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Risk Factors for New Neurologic Diagnoses in Hospitalized Patients With COVID-19: A Case-Control Study in New York
Kiran T Thakur1, Victoria T Chu1, Christine Hughes1
1Department of Neurology (KTT, CYK, EM, A. Balbi, A. Bilski, MC, OL, SDJ, SA, DR, SP, VS, WGS, WDV, AG, MB, BW, JC, A. Boehme, JZW, MSVE), Columbia University Irving Medical Center-New York Presbyterian Hospital; United States Centers for Disease Control and Prevention (VTC, CH, SF-D, CEB, AR, AM, JS), Atlanta, GA; Department of Pediatrics (AG), Columbia University Irving Medical Center-New York Presbyterian Hospital; and Division of Infectious Diseases, Department of Internal Medicine, Columbia University Irving Medical Center-New York Presbyterian Hospital (MES, JZ), New York.
Background And Objectives:
There have been numerous reports of neurologic manifestations identified in hospitalized patients infected with SARS-CoV-2, the virus that causes COVID-19. Here, we identify the spectrum of associated neurologic symptoms and diagnoses, define the time course of their development, and examine readmission rates and mortality risk posthospitalization in a multiethnic urban cohort.
Methods:
We identify the occurrence of new neurologic diagnoses among patients with laboratory-confirmed SARS-CoV-2 infection in New York City. A retrospective cohort study was performed on 532 cases (hospitalized patients with new neurologic diagnoses within 6 weeks of positive SARS-CoV-2 laboratory results between March 1, 2020, and August 31, 2020). We compare demographic and clinical features of the 532 cases with 532 controls (hospitalized COVID-19 patients without neurologic diagnoses) in a case-control study with one-to-one matching and examine hospital-related data and outcomes of death and readmission up to 6 months after acute hospitalization in a secondary case-only analysis.
Results:
Among the 532 cases, the most common new neurologic diagnoses included encephalopathy (478, 89.8%), stroke (66, 12.4%), and seizures (38, 7.1%). In the case-control study, cases were more likely than controls to be male (58.6% vs 52.8%, p = 0.05), had baseline neurologic comorbidities (36.3% vs 13.0%, p < 0.0001), and were to be treated in an intensive care unit (62.0% vs 9.6%, p < 0.0001). Of the 394 (74.1%) cases who survived acute hospitalization, more than half (220 of 394, 55.8%) were readmitted within 6 months, with a mortality rate of 23.2% during readmission.
Discussion:
Hospitalized patients with SARS-CoV-2 and new neurologic diagnoses have significant morbidity and mortality postdischarge. Further research is needed to define the effect of neurologic diagnoses during acute hospitalization on longitudinal post-COVID-19-related symptoms including neurocognitive impairment.
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