Neurological manifestations as the predictors of severity and mortality in hospitalized individuals with COVID-19: a multicenter prospective clinical study

Abstract

Backgrounds The reports of neurological symptoms are increasing in cases with coronavirus disease 2019 (COVID-19). This multi-center prospective study was conducted to determine the incidence of neurological manifestations in hospitalized cases with COVID-19 and assess these symptoms as the predictors of severity and death. Methods Hospitalized males and females with COVID-19 who aged over 18 years were included in the study. They were examined by two neurologists at the time of admission. All survived cases were followed for 8 weeks after discharge and 16 weeks if their symptoms had no improvements. Results We included 873 participants. Of eligible cases, 122 individuals (13.97%) died during hospitalization. The most common non-neurological manifestations were fever (81.1%), cough (76.1%), fatigue (36.1%), and shortness of breath (27.6%). Aging, male gender, co-morbidity, smoking, hemoptysis, chest tightness, and shortness of breath were associated with increased odds of severe cases and/or mortality. There were 561 (64.3%) cases with smell and taste dysfunctions (hyposmia: 58.6%; anosmia: 41.4%; dysguesia: 100%). They were more common among females (69.7%) and non-smokers (66.7%). Hyposmia/anosmia and dysgeusia were found to be associated with reduced odds of severe cases and mortality. Myalgia (24.8%), headaches (12.6%), and dizziness (11.9%) were other common neurological symptoms. Headaches had negative correlation with severity and death due to COVID-19 but myalgia and dizziness were not associated. The cerebrovascular events (n = 10) and status epilepticus (n = 1) were other neurological findings. The partial or full recovery of smell and taste dysfunctions was found in 95.2% after 8 weeks and 97.3% after 16 weeks. The parosmia (30.9%) and phantosmia (9.0%) were also reported during 8 weeks of follow-up. Five cases with mild headaches and 5 cases with myalgia were reported after 16 weeks of discharge. The demyelinating myelitis (n = 1) and Guillain-Barré syndrome (n = 1) were also found during follow-up. Conclusion Neurological symptoms were found to be prevalent among individuals with COVID-19 disease and should not be under-estimated during the current pandemic outbreak.

Neurological symptoms in hospitalised patients with COVID-19 and their association with in-hospital mortality

“…On the other hand, in our study some symptoms which could be evaluated only in those patients who were able to fill out the questionnaire, such as headache or decreased mood, increased the chance of survival. Our results were similar to the findings of a prospective study of nearly 900 patients with SARS-Cov-2 infection where the presence of headache was a protective factor against death due to COVID-19 [7]. The frequency of headache in previous studies has been reported as between 7% and 75%, with higher percentages in European populations than in Chinese cohorts [11].…”

“…Fleischer et al showed that nearly 60% of 102 patients infected with the SARS-Cov-2 virus had non-specific neurological involvement with general weakness, cognitive decline or delirium [6]. In another study, the most common neurological complaints in a cohort of 873 Iranian patients were: smell and taste dysfunction, myalgia, headache, and dizziness [7].…”

“…Recently, two prospective studies on neurological symptoms in COVID-19 patients were performed, in which neurological consultation was used to identify neurological manifestations [6,7]. Fleischer et al showed that nearly 60% of 102 patients infected with the SARS-Cov-2 virus had non-specific neurological involvement with general weakness, cognitive decline or delirium [6].…”

Is loss of smell an early predictor of COVID-19 severity: a systematic review and meta-analysis

“…In total, 34 studies provided information on the severity of COVID-19 disease. Of them, four studies were preprints (Al Harthi et al 2020 ; Bertlich et al 2020 ; Papizadeh et al 2020 ; Patel et al 2020 ), and 30 articles were published studies (Aggarwal et al 2020 ; Alasia et al 2021 ; Alizadehsani et al 2021 ; Allenbach et al 2020 ; Amanat et al 2021 ; Borobia et al 2020 ; Delorme et al 2021 ; Elimian et al 2020 ; Ermis et al 2021 ; García-Azorín et al 2021 ; Ghaffari et al 2021 ; Goyal et al 2021 ; Izquierdo et al 2020 ; Kadiane-Oussou et al 2020 ; Kocayığıt et al 2021 ; Lechien et al 2021 ; Liotta et al 2020 ; Mao et al 2020 ; McElvaney et al 2020 ; Muñoz-Rodríguez et al 2021 ; Printza et al 2021 ; Romero-Sánchez et al 2020 ; Salepci et al 2021 ; Sobhani et al 2021 2021 ; Song et al 2021 ; Studart-Neto et al 2020 ; Sun et al 2021 ; Tomlins et al 2020 ; Vaira et al 2020 ; Vial et al 2020 ). The OD were present in 482 severely ill and 2640 non-severely ill patients with COVID-19.…”

COVID-19 outcomes of 10,881 patients: retrospective study of neurological symptoms and associated manifestations (Philippine CORONA Study)

“…Current reports of neurological symptoms/signs and complications of this infection are limited due to the small number of included patients and relatively short duration of data collection which could hinder more precise estimates and detection of rarer manifestations (Amanat et al 2021;Benussi et al 2020;Chachkhiani et al 2020;Chuang et al 2021;Collantes et al 2021;Flores-Silva et al 2021). Although there were two powered studies that provided a glimpse on the effects of neurological manifestations on mortality (Eskandar et al 2021;Frontera et al 2021), there are no comparative cohort studies yet that explored the effects of new-onset neurological symptoms (NNS) on other clinically relevant outcomes such as respiratory failure, duration of ventilator dependence, admission to the intensive care (ICU) unit and length of ICU and hospital stay.…”