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Neurological symptoms occur frequently with COVID-19 and increase in-hospital mortality




Disclosure: Chou has not reported disclosure of relevant financial information. See the full survey for relevant financial disclosures of all other authors.

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Neurological symptoms occurred frequently in patients admitted with COVID-19 and correlated with increased in-hospital mortality. JAMA network open..

This study also showed a relationship between existing neurological conditions and an increased risk of developing neurological signs and / or symptoms in COVID-19.

“This study is the first report from the Global Consortium Study on COVID-19 Neurodysfunction (GCS-NeuroCOVID), an international multicenter study on COVID-19 neurodysfunction.” Sherry Chow, MD, MMSC, FNCS, An associate professor of emergency medicine, neurology and neurosurgery at the University of Pittsburgh School of Emergency Medicine told Healtho Neurology. “In this particular study, we examined three cohorts: COVID-19 patients are ill enough to require hospitalizationWe systematically determined the frequency of neurological symptoms and signs and investigated how these factors affect the risk of patient death during acute hospitalization. “

research result

Chou et al. Conducted a cohort study of clinically diagnosed or laboratory-confirmed patients with COVID-19 from 28 centers in 13 countries. This study includes the GCS-NeuroCOVID group, which conducted research from March 1, 2020 to September 30, 2020, and the European Neurological Society (EAN) Neuro-COVID, which conducted research from March to October 2020. The registry (ENGERY) was included. The researchers stratified the patients into three groups. GCS-NeuroCOVID All COVID-19 cohorts (n = 3,055). This included consecutive inpatients with COVID-19, with or without neurological symptoms. GCS-NeuroCOVID COVID-19 Neurological cohort (n = 475). It consisted of consecutive patients admitted with COVID-19 with confirmed neurological symptoms. The ENERGY cohort (n = 214) included patients with COVID-19 who underwent formal neurological examination.

Researchers have classified neurological phenotypes as self-reported symptoms or neurological signs and / or syndromes according to clinical evaluation. They reported a combined incidence of groups with at least one neurological symptomatology. According to the study results, in-hospital mortality served as a major outcome indicator.

All COVID-19 cohorts included 1,742 men (57%) with an average patient age of 59.9 years (95% CI, 59.3-60.6 years). The COVID-19 neurological cohort included 262 men (55%) with an average patient age of 62.6 years (95% CI, 61.1-64.1 years). The ENERGY cohort included 133 men (62%) with an average age of 67 years (95% CI, 52-78 years).

In total, 3,083 patients (82%) in all groups (n = 3,743) experienced Neurological symptoms of COVID-19, Self-reported and / or clinically identified. Studies showed that the most frequently self-reported symptoms included headache (37%) and anosmia or ageusia (26%). The most predominant neurological signs and / or syndromes included acute encephalopathy (49%), coma (17%) and stroke (6%). Meningitis and / or encephalitis occurred rarely (0.5%), found by Chou and colleagues.

The incidence of neurological signs and / or syndromes clinically identified with COVID-19 correlates with an increased risk of in-hospital mortality after adjusting for study site, age, gender, race and ethnicity. (Adjusted OR = 5.99; 95% CI, 4.33-8.28). Chou et al. Also identified an association between the presence of pre-existing neuropathy and the increased risk of developing neurological signs and / or syndromes due to COVID-19 (aOR = 2.23; 95% CI, 1.8-2.75). ).

“Important” take-out message, future research

According to Chou, the first report from the GCS-NeuroCOVID group showed some “important takeaway messages.” These included the fact that neurological symptoms and syndromes commonly occurred in COVID-19 patients who were ill enough to require hospitalization.

“More than one in two patients hospitalized with COVID-19 experience certain neurological symptoms or dysfunctions,” said Chou. “The most common neurological syndrome seen in COVID-19 inpatients is acute encephalopathy, which is not the patient himself, confused, delirium, upset, or sensation. Means that is changing. The least common or rarest neurological syndrome is meningitis / encephalitis. “

In addition, patients with neurosyndrome clinically validated as COVID-19 were “acutely hospitalized,” even after considering the effects of age, gender, racial and ethnic differences, and different mortality rates in different hospitals. The risk of dying is much higher. ” Said Chow. Specifically, patients with acute encephalopathy in this study were more than five times more likely to die during acute hospitalization for COVID-19 than patients without encephalopathy.

The first report from the GCS-NeuroCOVID group showed that the effects of COVDI-19’s neurological problems were “significant,” she continued.

“The first step for the medical community is to pay attention to the neurological problems of patients admitted with COVID-19, to pay attention to the neurological problems, and to be able to detect and diagnose these conditions as soon as possible. That’s what Chou said. “Patients who already have a history of neurological problems in the past are particularly vulnerable to new neurological problems, which are now known to be associated with an increased risk of death. Doctors and medical systems may need to consider directing available resources to provide additional care and support for COVID-19 patients with neurological problems. “

The “important next step” of this study is: Long-term neurological problems and consequences In patients who survived discharge, COVID-19 survivors “may continue to experience significant disability and long-term consequences” due to neurological problems that develop during or after the acute phase of COVID-19 infection. There is, “Chou said.

“Recovery from neurological conditions is often incomplete and can take a very long time. A large number of people infected with COVID-19 and ill enough to require hospitalization, and two of them. Given the fact that one person may have a neurological problem with COVID-19, this means that there may be a large number of COVID-19 survivors. I am suffering from the consequences of long-term disability and neurological problems, “she said. “This is an important public health concern and there is an urgent need to learn more about the neurological effects of COVID-19.”

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