Outcome of Hospitalized Parkinson's Disease Patients with and without COVID‐19

Abstract

BackgroundBackground: The Parkinson's disease (PD) patient population, with an already reduced life expectancy, is rendered particularly vulnerable by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Objectives Objectives: We determined the risk factors that increase the risk of death in patients with Parkinson's disease who are infected by SARS-CoV-2. Methods Methods: Patients with a diagnosis of PD admitted to Montefiore Hospital (Bronx, New York) and tested for SARS-CoV-2 were identified. Retrospective review of electronic medical records confirmed the diagnosis; patients were classified by severity of PD. PD severity, demographic, socioeconomic factors, and co-morbidities were correlated with mortality rates in patients with SARS-CoV-2. Results Results: We identified 162 patients meeting criteria; chart review confirmed a diagnosis of PD in 70 patients. Of the 70 patients, 53 were positive for SARS-CoV-2 and 17 were negative. PD patients with SARS-CoV-2 infection had a higher mortality rate (35.8%) compared to PD patients without the infection (5.9%, P = 0.028). PD patients older than 70 years of age, those with advanced Parkinson's disease, those with reductions in their medications, and non-Hispanics (largely comprised of Black/African-Americans) had a statistically significant higher mortality rate, if infected. Conclusions Conclusions: PD did not increase mortality rates from SARS-CoV-2 infection when age was controlled. However, certain unalterable factors (advanced disease and age greater than 70 years) and alterable ones (reductions in PD medications) placed PD patients at increased risk for mortality. Also several socioeconomic factors contributed to mortality, for example, non-Hispanic patients with SARS-CoV-2 infection fared worse, likely driven by poorer outcomes in the Black/African-American cohort.Parkinson's disease (PD) is the second most common neurodegenerative disorder that reduces life expectancy. 1 The features most commonly found to reduce survival are the akinetic-rigid phenotype, PD dementia or mild cognitive impairment (MCI), and early autonomic dysfunction. 1,2,3,4 Based on Medicare data, in New York approximately 1.78% of individuals (1781/100,000) aged 65 or older have PD, and the annual inpatient hospital admission rate for PD patients is greater than 558/1000, for both neurologic and non-neurologic causes. 5 One study found that the prevalence of PD in the US is 1.6% in patients over the age of 65 years. Of those patients, 7% to 28% were hospitalized -approximately 1.5 times more often than non-PD patients. 6 The PD patient population, with an already reduced life expectancy, is rendered particularly vulnerable by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). The Bronx has had the highest rates of infection, hospitalizations, and deaths from coronavirus disease-2019 (COVID-19) in New York City, 7 which was an epicenter of the pandemic. Up to the point of preparation of this manuscript, 5.9% of residents in the Bronx had contracted COVID-19, and...

Prevalence and outcomes of Covid-19 in Parkinson's disease: Acute settings and hospital

“… Kobylecki et al (2020) Hospitalized patients in a single center 58 (3 COVID +) 5.2% NA NA Fasano, Cereda, et al (2020) , Fasano, Elia, et al (2020) Phone survey 1486 (105 COVID +) 5.7% 7.6% NA Artusi et al (2020) Phone survey 1407 (8 COVID +) 75% NA NA Del Prete et al (2020) Phone survey 740 (7 COVID +) 14% NA NA Fasano, Cereda, et al (2020) , Fasano, Elia, et al (2020) Multi-center case series 117 (117 COVID +) 19.7% NA Dementia, hypertension, disease duration Sainz-Amo et al (2020) Single-center case series 211 (33 COVID +) 21% NA Cancer, hospital admission (no DA use, dementia) a Vignatelli et al (2021) Prospective cohort study 696 (4 hospitalized with COVID-19) 25% 39% Control group was matched for age and comorbidities Salari, Etemadifar, Ashrafi, Ommi, et al (2021) , Salari, Etemadifar, Zali, Aminzade, et al (2021) , Salari, Etemadifar, Zali, Medghalchi, et al (2021) Hospitalized pts. patients in two referral centers 87 (87 COVID +) 35.6% 16.6% Dementia (Age) Parihar et al (2021) Retrospective review of admitted pts. (1 hospital in NYC) 70 (53 COVID +) 35.8% NA Age > 70, advanced PD, meds reduction, Black race Nwabuobi et al (2021) Retrospective review of admitted pts.…”

“…Another study examining 70 PwP admitted to a single hospital in New York found that the 53 patients who were Covid-19-positive had a significantly higher mortality than the 17 Covid-19-negative patients who were admitted to hospital (35.8% vs 5.9%, P = 0.028) ( Parihar, Ferastraoaru, Galanopoulou, Geyer, & Kaufman, 2021 ). PwP older than 70 years of age, those with advanced disease, those with reductions in their medications, and non-Hispanics (largely comprised of Black/African-Americans) had a statistically significant higher mortality rate, if infected with SARS-CoV-2.…”

Parkinson's disease and Covid-19: Is there an impact of ethnicity and the need for palliative care

“…Of note, PwP from ethnic minority backgrounds (in populations living in London) have recently been reported to exhibit greater motor disability, greater burden of non-motor symptoms (NMS), and a higher degree of cardiovascular comorbidities; the above features might further exacerbate the differences in risk for Covid-19 adverse outcomes between White and non-White PwP ( Sauerbier et al, 2021 ). Indeed, a statistically significant higher mortality rate among Black/African American PwP with Covid-19 has been reported ( Parihar et al, 2021 ). Moreover, the ethnic disparities are evident even beyond the direct impact of the virus per se.…”

Best practice approaches to outpatient management of people living with Parkinson’s disease during the COVID-19 pandemic

“…Although the risk of a complicated COVID-19 disease course is increased for people with older age and associated arterial hypertension, this risk is even higher in PD patients, especially with longer disease duration, than in non-PD patients (Fasano et al 2020b, c;Orlando et al 2021;Chambergo-Michilot et al 2021). PD patients may also have a higher mortality risk from COVID-19 infection per se (Zhang et al 2020b;Rutten et al 2020;Grasselli et al 2020;Parihar et al 2021). This calls for critical evaluation and planning of outpatient visits to provide sufficient care for these patients during the pandemic without placing them at an unnecessary risk of infection.…”