8 Out of 10 People Hospitalized With COVID-19 Develop Neurological Problems

Summary: Neurological symptoms associated with COVID-19, from losing the sense of smell to stroke, are linked to a six-fold higher risk of dying as a result of coronavirus.

Source: University of Pittsburgh

Patients with clinically diagnosed neurological symptoms associated with COVID-19 are six times more likely to die in the hospital than those without the neurological complications, according to an interim analysis from the Global Consortium Study of Neurologic Dysfunction in COVID-19 (GCS-NeuroCOVID).

A paper published today in JAMA Network Open presents early results of the global effort to gather information about the incidence, severity and outcomes of neurological manifestations of COVID-19 disease.

“Very early on in the pandemic, it became apparent that a good number of people who were sick enough to be hospitalized also develop neurological problems,” said lead author Sherry Chou, M.D., M.Sc., principal investigator of the consortium and associate professor of critical care medicine, neurology, and neurosurgery at the University of Pittsburgh School of Medicine and UPMC.

“A year later, we are still fighting an unknown invisible enemy and, like in any battle, we need intel–we have to learn as much as we can about neurological impacts of COVID-19 in patients who are actively sick and in survivors.”

The GCS-NeuroCOVID is the largest cohort study of neurological manifestations of COVID-19 to date, spanning 133 adult patient sites in all continents except Antarctica.

Among one group of 3,744 hospitalized adult patients with COVID-19, 82% had self-reported or clinically captured neurological symptoms. Nearly 4 out of 10 patients reported having headaches, and approximately 3 out of 10 said they lost their sense of smell or taste.

Of the clinically diagnosed syndromes–abnormalities that a bedside clinician can observe, regardless of whether the patient is aware of the problem–acute encephalopathy was most common, affecting nearly half of the patients, followed by coma (17%) and strokes (6%).

Despite early concerns about the coronavirus’s ability to directly attack the brain and cause brain swelling and inflammation–meningitis and encephalitis–those events were very rare, occurring in less than 1% of hospitalized COVID-19 patients.

“Acute encephalopathy is by far the most common symptom that we see in the clinic,” said Chou, also associate director of the Pitt Safar Center for Resuscitation Research. “Those patients may be in an altered sensory state or have impaired consciousness, or they don’t feel like themselves and act confused, delirious or agitated.”

The researchers analyzed data from three different types of patient cohorts–the “all COVID-19” cohort, which included all 3,055 hospitalized patients with COVID-19, irrespective of their neurological status; the “neurological” cohort, which included 475 hospitalized COVID-19 patients with clinically confirmed neurological symptoms compiled by the GCS-NeuroCOVID Consortium; and the “ENERGY” cohort, or 214 hospitalized COVID-19 patients who required evaluation by a consulting neurologist and provided consent to participate in the European Academy of Neurology Neuro-COVID Registry (ENERGY), a formal partner of the GCS-NeuroCOVID Consortium.

The study found that having a preexisting neurological condition of any kind–from brain, spinal cord and nerve diseases to chronic migraines, dementia or Alzheimer’s disease, among others–is the strongest predictor of developing COVID-19-related neurological complications, increasing the risk by two-fold.

This shows a woman wearing a face mask
Despite early concerns about the coronavirus’s ability to directly attack the brain and cause brain swelling and inflammation–meningitis and encephalitis–those events were very rare, occurring in less than 1% of hospitalized COVID-19 patients. Image is in the public domain

In addition, having any neurological symptoms related to COVID-19–from something as seemingly innocuous as the loss of smell to major events like strokes–is associated with a six-fold higher risk of dying.

But even if a patient beats the odds and recovers, their long-term health outlook is still uncertain.

“Even if the pandemic is completely eradicated, we are still talking about millions of survivors who need our help,” said Chou. “It is important to find out what symptoms and health problems those patients are facing, and there is still plenty of work for years to come.”

Additional authors of the study include Valeria Altamirano, M.S., of Pitt; Ettore Beghi, M.D., of Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy; Raimund Helbok, M.D., of Medical University of Innsbruck, Austria; Elena Moro, M.D., Ph.D., of Grenoble Institute of Neuroscience, France; Joshua Sampson, Ph.D., of the National Cancer Institute, Baltimore; Shraddha Mainali, M.D., and Molly McNett, Ph.D., of The Ohio State University, Columbus, Ohio; Claudio Bassetti, M.D., of University of Bern, Switzerland; Jose Suarez, M.D., of the Johns Hopkins University School of Medicine, Baltimore; and other GCS-NeuroCOVID Consortium and ENERGY Consortium members. The GCS-NeuroCOVID consortium is endorsed by the Neurocritical Care Society.

Authors thank the research team at the Pitt School of Medicine, including the GCS-NeuroCOVID Consortium coordinator Ali Scott-Smith, volunteer Pitt neurology residents, Pitt medical students and undergrad students.

Funding: This research was supported by the National Institutes of Health (grant R21NS113037), National Center for Advancing Translational Sciences (grant UL1TR001857) and the University of Pittsburgh Dean’s Faculty Advancement Award.

About this COVID-19 research news

Source: University of Pittsburgh
Contact: Anastasia Gorelova – University of Pittsburgh
Image: The image is in the public domain

Original Research: Open access.
Global Incidence of Neurological Manifestations Among Patients Hospitalized With COVID-19—A Report for the GCS-NeuroCOVID Consortium and the ENERGY Consortium” by Sherry Chou et al. JAMA Open Network


Abstract

Global Incidence of Neurological Manifestations Among Patients Hospitalized With COVID-19—A Report for the GCS-NeuroCOVID Consortium and the ENERGY Consortium

Importance  The COVID-19 pandemic continues to affect millions of people globally, with increasing reports of neurological manifestations but limited data on their incidence and associations with outcome.

Objective  To determine the neurological phenotypes, incidence, and outcomes among adults hospitalized with COVID-19.

Design, Setting, and Participants  This cohort study included patients with clinically diagnosed or laboratory-confirmed COVID-19 at 28 centers, representing 13 countries and 4 continents. The study was performed by the Global Consortium Study of Neurologic Dysfunction in COVID-19 (GCS-NeuroCOVID) from March 1 to September 30, 2020, and the European Academy of Neurology (EAN) Neuro-COVID Registry (ENERGY) from March to October 2020. Three cohorts were included: (1) the GCS-NeuroCOVID all COVID-19 cohort (n = 3055), which included consecutive hospitalized patients with COVID-19 with and without neurological manifestations; (2) the GCS-NeuroCOVID COVID-19 neurological cohort (n = 475), which comprised consecutive patients hospitalized with COVID-19 who had confirmed neurological manifestations; and (3) the ENERGY cohort (n = 214), which included patients with COVID-19 who received formal neurological consultation.

Exposures  Clinically diagnosed or laboratory-confirmed COVID-19.

Main Outcomes and Measures  Neurological phenotypes were classified as self-reported symptoms or neurological signs and/or syndromes assessed by clinical evaluation. Composite incidence was reported for groups with at least 1 neurological manifestation. The main outcome measure was in-hospital mortality.

Results  Of the 3055 patients in the all COVID-19 cohort, 1742 (57%) were men, and the mean age was 59.9 years (95% CI, 59.3-60.6 years). Of the 475 patients in the COVID-19 neurological cohort, 262 (55%) were men, and the mean age was 62.6 years (95% CI, 61.1-64.1 years). Of the 214 patients in the ENERGY cohort, 133 (62%) were men, and the mean age was 67 years (95% CI, 52-78 years). A total of 3083 of 3743 patients (82%) across cohorts had any neurological manifestation (self-reported neurological symptoms and/or clinically captured neurological sign and/or syndrome). The most common self-reported symptoms included headache (1385 of 3732 patients [37%]) and anosmia or ageusia (977 of 3700 patients [26%]).

The most prevalent neurological signs and/or syndromes were acute encephalopathy (1845 of 3740 patients [49%]), coma (649 of 3737 patients [17%]), and stroke (222 of 3737 patients [6%]), while meningitis and/or encephalitis were rare (19 of 3741 patients [0.5%]). Presence of clinically captured neurologic signs and/or syndromes was associated with increased risk of in-hospital death (adjusted odds ratio [aOR], 5.99; 95% CI, 4.33-8.28) after adjusting for study site, age, sex, race, and ethnicity. Presence of preexisting neurological disorders (aOR, 2.23; 95% CI, 1.80-2.75) was associated with increased risk of developing neurological signs and/or syndromes with COVID-19.

Conclusions and Relevance  In this multicohort study, neurological manifestations were prevalent among patients hospitalized with COVID-19 and were associated with higher in-hospital mortality. Preexisting neurological disorders were associated with increased risk of developing neurological signs and/or syndromes in COVID-19.

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