Neurological Diagnoses in Hospitalized COVID-19 Patients Associated With Adverse Outcomes: A Multinational Cohort Study

Abstract

Background

To determine whether neurological diagnoses during COVID-19 hospitalization are associated with adverse clinical outcomes.

Methods

We investigated the clinical outcomes (length of hospital stay, COVID-19 disease severity based on published criteria, and mortality) of reverse transcription polymerase chain reaction (RT-PCR)-confirmed COVID-19 patients hospitalized from 21 healthcare systems across 6 countries. Leveraging a unique federated multinational network in which electronic health records data are curated by local clinicians and informatics experts, we categorized patients according to the presence of central nervous system (CNS) or peripheral nervous system (PNS) diagnoses during COVID-19 hospitalization. We further identified comorbidities preceding hospitalization for COVID-19 up to 12 months. Each healthcare system locally performed covariate-adjusted survival analysis using Cox proportional hazard models to estimate the association between neurologic status and time to discharge, severe COVID-19 disease, and death. We performed a random-effects meta-analysis on locally generated results to estimate the risk of adverse clinical outcomes in patients with concurrent neurological diagnoses during COVID-19 hospitalization versus those with no neurological condition (NNC).

Findings

We analyzed 87,869 hospitalized COVID-19 patients from January 2020 until September 2021, 13,518 (15%) with at least one CNS diagnosis, and 2,461 (3%) with at least one PNS diagnosis. The CNS group had longer hospital stay (median of 12 days), greater risk of severe disease, and higher risk of mortality than the NNC group. The PNS group also had longer hospital stay, but a similar risk of severe disease and lower risk of mortality than the NNC group. Patients with CNS diagnoses had a greater burden of pre-existing comorbidities, including neurologic conditions, when compared to the NNC group.

Interpretation

Patients with CNS diagnoses during COVID-19 hospitalization harbored a greater burden of pre-existing comorbidities and had greater risk for adverse clinical outcomes.

Citation

MR Hutch, J Son, TT Le, C Hong, X Wang, Z Shakeri Hossein Abad, M Morris, A Gutiérrez-Sacristán, JG Klann, A Spiridou, R Bellazzi, V Benoit, CL Bonzel, WA Bryant, K Cho, P Das, DA Hanauer, DW Henderson, YL Ho, NHW Loh, A Makoudjou, A Malovini, B Moal, DL Mowery, MJ Samayamuthu, FJ Sanz Vidorreta, ER Schriver, P Schubert, J Talbert, AL Tan, BW Tan, BW Tan, V Tibollo, W Yuan, P Avillach, N Gehlenborg, GS Omenn, S Visweswaran, T Cai, Y Luo, Z Xia. “Neurological Diagnoses in Hospitalized COVID-19 Patients Associated With Adverse Outcomes: A Multinational Cohort Study”, SSRN Electronic Journal (2022). doi:10.2139/ssrn.4057133