Severe COVID-19 outcomes in patients with epilepsy: evidence from a nationwide, population-based study in Poland

The course of COVID-19 and its mortality rate largely depend on the presence of comorbidities. The aim of the study was to evaluate the association between epilepsy and severe COVID-19 outcomes in a nationwide cohort of hospitalized patients in Poland.

This retrospective, nationwide, population-based cohort study used National Health Fund data to identify adults hospitalized due to COVID-19 between 1 March 2021 and 31 December 2023. Patients with epilepsy were identified based on neurologist-confirmed diagnosis and antiseizure medication use. Exact matching was applied to ensure comparability between people with epilepsy (PWE) and patients without epilepsy (PWOE). Outcomes included 60-day mortality, intensive care unit (ICU) admission, mechanical ventilation, and length of hospital stay (LOS).

A total of 404,639 COVID-19 hospitalizations were analyzed, including 3,362 PWE in the unmatched cohort. After matching, epilepsy was associated with a significantly higher risk of death within 60 days of admission, with odds of death 26.4% higher among PWE compared with PWOE. LOS was also significantly longer in PWE, by approximately 14.6%. Epilepsy was not independently associated with an increased risk of mechanical ventilation or ICU admission.

In this large nationwide cohort, epilepsy was associated with increased mortality and prolonged hospitalization among patients hospitalized with COVID-19 in Poland, although it did not independently increase the likelihood of ICU admission or mechanical ventilation. These findings suggest that PWE - particularly those with substantial comorbidity burden - represent a clinically vulnerable population in the context of COVID-19 and may require heightened clinical attention and preventive strategies.