Neurologic Syndromes Predict Higher In-Hospital Mortality in COVID-19

Abstract

Objective:The SARS-Cov2 virus is protean in its manifestations, affecting nearly every organ system. However, nervous system involvement and its impact on disease outcome are poorly characterized. The objective of the study is to determine if neurological syndromes are associated with increased risk of inpatient mortality.Methods:581 hospitalized patients with confirmed SARS-Cov2 infection, neurological involvement and brain-imaging were compared to hospitalized non-neurological COVID-19 patients. Four patterns of neurological manifestations were identified –acute stroke, new or recrudescent seizures, altered mentation with normal imaging, and neuro-COVID-19 complex. Factors present on admission were analyzed as potential predictors of in-hospital mortality, including sociodemographic variables, pre-existing comorbidities, vital-signs, laboratory values, and pattern of neurological manifestations. Significant predictors were incorporated into a disease-severity score. Patients with neurological manifestations were matched with patients of the same age and disease severity to assess the risk of death.Results:4711 patients with confirmed SARS-Cov2 infection were admitted to one medical system in New York City during a 6-week period. Of these, 581 (12%) had neurological issues of sufficient concern to warrant neuro-imaging. These patients were compared to 1743 non-neurological COVID-19 patients matched for age and disease-severity admitted during the same period. Patients with altered mentation (n=258, p =0.04, OR 1.39, CI 1.04 – 1.86) or radiologically confirmed stroke (n=55, p = 0.001, OR 3.1, CI 1.65-5.92) had a higher risk of mortality than age and severity-matched controls.Conclusions:The incidence of altered mentation or stroke on admission predicts a modest but significantly higher risk of in-hospital mortality independent of disease severity. While other biomarker factors also predict mortality, measures to identify and treat such patients may be important in reducing overall mortality of COVID-19.

Sex differences in a cohort of COVID-19 Italian patients hospitalized during the first and second pandemic waves.

“…An altered state of consciousness, equally reported by women and men and signi cantly more frequent in the rst wave, was the principal no-COVID-19-related cause of hospitalization. Noteworthy, it has been reported that hospitalized COVID-19 patients who presented with altered mental state had signi cantly higher risk of in-hospital death, even when pulmonary problems were not severe [27]. We have not found this association, but it cannot be considered a discrepancy because in our patients this symptom was the cause of hospitalization with identi cation of SARS-CoV-2 infection being an accidental event, while in the work of Eskandar and collaborators [27], this neurologic symptom was linked to be a complication of COVID-19.…”

Imaging in the COVID-19 era: Lessons learned during a pandemic

“…Up to 12% of hospitalized patients with COVID-19 undergo neuroimaging[ 132 ]. The most common neurological symptoms are: anosmia, ageusia, altered mental status, headache, dizziness and focal neurological deficits[ 116 ].…”

“…Among critically-ill patients with COVID-19, neurological symptoms were observed upon admission to the ICU in 14% and upon weaning from sedation in 67%[ 134 ]. Patients with altered mentation were more likely to be hypotensive, hypoxic, and have elevated creatinine, D-dimers and inflammatory markers, suggesting an interplay between neurological damage and multi-system failure[ 132 ]. Neuroimaging may be revealing in up to 23% of patients; however, none of the reported abnormalities is specific for COVID-19[ 135 ].…”

“…Among ICU patients undergoing neuroimaging, acute infarcts were identified in 23%[ 134 ]. The occurrence of a stroke in COVID-19 patients has been associated with a higher mortality rate [ 132 ]. An unenhanced CT of the head is usually the first-line imaging modality, as it can identify acute infarcts (ischemic, embolic or venous), large vessel occlusion, hemorrhagic transformation, and venous sinus thrombosis[ 106 ].…”

Update 2021: COVID-19 aus Sicht der Neurologie

“…Das Vorhandensein von neurologischen Symptomen ging in einer Kohortenstudie mit ca. 5000 Patienten mit einer Verdopplung der Mortalität einher [3]. Eine Analyse großer Patientenkollektive findet sich für die Akutsitua-tion bei Yassin et al [4] und als 6-Monats-Follow-up bei Taquet et al [5].…”