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October 05, 2020Article

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

View ORCID ProfileJennifer A. Frontera, Sakinah Sabadia, Rebecca Lalchan, Taolin Fang, Brent Flusty, View ORCID ProfilePatricio Millar-Vernetti, Thomas Snyder, Stephen Berger, Dixon Yang, Andre Granger, Nicole Morgan, View ORCID ProfilePalak Patel, Josef Gutman, View ORCID ProfileKara Melmed, Shashank Agarwal, Matthew Bokhari, Andres Andino, View ORCID ProfileEduard Valdes, Mirza Omari, Alexandra Kvernland, Kaitlyn Lillemoe, View ORCID ProfileSherry H.-Y. Chou, Molly McNett, Raimund Helbok, View ORCID ProfileShraddha Mainali, Ericka L. Fink, Courtney Robertson, Michelle Schober, Jose I. Suarez, Wendy Ziai, David Menon, Daniel Friedman, David Friedman, Manisha Holmes, Joshua Huang, Sujata Thawani, Jonathan Howard, Nada Abou-Fayssal, Penina Krieger, Ariane Lewis, View ORCID ProfileAaron S. Lord, Ting Zhou, D. Ethan Kahn, View ORCID ProfileBarry M. Czeisler, Jose Torres, Shadi Yaghi, Koto Ishida, Erica Scher, Adam de Havenon, Dimitris Placantonakis, Mengling Liu, View ORCID ProfileThomas Wisniewski, Andrea B. Troxel, Laura Balcer, Steven Galetta
First published October 5, 2020, DOI: https://doi.org/10.1212/WNL.0000000000010979
Jennifer A. Frontera
1 New York University Grossman School of Medicine, New York, NY, USA
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Sakinah Sabadia
1 New York University Grossman School of Medicine, New York, NY, USA
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Rebecca Lalchan
1 New York University Grossman School of Medicine, New York, NY, USA
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Taolin Fang
1 New York University Grossman School of Medicine, New York, NY, USA
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Brent Flusty
1 New York University Grossman School of Medicine, New York, NY, USA
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Patricio Millar-Vernetti
1 New York University Grossman School of Medicine, New York, NY, USA
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Thomas Snyder
1 New York University Grossman School of Medicine, New York, NY, USA
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Stephen Berger
1 New York University Grossman School of Medicine, New York, NY, USA
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Dixon Yang
1 New York University Grossman School of Medicine, New York, NY, USA
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Andre Granger
1 New York University Grossman School of Medicine, New York, NY, USA
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Nicole Morgan
1 New York University Grossman School of Medicine, New York, NY, USA
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Palak Patel
1 New York University Grossman School of Medicine, New York, NY, USA
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Josef Gutman
1 New York University Grossman School of Medicine, New York, NY, USA
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Kara Melmed
1 New York University Grossman School of Medicine, New York, NY, USA
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Shashank Agarwal
1 New York University Grossman School of Medicine, New York, NY, USA
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Matthew Bokhari
1 New York University Grossman School of Medicine, New York, NY, USA
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Andres Andino
1 New York University Grossman School of Medicine, New York, NY, USA
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Eduard Valdes
1 New York University Grossman School of Medicine, New York, NY, USA
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Mirza Omari
1 New York University Grossman School of Medicine, New York, NY, USA
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Alexandra Kvernland
1 New York University Grossman School of Medicine, New York, NY, USA
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Kaitlyn Lillemoe
1 New York University Grossman School of Medicine, New York, NY, USA
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Sherry H.-Y. Chou
2 University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Molly McNett
3The Ohio State University, Columbus, OH, USA
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Raimund Helbok
4Medical University of Innsbruck, Innsbruck, Austria.
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Shraddha Mainali
3The Ohio State University, Columbus, OH, USA
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Ericka L. Fink
2 University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Courtney Robertson
5The Johns Hopkins University School of Medicine, Baltimore, MD,USA
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Michelle Schober
6University of Utah School of Medicine, Salt Lake City, UT, USA
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Jose I. Suarez
5The Johns Hopkins University School of Medicine, Baltimore, MD,USA
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Wendy Ziai
5The Johns Hopkins University School of Medicine, Baltimore, MD,USA
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David Menon
7 University of Cambridge, Cambridge, UK
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Daniel Friedman
1 New York University Grossman School of Medicine, New York, NY, USA
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David Friedman
1 New York University Grossman School of Medicine, New York, NY, USA
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Manisha Holmes
1 New York University Grossman School of Medicine, New York, NY, USA
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Joshua Huang
1 New York University Grossman School of Medicine, New York, NY, USA
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Sujata Thawani
1 New York University Grossman School of Medicine, New York, NY, USA
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Jonathan Howard
1 New York University Grossman School of Medicine, New York, NY, USA
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Nada Abou-Fayssal
1 New York University Grossman School of Medicine, New York, NY, USA
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Penina Krieger
1 New York University Grossman School of Medicine, New York, NY, USA
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Ariane Lewis
1 New York University Grossman School of Medicine, New York, NY, USA
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Aaron S. Lord
1 New York University Grossman School of Medicine, New York, NY, USA
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Ting Zhou
1 New York University Grossman School of Medicine, New York, NY, USA
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D. Ethan Kahn
1 New York University Grossman School of Medicine, New York, NY, USA
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Barry M. Czeisler
1 New York University Grossman School of Medicine, New York, NY, USA
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Jose Torres
1 New York University Grossman School of Medicine, New York, NY, USA
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Shadi Yaghi
1 New York University Grossman School of Medicine, New York, NY, USA
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Koto Ishida
1 New York University Grossman School of Medicine, New York, NY, USA
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Erica Scher
1 New York University Grossman School of Medicine, New York, NY, USA
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Adam de Havenon
6University of Utah School of Medicine, Salt Lake City, UT, USA
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Dimitris Placantonakis
1 New York University Grossman School of Medicine, New York, NY, USA
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Mengling Liu
1 New York University Grossman School of Medicine, New York, NY, USA
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Thomas Wisniewski
1 New York University Grossman School of Medicine, New York, NY, USA
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Andrea B. Troxel
1 New York University Grossman School of Medicine, New York, NY, USA
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Laura Balcer
1 New York University Grossman School of Medicine, New York, NY, USA
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Steven Galetta
1 New York University Grossman School of Medicine, New York, NY, USA
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Full PDF
Citation
A Prospective Study of Neurologic Disorders in Hospitalized COVID-19 Patients in New York City
Jennifer A. Frontera, Sakinah Sabadia, Rebecca Lalchan, Taolin Fang, Brent Flusty, Patricio Millar-Vernetti, Thomas Snyder, Stephen Berger, Dixon Yang, Andre Granger, Nicole Morgan, Palak Patel, Josef Gutman, Kara Melmed, Shashank Agarwal, Matthew Bokhari, Andres Andino, Eduard Valdes, Mirza Omari, Alexandra Kvernland, Kaitlyn Lillemoe, Sherry H.-Y. Chou, Molly McNett, Raimund Helbok, Shraddha Mainali, Ericka L. Fink, Courtney Robertson, Michelle Schober, Jose I. Suarez, Wendy Ziai, David Menon, Daniel Friedman, David Friedman, Manisha Holmes, Joshua Huang, Sujata Thawani, Jonathan Howard, Nada Abou-Fayssal, Penina Krieger, Ariane Lewis, Aaron S. Lord, Ting Zhou, D. Ethan Kahn, Barry M. Czeisler, Jose Torres, Shadi Yaghi, Koto Ishida, Erica Scher, Adam de Havenon, Dimitris Placantonakis, Mengling Liu, Thomas Wisniewski, Andrea B. Troxel, Laura Balcer, Steven Galetta
Neurology Oct 2020, 10.1212/WNL.0000000000010979; DOI: 10.1212/WNL.0000000000010979

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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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