Prognostic Factors in COVID-19 Patients With New Neurological Manifestations: A Retrospective Cohort Study in a Romanian Neurology Department

Abstract

Introduction: The emerging Coronavirus Disease (COVID-19) pandemic caused by Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a serious public health issue due to its rapid spreading, high mortality rate and lack of specific treatment. Given its unpredictable clinical course, risk assessment, and stratification for severity of COVID-19 are required. Apart from serving as admission criteria, prognostic factors might guide future therapeutic strategies.Aim: We aimed to compare clinical features and biological parameters between elderly (age ≥ 65 years) and non-elderly (age <65 years) patients with COVID-19 and new neurological symptoms/conditions. We also aimed to determine factors independently associated with all-cause in-hospital mortality.Methods: All consecutive patients with COVID-19 and new neurological symptoms/conditions admitted in our Neurology Department between April 1 and August 23, 2020 were enrolled in this observational retrospective cohort study. Patient characteristics such as demographic data, comorbidities, biological parameters, imaging findings and clinical course were recorded. All-cause in-hospital mortality was the main outcome, whereas COVID-19 severity, hospitalization duration and the levels of supplemental oxygen were the secondary outcomes.Results: One hundred forty-eight patients were included, out of which 54.1% were women. The average age was 59.84 ± 19.06 years and 47.3% were elderly, the majority having cardiovascular and metabolic comorbidities. In the elderly group, the most frequent neurological symptoms/manifestations responsible for hospitalization were stroke symptoms followed by confusion, whereas in the non-elderly, headache prevailed. The final neurological diagnosis significantly varied between the two groups, with acute cerebrovascular events and acute confusional state in dementia most commonly encountered in the elderly (65.71 and 14.28%, respectively) and secondary headache attributed to SARS-CoV-2 infection often experienced by the non-elderly (38.46%). The elderly had statistically significant higher median values of white blood cell (8,060 vs. 6,090/μL) and neutrophil count (6,060 vs. 4,125/μL), C-reactive protein (29.2 vs. 5.72 mg/L), ferritin (482 vs. 187 mg/dL), fibrinogen (477 vs. 374 mg/dL), D-dimer (1.16 vs. 0.42), prothrombin time (151.15 vs. 13.8/s), aspartate transaminase (26.8 vs. 20.8 U/l), creatinine (0.96 vs. 0.77 mg/dL), and blood urea nitrogen level (51.1 vs. 27.65 mg/dL), as well as lower median value of hemoglobin (13.05 vs. 13.9 g/dL) and lymphocyte count (1,245 vs. 1,670/μL). Moreover, advanced age was significantly associated with more extensive lung involvement (25 vs. 10%) and higher fatality rate (40 vs. 9%). Overall, the mortality rate was 23.6%. Age as well as neutrophil count, C-reactive protein, fibrinogen, and activated partial thromboplastin time levels were independently associated with mortality.Conclusions: Older age, higher neutrophil count, C-reactive protein, fibrinogen, and activated partial thromboplastin time levels are independent predictors of mortality in COVID-19 patients with new neurological manifestations/conditions at admission.

COVID-19 and Laboratory Markers from Romanian Patients—A Narrative Review

“…Furthermore, Paranga et al concluded that the best role for CRP as a biomarker was to distinguish between severe and non-severe cases [ 61 ]. CRP levels were also associated with new neurological manifestations in elder patients [ 62 ] and children with pediatric inflammatory multisystem syndrome (PIMS) [ 41 , 63 ]. In the rare cases of vertical transmission, such as the one identified by Iacob and his team, CRP was elevated in the newborns with positive SARS-CoV-2 PCR testing [ 64 ].…”

“…The major laboratory markers that were studied by Romanian authors are displayed in Table 1. Yes, even more so in Roma [53,54,[58][59][60][61][62]70] Diabetes [48,94] Antiphospholipid syndrome [47] Hypertension [27] Cardiac dysfunction [46,73,93] Overweight/metabolic syndrome [27,54,93] Lung involvement [50,57] PIMS [83] Chronic Spontaneous Urticaria Exacerbation [42] Pneumothorax/ pneumomediastinum [31,72] Liver failure [44] Multiple organ dysfunction [ [57,58,102,103] No [55] More comorbidities [29,101] Lung involvement [57] In addition, this article aimed to identify gaps in this research and provide encouragement for Romanian research to focus on novel and detailed aspects of the pandemic. For instance, as Romania grapples with the aftermath of the COVID-19 pandemic, understanding the long-term effects of the disease is of paramount importance.…”

“…Elevated BUN levels may indicate impaired kidney function, which is a common complication of severe COVID-19 disease. Many authors have reported high levels in data from Romania and suggested a link with the severity of the infection, as well as a possible marker for severity [26,[32][33][34]40,62]. Some authors have reported other common renal markers such as creatinine and urea [30,40,59].…”

Post-COVID Headache: A Literature Review

“…It should be noted that studies that cite higher frequency of headache are often using healthcare professionals as their population, and therefore these individuals may be better able to recognize their symptoms. Davidescu et al described in their retrospective cohort study that the most frequent neurological manifestation of COVID-19 in younger patients was headache, in contrast to stroke and confusion in older adults [ 10 ].…”

The Evolution and Treatment Options of Patients With Covid-19 and Neurological Manifestations – A Narrative Review

“…Moreover, it was established that reducing IL-6 levels is correlated with the amelioration of olfaction and taste dysfunction in COVID-19 [26]. Additionally, in stroke, as in other neurological manifestations, the neutrophillymphocyte ratio [116], C reactive protein [130] and serum ferritin are increased in a large proportion of patients with COVID-19 [8,39]. Severe hypoxia, characteristic in many COVID-19 patients, can induce cerebrovascular dilation, oedema and ischemia [125].…”