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Older adults with epilepsy and COVID-19: Outcomes in a multi-hospital health system
Claire Ufongene1, Grace Van Hyfte2, Parul Agarwal2
1Icahn School of Medicine at Mount Sinai (ISMMS), New York, NY, United States.
Insights
Older adults with epilepsy admitted for COVID-19 experienced worse outcomes, including higher mortality and longer hospital stays. This highlights epilepsy as a significant risk factor, emphasizing the need for timely COVID-19 care in this population.
Area of Science:
- Neurology
- Infectious Diseases
- Geriatrics
Background:
- Coronavirus disease 2019 (COVID-19) poses significant risks to older adults, particularly those with comorbidities.
- Limited research exists on the impact of neurological conditions, such as epilepsy, on COVID-19 outcomes in the elderly.
Purpose of the Study:
- To compare in-hospital outcomes, including mortality, in older adults with and without epilepsy admitted for COVID-19.
- To identify epilepsy as a potential risk factor for adverse outcomes in elderly COVID-19 patients.
Main Methods:
- Retrospective study of older patients (≥65 years) with and without epilepsy admitted with COVID-19.
- Utilized International Classification of Disease (ICD) codes and antiseizure medications for epilepsy case definition.
- Employed Chi-square, Fisher's exact, Mann-Whitney U, Student's t-tests, and multivariable logistic regression for analysis.
Main Results:
- Older adults with epilepsy (3.21%) had significantly higher in-hospital mortality (35.84% vs. 28.29%) and longer median length of stay (LOS) (13 vs. 8 days).
- Patients with epilepsy were more likely to require ventilation (35.84% vs. 16.18%) and less likely to be discharged home (21.39% vs. 43.12%).
- Epilepsy independently associated with increased odds of in-hospital death (aOR 1.55), non-routine discharge (aOR 3.34), and longer LOS.
Conclusions:
- Epilepsy is independently associated with higher in-hospital mortality, longer LOS, and worse discharge disposition in older adults with COVID-19, even after adjusting for confounders.
- This study reinforces epilepsy as a risk factor for adverse outcomes in elderly COVID-19 patients.
- Prompt identification and management of COVID-19 in individuals with epilepsy may improve clinical outcomes.
Background:
Coronavirus disease 2019 (COVID-19) is associated with high rates of mortality and morbidity in older adults, especially those with pre-existing conditions. There is little work investigating how neurological conditions affect older adults with COVID-19. We aimed to compare in-hospital outcomes, including mortality, in older adults with and without epilepsy.
Methods:
This retrospective study in a large multicenter New York health system included consecutive older patients (age ≥65 years) either with or without epilepsy who were admitted with COVID-19 between 3/2020-5/2021. Epilepsy was identified using a validated International Classification of Disease (ICD) and antiseizure medicationbased case definition. Univariate comparisons were calculated using Chi-square, Fisher's exact, Mann-Whitney U, or Student's t-tests. Multivariable logistic regression models were generated to examine factors associated with mortality, discharge disposition and length of stay (LOS).
Results:
We identified 5384 older adults admitted with COVID-19 of whom 173 (3.21 %) had epilepsy. Mean age was significantly lower in those with (75.44, standard deviation (SD): 7.23) compared to those without epilepsy (77.98, SD: 8.68, p = 0.007). Older adults with epilepsy were more likely to be ventilated (35.84 % vs. 16.18 %, p < 0.001), less likely to be discharged home (21.39 % vs. 43.12 %, p < 0.001), had longer median LOS (13 days vs. 8 days, p < 0.001), and had higher in-hospital death (35.84 % vs. 28.29 %, p = 0.030) compared to those without epilepsy. Epilepsy in older adults was associated with increased odds of in-hospital death (adjusted odds ratio (aOR), 1.55; 95 % CI 1.12-2.14, p = 0.032), non-routine discharge disposition (aOR, 3.34; 95 % CI 2.21-5.03, p < 0.001), and longer LOS (46.46 % 95 % CI 34 %-59 %, p < 0.001).
Conclusions:
In models that adjusted for multiple confounders including comorbidity and age, our study found that epilepsy was still associated with higher in-hospital mortality, longer LOS and worse discharge dispositions in older adults with COVID-19 higher in-hospital mortality, longer LOS and worse discharge dispositions in older adults with COVID-19. This work reinforces that epilepsy is a risk factor for worse outcomes in older adults admitted with COVID-19. Timely identification and treatment of COVID-19 in epilepsy may improve outcomes in older people with epilepsy.
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