Neurological symptoms with COVID-19 serve as ‘important predictor’ of poor outcomes
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Patients with COVID-19 and certain neurological problems had longer hospital lengths of stay and higher in-hospital mortality, among other adverse outcomes, according to findings from a prospective cohort study of 211 hospitalized patients.
Other adverse outcomes included increased risk for requiring mechanical ventilation and decreased likelihood to be discharged to home. Researchers presented results from the University of Pittsburgh/University of Pittsburgh Medical Center site in the Global Consortium Study of Neurological Dysfunction in COVID-19, a tier 1, international, multicenter study on neurological dysfunction in COVID-19, at the American Academy of Neurology annual meeting, which was held virtually.
“We have little information about how frequently neurological conditions occur among everyone with COVID-19,” Nicole C. Paul, a fourth-year medical student at the University of Pittsburgh School of Medicine, told Healio Neurology. “We also don’t know the impact of having neurological symptoms on the patient’s outcomes, both in the acute phase and long term. In this study, we looked at a cohort of COVID-19 patients ill enough to require hospitalization and systematically determined the frequency of neurological symptoms and dysfunctions, as well as specifically looked at encephalopathy as a prominent syndrome in this population.”
Paul and colleagues also assessed how these factors affected the patient’s risk for death during acute hospitalization, level of disability at hospital discharge according to modified Rankin score and likelihood of return to home following hospital discharge. They included participants aged 18 years or older with suspected or confirmed COVID-19 infection who had been admitted to two hospitals in the same health care network between March 22, 2020, and Nov. 15, 2020. They excluded eight patients with severe pre-existing baseline neurologic dysfunction, including coma or vegetative state, that hindered identification of new or worsening neurologic symptoms. Depending on distribution of data, Paul and colleagues compared continuous variables using either Student’s t or Wilcoxon rank sum test.
The researchers identified 203 patients (47.3% women) with a confirmed COVID-19 diagnosis, for whom the average age was 64.8 years and of whom 70.4% had a BMI of 25 or greater. A total of 135 (66.5%) cohort participants exhibited neurological symptoms during their hospital stay.
Outcomes related to the presence of any neurological manifestations included longer length of hospitalization, for a median of 10 days (P = .0002), as well as independent longer lengths of stay among those with objective neurological dysfunction and encephalopathy, for a median of 19 days and 18 days, respectively (P < .0001 for both). Those with any neurological manifestation, objective neurological dysfunction and encephalopathy (P < .0001 for all) had increased risk for requiring mechanical ventilation. Those with any neurological dysfunction (P < .0023), objective neurological dysfunction (P < .0001) and encephalopathy (P < .0001) had decreased likelihood for discharge to home. Paul and colleagues also observed an association between neurological manifestations and higher mortality in the hospital, with risk for in-hospital death 2.65 times higher among those with any neurological manifestation and 6 times higher among those with objective neurological dysfunction.
“These findings are important because they suggest that having neurological dysfunctions with COVID-19 is an important predictor of poor patient outcome in addition to risk factors we already know about, such as older age,” Paul said. “It is important that we identify these at-risk patients and direct available resources to them. It is also important that we continue to follow these patients after discharge to further understand the longer-term impact of having acute neurological dysfunctions with COVID-19.”
Perspective
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Edith L. Graham, MD
In addition to respiratory status and need for oxygen or intubation, neurological status can predict hospital length of stay and mortality. It cannot be determined based on the abstract alone if these are two independent factors or if one is causative of the other (ie. severe hypoxia can lead to neurological changes). The authors state the median length of stay in patients with neurological symptoms was 10 days, but they do not state the median length of stay for those without neurological symptoms, which would be important for comparison.
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Paul N, et al. Acute hospital outcomes COVID-19 associated neurological dysfunction. Presented at: American Academy of Neurology Annual Meeting; April 17-22, 2021 (virtual meeting).
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