History of neurological disorder increases risk for hospital re-encounters after COVID-19

Individuals with a history of a neurological disorder prior to COVID-19 infection experienced an increased likelihood of acute care hospital re-encounters at both 30 days and 4 months, according to findings published in GeroScience.

“There have been numerous reports of patients having a variety of persistent symptoms after being discharged with COVID-19. While it appears that there is a ‘long hauler’ phenomena after acute COVID-19, it has been difficult to gauge how frequent these symptoms are and how severe they are,” Eric M. Liotta, MD, MS, assistant professor of neurology (neurocritical care) and surgery (organ transplantation), told Healio Neurology. “Since patients seeking acute medical attention would represent the most severe type of symptoms, we thought that reencounters might provide some insight into the scope and type of symptoms being experienced after COVID-19 discharge. The frequency of reencounters could also provide insight regarding additional stressors on the healthcare system and if there were interventions that might suggest symptomatic benefit after COVID-19 hospitalization.”

Liotta and colleagues examined the rate of short- and long-term acute care hospital re-encounters in a consecutive cohort of patients within 30 days and 4 months of hospitalization due to COVID-19. The researchers used electronic medical records to identify the first consecutive patients admitted with a confirmed primary diagnosis of COVID-19 in the Northwestern Medical Health Care system, which includes an academic medical center and nine other hospitals in the Chicago area, between March 5, 2020, and April 6, 2020. They classified acute care hospital re-encounters as ED visits, observational stays or hospital readmissions.

Study results

Among 509 patients hospitalized with COVID-19 during this timeframe, the majority (91.6%) were discharged alive. These patients had a mean age of 57.4 years and included more men (53.6%) than women.

The researchers reported acute care hospital re-encounters in 12.4% of patients within 30 days of index hospitalization discharge (n = 58). An additional 9% of patients (n = 42) experienced their first acute care hospital re-encounter within 31 days to 4 months of their index hospitalization discharge. Liotta and colleagues observed no correlation between age, sex, race or ethnicity and acute care hospital re-encounters at either 30 days or 4 months, according to the study results.

Additionally, the only comorbidity that demonstrated a relationship with acute care hospital re-encounters was a history of a neurological disorder prior to COVID-19 infection (43.1% vs. 22.8% for re-encounters within 30 days, P = .002 and 41% vs. 21% for re-encounters within 4 months, P = .001). Neurological disorders in this group included spinal stenosis, radiculopathy, epilepsy, prior stroke, neurodegenerative diseases including dementia, history of migraines, and peripheral neuropathy.

Liotta and colleagues also found that patients with a medical history of diabetes or chronic obstructive pulmonary disease had a tendency for more frequent re-encounters within 4 months.

“Needing to return to the hospital after initial COVID-19 hospitalization is common and that recurrence of COVID-19 symptoms is the leading reason patients seek hospital-level care within 30 days of discharge,” Liotta said. “Patients with a history of neurologic disorders before COVID-19 were at elevated risk to return to the hospital. Neither age, need for mechanical ventilation during COVID-19, nor length of the COVID-19 hospitalization predicted having a hospital reencounter.”

Implications of neurological disorders in COVID-19

Patients with neurological disorders may be more vulnerable to certain aspects of the SARS-CoV-2 virus or more drawn-out effects of the virus, according to Liotta.

“For example, Kaneko and colleagues recently demonstrated evidence that binding of SARS-CoV-2 to the endothelium may be dependent on flow dependent shear forces such that patients with cerebrovascular disease would be more susceptible to viral binding,” he said. “Neurologist should be aware that their patients may be more susceptible to complications and protracted symptoms after COVID-19.”

He also pointed to research regarding the impact of neurologic disease during hospitalization for COVID-19 and on functional outcomes after discharge.

“While our study showed that patients with neurologic disease were more likely to have re-encounters, we previously showed that patients with neurologic disease had higher rates of encephalopathy/delirium during hospitalization and higher mortality and worse functional outcome at time of hospital discharge for COVID-19,” Liotta said. “This finding has been independently confirmed by others.”

Those findings, from Chou and colleagues, demonstrated that neurological manifestations occurred often in patients hospitalized with COVID-19 and correlated with increased in-hospital mortality. They published the multicohort study in JAMA Network Open.

Regarding the current study, Liotta does not think the findings “are likely to be isolated” to the Northwestern Medicine healthcare system.

“Our study looked at a network of 10 hospitals rather than a single hospital,” he said. “In addition, our finding about the increased risk in patients with a history of neurologic disease is in line with similar findings concerning the unique risks of prior neurologic disease that has been confirmed by other independent groups.”

Reference:

Kaneko N, et al. Stroke. 2021;doi:10.1161/STROKEAHA.120.032764.