Neurological Morbidities in COVID-19 Mark Increased Mortality

Patients hospitalized for COVID-19 are 6 times more likely to die in the hospital if they have clinically diagnosed neurological symptoms, according to an interim analysis from the largest cohort study of neurological manifestations of COVID-19 to date.

Records of over 3700 adult patients at 133 inpatient sites across the globe were gathered and analyzed by two clinical research consortia: the Global Consortium Study of Neurologic Dysfunction in COVID-19 (GCS-NeuroCOVID); and the European Academy of Neurology (EAN) Neuro-COVID Registry (ENERGY) Consortium.

Sherry Chou, MD, MSc, principle investigator of the study and of the CGS-NeuroCOVID consortium, and associate professor of critical care medicine, neurology, and neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, commented on the findings in a statement released by the University of Pittsburgh Medical Center (UPMC) on the occasion of the study publication.

"Very early on in the pandemic, it became apparent that a good number of people who were sick enough to be hospitalized also develop neurological problems," Chou said.

Self-reported or clinically captured neurological symptoms were found in 82% of the studied population, with approximately 4 out of 10 reporting headaches, and approximately 3 out of 10 reporting loss of sense of smell or taste. Of the clinically diagnosed syndromes, acute encephalopathy was most common, affecting nearly half the patients, followed by coma (17%) and strokes (6%).

"Acute encephalopathy is by far the most common symptom that we see in the clinic," Chou commented."Those patients may be in an altered sensory state or have impaired consciousness, or they don't feel like themselves and act confused, delirious, or agitated."

Chou and colleagues constructed the study with 3 cohorts of patients hospitalized for COVID-19: the GCS-NeuroCOVID ALL (n=3055) which comprised consecutive hospitalized patients with, and without neurological manifestations; GCS- NeuroCOVID NEUROLOGICAL (n=475) with confirmed neurological manifestations; and the ENERGY cohort (n-214) who received formal neurological consultation.

"The presentation of the data as distinct cohorts allowed for precise reporting of parameters, which was needed to definitively build the science around these conditions within the setting of COVID-19 infection and to compare outcomes between patients with COVID-19 with and without neurological manifestation," Chou and colleagues explained.

A total of 3083 of 3743 (82%) across cohorts had any neurological manifestation, self-reported and/or clinically captured. The most common self-reported symptoms included headache (1385 of 3732 patients [37%]), and anosmia or ageusia (977 of 3700 patients [26%]).The most prevalent neurological signs and/or syndromes were acute encephalopathy (1845 of 3740 patients [49%]), coma (649 of 3737 [17%}), and stroke (222 of 3737 [6%].

In addition to the increased risk of in-hospital death in those with neurological manifestations (adjusted odds ratio [aOR] 5.99; 95%CI 4.33-8.28), the investigators found that a preexisting neurological disorder was independently associated with increased risk of developing neurological signs or syndromes with COVID-19.

"Our findings...supported the conclusion that neurological manifestations with COVID-19 are an important risk factor for mortality," Chou and colleagues indicate."As such, a formal neurological consultation may be warranted when neurological signs or symptoms are suspected among individuals who test positive for COVID-19."