RT Journal Article
SR Electronic
T1 Neurologic Syndromes Predict Higher In-Hospital Mortality in COVID-19
JF Neurology
JO Neurology
FD Lippincott Williams & Wilkins
SP e1527
OP e1538
DO 10.1212/WNL.0000000000011356
VO 96
IS 11
A1 Eskandar, Emad Nader
A1 Altschul, David J.
A1 de la Garza Ramos, Rafael
A1 Cezayirli, Phillip
A1 Unda, Santiago R.
A1 Benton, Joshua
A1 Dardick, Joseph
A1 Toma, Aureliana
A1 Patel, Nikunj
A1 Malaviya, Avinash
A1 Flomenbaum, David
A1 Fernandez-Torres, Jenelys
A1 Lu, Jenny
A1 Holland, Ryan
A1 Burchi, Elisabetta
A1 Zampolin, Richard
A1 Hsu, Kevin
A1 McClelland, Andrew
A1 Burns, Judah
A1 Erdfarb, Amichai
A1 Malhotra, Rishi
A1 Gong, Michelle
A1 Semczuk, Peter
A1 Gursky, Jonathan
A1 Ferastraoaru, Victor
A1 Rosengard, Jillian
A1 Antoniello, Daniel
A1 Labovitz, Daniel
A1 Esenwa, Charles
A1 Milstein, Mark
A1 Boro, Alexis
A1 Mehler, Mark F.
YR 2021
UL http://n.neurology.org/content/96/11/e1527.abstract
AB Objective Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is protean in its manifestations, affecting nearly every organ system. However, nervous system involvement and its effect on disease outcome are poorly characterized. The objective of this study was to determine whether neurologic syndromes are associated with increased risk of inpatient mortality.Methods A total of 581 hospitalized patients with confirmed SARS-CoV-2 infection, neurologic involvement, and brain imaging were compared to hospitalized non-neurologic patients with coronavirus disease 2019 (COVID-19). Four patterns of neurologic manifestations were identified: acute stroke, new or recrudescent seizures, altered mentation with normal imaging, and neuro-COVID-19 complex. Factors present on admission were analyzed as potential predictors of in-hospital mortality, including sociodemographic variables, preexisting comorbidities, vital signs, laboratory values, and pattern of neurologic manifestations. Significant predictors were incorporated into a disease severity score. Patients with neurologic manifestations were matched with patients of the same age and disease severity to assess the risk of death.Results A total of 4,711 patients with confirmed SARS-CoV-2 infection were admitted to one medical system in New York City during a 6-week period. Of these, 581 (12%) had neurologic issues of sufficient concern to warrant neuroimaging. These patients were compared to 1,743 non-neurologic patients with COVID-19 matched for age and disease severity admitted during the same period. Patients with altered mentation (n = 258, p = 0.04, odds ratio [OR] 1.39, confidence interval [CI] 1.04–1.86) or radiologically confirmed stroke (n = 55, p = 0.001, OR 3.1, CI 1.65–5.92) had a higher risk of mortality than age- and severity-matched controls.Conclusions The incidence of altered mentation or stroke on admission predicts a modest but significantly higher risk of in-hospital mortality independent of disease severity. While other biomarker factors also predict mortality, measures to identify and treat such patients may be important in reducing overall mortality of COVID-19.AST=aspartate aminotransferase; BMI=body mass index; BUN=blood urea nitrogen; CI=confidence interval; COVID-19=coronavirus disease 2019; CRP=C-reactive protein; HR=hazard ratio; ICD-10=International Classification of Diseases–10; INR=international normalized ratio; OR=odds ratio; SARS-CoV-2=severe acute respiratory syndrome coronavirus 2