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Observational Study
. 2021 Jan 26;96(4):e575-e586.
doi: 10.1212/WNL.0000000000010979. Epub 2020 Oct 5.

A Prospective Study of Neurologic Disorders in Hospitalized Patients With COVID-19 in New York City

Jennifer A Frontera  1 , Sakinah Sabadia  2 , Rebecca Lalchan  2 , Taolin Fang  2 , Brent Flusty  2 , Patricio Millar-Vernetti  2 , Thomas Snyder  2 , Stephen Berger  2 , Dixon Yang  2 , Andre Granger  2 , Nicole Morgan  2 , Palak Patel  2 , Josef Gutman  2 , Kara Melmed  2 , Shashank Agarwal  2 , Matthew Bokhari  2 , Andres Andino  2 , Eduard Valdes  2 , Mirza Omari  2 , Alexandra Kvernland  2 , Kaitlyn Lillemoe  2 , Sherry H-Y Chou  2 , Molly McNett  2 , Raimund Helbok  2 , Shraddha Mainali  2 , Ericka L Fink  2 , Courtney Robertson  2 , Michelle Schober  2 , Jose I Suarez  2 , Wendy Ziai  2 , David Menon  2 , Daniel Friedman  2 , David Friedman  2 , Manisha Holmes  2 , Joshua Huang  2 , Sujata Thawani  2 , Jonathan Howard  2 , Nada Abou-Fayssal  2 , Penina Krieger  2 , Ariane Lewis  2 , Aaron S Lord  2 , Ting Zhou  2 , D Ethan Kahn  2 , Barry M Czeisler  2 , Jose Torres  2 , Shadi Yaghi  2 , Koto Ishida  2 , Erica Scher  2 , Adam de Havenon  2 , Dimitris Placantonakis  2 , Mengling Liu  2 , Thomas Wisniewski  2 , Andrea B Troxel  2 , Laura Balcer  2 , Steven Galetta  2
Affiliations
Observational Study

A Prospective Study of Neurologic Disorders in Hospitalized Patients With COVID-19 in New York City

Jennifer A Frontera et al. Neurology. .

Abstract

Objective: To determine the prevalence and associated mortality of well-defined neurologic diagnoses among patients with coronavirus disease 2019 (COVID-19), we prospectively followed hospitalized severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive patients and recorded new neurologic disorders and hospital outcomes.

Methods: We conducted a prospective, multicenter, observational study of consecutive hospitalized adults in the New York City metropolitan area with laboratory-confirmed SARS-CoV-2 infection. The prevalence of new neurologic disorders (as diagnosed by a neurologist) was recorded and in-hospital mortality and discharge disposition were compared between patients with COVID-19 with and without neurologic disorders.

Results: Of 4,491 patients with COVID-19 hospitalized during the study timeframe, 606 (13.5%) developed a new neurologic disorder in a median of 2 days from COVID-19 symptom onset. The most common diagnoses were toxic/metabolic encephalopathy (6.8%), seizure (1.6%), stroke (1.9%), and hypoxic/ischemic injury (1.4%). No patient had meningitis/encephalitis or myelopathy/myelitis referable to SARS-CoV-2 infection and 18/18 CSF specimens were reverse transcriptase PCR negative for SARS-CoV-2. Patients with neurologic disorders were more often older, male, white, hypertensive, diabetic, intubated, and had higher sequential organ failure assessment (SOFA) scores (all p < 0.05). After adjusting for age, sex, SOFA scores, intubation, history, medical complications, medications, and comfort care status, patients with COVID-19 with neurologic disorders had increased risk of in-hospital mortality (hazard ratio [HR] 1.38, 95% confidence interval [CI] 1.17-1.62, p < 0.001) and decreased likelihood of discharge home (HR 0.72, 95% CI 0.63-0.85, p < 0.001).

Conclusions: Neurologic disorders were detected in 13.5% of patients with COVID-19 and were associated with increased risk of in-hospital mortality and decreased likelihood of discharge home. Many observed neurologic disorders may be sequelae of severe systemic illness.

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Figure
Figure. Flowchart of Patient Inclusion and Exclusion
SARS-CoV-2 = severe acute respiratory syndrome coronavirus 2.
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