COVID-19 patients with neurological issues. “

An “important next step” for this research is to examine the longer-term neurological problems and outcomes in patients who survive after hospital discharge, Chou said, noting that survivors of COVID-19 “continue to have significant disabilities and long-term consequences can have”. because of neurological problems that developed during or after the acute phase of COVID-19 infection.

“Recovery from neurological diseases is often incomplete and can take a long time. If we look at the large number of people who have had COVID-19 and were sick enough to be hospitalized, and the fact that one in two of them may have had neurological problems with COVID-19, it means that we may have large numbers of COVID-19 survivors suffer from long-term disability and the consequences of neurological problems, “she said. “This is a major public health concern and we urgently need to learn more about the neurological consequences of COVID-19.”

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