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

Published on
Journal: Neurology
[저자] 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
[Category] 임상,
PMC URL    [DOI] 10.1212/WNL.0000000000010979    
[Article Type] Observational Study
[Source] PMC

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.

All Keywords
【초록키워드】 COVID-19, coronavirus disease, SARS-CoV-2, coronavirus, Hospitalized, Mortality, stroke, SARS-COV-2 infection, hospital, intubation, Sex, medications, discharge, New York City, Prevalence, outcomes, male, Patient, complications, Encephalopathy, age, SOFA, multicenter, reverse transcriptase PCR, Care, in-hospital mortality, diagnose, CSF, Injury, Seizure, Organ failure, COVID-19 symptom, Diabetic, acute respiratory syndrome, Older, Intubated, 95% CI, 95% confidence interval, increased risk, hazard ratio, specimen, hypertensive, laboratory-confirmed SARS-CoV-2 infection, disorder, neurologic disorders, neurologic, likelihood, systemic illness, SOFA scores, discharge home, diagnosed, conducted, median, determine, recorded, neurologic disorder, patients with COVID-19, was recorded, 【제목키워드】 COVID-19, New York City, Prospective,