Neurological Predictors of Clinical Outcomes in Hospitalized Patients With COVID-19

Abstract

Introduction: Multiple risk factors of mortality have been identified in patients with COVID-19. Here, we sought to determine the effect of a history of neurological disorder and development of neurological manifestations on mortality in hospitalized patients with COVID-19.Methods: From March 20 to May 20, 2020, hospitalized patients with laboratory confirmed or highly suspected COVID-19 were identified at four hospitals in Ohio. Previous history of neurological disease was classified by severity (major or minor). Neurological manifestations during disease course were also grouped into major and minor manifestations. Encephalopathy, ischemic or hemorrhagic stroke, and seizures were defined as major manifestations, whereas minor neurological manifestations included headache, anosmia, dysgeusia, dizziness or vertigo, and myalgias. Multivariate logistic regression models were used to determine significant predictors of mortality in patients with COVID-19 infection.Results: 574/626 hospitalized patients were eligible for inclusion. Mean age of the 574 patients included in the analysis was 62.8 (SD 17.6), with 298 (51.9%) women. Of the cohort, 240(41.8%) patients had a prior history of neurological disease (HND), of which 204 (35.5%) had a major history of neurological disease (HND). Mortality rates were higher in patients with a major HND (30.9 vs. 15.4%; p = 0.00002), although this was not a significant predictor of death. Major neurological manifestations were recorded in 203/574 (35.4%) patients during disease course. The mortality rate in patients who had major neurological manifestations was 37.4% compared to 11.9% (p = 2 × 10 −12 ) in those who did not. In multivariate analysis, major neurological manifestation (OR 2.1,; p = 0.002) was a predictor of death. Conclusions: In this retrospective study, history of pre-existing neurological disease in hospitalized COVID-19 patients did not impact mortality; however, development of major neurological manifestations during disease course was found to be an independent predictor of death. Larger studies are needed to validate our findings.

Neurological manifestations in patients with symptomatic COVID-19 admitted to the Bafoussam Regional Hospital, Cameroon

“…Myalgia was reported in 35.6% of patients. Our results are in line with those published previously, where myalgia was reported in 31% to 50% of patients with COVID-19 [ 23 , 28 , 31 , 32 ]. Two studies found an increased creatine kinase level in 33% of patients [ 21 , 33 ].…”

Neurological Manifestations in Patients with COVID-19: Experiences from the Central Infectious Diseases Hospital in South Korea

“… 1 4 39 The development of major neurological manifestations, including encephalopathy, stroke, and seizure, was found to be an independent predictor of COVID-19-related death. 40 …”

Stroke in patients with COVID-19: Clinical and neuroimaging characteristics

“…The mortality rate was particularly high in cases with stroke ensuing in association with severe respiratory disease requiring ICU admission [ 7 ]. In general, the development of major neurological manifestations (defined as the presence of encephalopathy, stroke, or seizures) during the course of SARS-CoV-2 infection was found to be an independent predictor of death in hospitalized patients [ 61 ]. For cerebrovascular disease, some of the predictors of poor outcome were in line with the experience in non-COVID stroke cases, such as older age, higher NIHSS at admission, baseline glucose, and creatinine levels, while others appear to be more specific to this particular population (e.g.…”