COVID-19-Related Neurologic Disorders Confer Greater In-Hospital Mortality

Neurologic disorders in hospitalized patients with coronavirus disease 2019 (COVID-19) are associated with increased in-hospital mortality and a reduced probability of discharge home, suggesting neurologic manifestations may be an important consequence of severe COVID-19, according to study results published in Neurology.

The goal of this study was to assess the prevalence and related risk of in-hospital mortality of well-defined neurologic disorders among patients with COVID-19.

Study researchers conducted a prospective, multicenter, observational study that included 4491 consecutive adult patients with COVID-19 (age, ≥18 years). All patients were hospitalized with a laboratory-confirmed infection with severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2). Patients were hospitalized at 1 of 4 New York University Langone hospitals in the New York City metropolitan area between March 10 and May 20, 2020.

Researchers identified the prevalence of new neurologic disorders, the in-hospital mortality rate, and discharge disposition in this patient population. In-hospital mortality and discharge disposition were compared between patients with and without neurologic disorders.

The prevalence of neurologic disorders among infected, hospitalized patients was 13.5%. A total of 606 patients in this study developed a new neurologic disorder compared with 3885 hospitalized patients with COVID-19 who did not develop a neurologic disorder. The median duration between COVID-19 symptom onset to neurologic disorder onset was 2 days.

Common neurologic diagnoses in these hospitalized patients with COVID-19 included toxic/metabolic encephalopathy (6.8%), seizure (1.6%), stroke (1.9%), and hypoxic/ischemic brain injury (1.4%).

Compared with patients in this population without neurologic disorders, those with neurologic disorders were significantly older (71 vs 63 years, respectively; P <.001) and were more likely to be men (66% vs 57%; P <.001). Additionally, those who developed neurologic disorders had a significantly higher comorbidity burden, including hypertension (47% vs 37%; P <.001), diabetes (31% vs 25%; P =.002), hyperlipidemia (31% vs 25%; P =.001), and atrial fibrillation (14% vs 8%; P <.001), among other conditions.

In an analysis adjusted for age, sex, intubation, past medical history, medical complications, medications and comfort-care-status, and sequential organ failure assessment scores, patients with COVID-19 and neurologic disorders had a significantly higher risk of in-hospital mortality (hazard ratio [HR], 1.38; 95% CI, 1.17-1.62; P <.001) and reduced likelihood of discharge home (HR, 0.72; 95% CI, 0.63-0.85; P <.001).

A limitation of the study was that many patients, due to severe illness, may not have had the capability of providing a thorough medical history of neurologic symptoms, likely contributing to underestimation of the prevalence of neurologic disorders in this population. Additionally, difficulty in transporting patients for neuroimaging may have contributed to this underestimation.

The study researchers concluded “that critical illness itself may have contributed to neurologic complications” and that “neurologic disorders in the context of SARS-CoV-2 infection confer a higher risk of in-hospital mortality and reduced likelihood of discharge home.”

Reference

Frontera JA, Sabadia S, Lalchan R, et al. A prospective study of neurologic disorders in hospitalized COVID-19 patients in New York City. Neurology. Published online October 5, 2020. doi:10.1212/WNL.0000000000010979