A Prospective Study of Neurologic Disorders in Hospitalized COVID-19 Patients in New York City
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Abstract
Objective: To determine the prevalence and associated mortality of well-defined neurologic diagnoses among COVID-19 patients, we prospectively followed hospitalized SARS-Cov-2 positive patients and recorded new neurologic disorders and hospital outcomes.
Methods: We conducted a prospective, multi-center, observational study of consecutive hospitalized adults in the NYC 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 COVID-19 patients with and without neurologic disorders.
Results: Of 4,491 COVID-19 patients 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 RT-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, past history, medical complications, medications and comfort-care-status, COVID-19 patients with neurologic disorders had increased risk of in-hospital mortality (Hazard Ratio[HR] 1.38, 95% 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 COVID-19 patients 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.
- Received July 14, 2020.
- Accepted in final form September 14, 2020.
- © 2020 American Academy of Neurology
Disputes & Debates: Rapid online correspondence
- Author response: A Prospective Study of Neurologic Disorders in Hospitalized COVID-19 Patients in New York City
- Jennifer A. Frontera, Neurologist, NYU Langone Health
- Ariane Lewis, Neurologist, NYU Langone Health
- Laura Balcer, Neurologist, NYU Langone Health
- Steven Galetta, Neurologist, NYU Langone Health
Submitted October 16, 2020 - Author response: A Prospective Study of Neurologic Disorders in Hospitalized COVID-19 Patients in New York City
- Jennifer A. Frontera, Neurologist, NYU Langone Hospitals
- Laura Balcer, Neurologist, NYU Langone Hospitals
- Steven Galetta, Neurologist, NYU Langone Hospitals
Submitted October 15, 2020 - Reader response: A Prospective Study of Neurologic Disorders in Hospitalized COVID-19 Patients in New York City
- Eric M. Liotta, MD, Northwestern University, Feinberg School of Medicine (Chicago, IL)
- Ayush Batra, MD, Northwestern University, Feinberg School of Medicine (Chicago, IL)
- Igor J. Koralnik, MD, Northwestern University, Feinberg School of Medicine (Chicago, IL)
Submitted October 13, 2020 - Reader response: A Prospective Study of Neurologic Disorders in Hospitalized COVID-19 Patients in New York City
- Anand Kumar, Assistant Professor,Department of Neurology, Banaras Hindu University, Institute of Medical Sciences (Varanasi, India)
- Neha Lall, Junior Resident, Radiotherapy & Radiation Medicine, Banaras Hindu University, Institute of Medical Sciences (Varanasi, India)
- Varun Kumar Singh, Assistant Professor,Department of Neurology, Banaras Hindu University, Institute of Medical Sciences (Varanasi, India)
Submitted October 10, 2020
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