TY - JOUR
T1 - Neurologic Syndromes Predict Higher In-Hospital Mortality in COVID-19
AU - Eskandar, Emad Nader
AU - Altschul, David J.
AU - De La Garza Ramos, Rafael
AU - Cezayirli, Phillip
AU - Unda, Santiago R.
AU - Benton, Joshua
AU - Dardick, Joseph
AU - Toma, Aureliana
AU - Patel, Nikunj
AU - Malaviya, Avinash
AU - Flomenbaum, David
AU - Fernandez-Torres, Jenelys
AU - Lu, Jenny
AU - Holland, Ryan
AU - Burchi, Elisabetta
AU - Zampolin, Richard
AU - Hsu, Kevin
AU - Mcclelland, Andrew
AU - Burns, Judah
AU - Erdfarb, Amichai
AU - Malhotra, Rishi
AU - Gong, Michelle
AU - Semczuk, Peter
AU - Gursky, Jonathan
AU - Ferastraoaru, Victor
AU - Rosengard, Jillian
AU - Antoniello, Daniel
AU - Labovitz, Daniel
AU - Esenwa, Charles
AU - Milstein, Mark
AU - Boro, Alexis
AU - Mehler, Mark F.
N1 - Publisher Copyright:
© 2020 American Academy of Neurology.
PY - 2021/3/16
Y1 - 2021/3/16
N2 - Objective: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is protean in its manifestations, affecting nearly every organ system. However, nervous system involvement and its effect on disease outcome are poorly characterized. The objective of this study was to determine whether neurologic syndromes are associated with increased risk of inpatient mortality. Methods: A total of 581 hospitalized patients with confirmed SARS-CoV-2 infection, neurologic involvement, and brain imaging were compared to hospitalized non-neurologic patients with coronavirus disease 2019 (COVID-19). Four patterns of neurologic manifestations were identified: acute stroke, new or recrudescent seizures, altered mentation with normal imaging, and neuro-COVID-19 complex. Factors present on admission were analyzed as potential predictors of in-hospital mortality, including sociodemographic variables, preexisting comorbidities, vital signs, laboratory values, and pattern of neurologic manifestations. Significant predictors were incorporated into a disease severity score. Patients with neurologic manifestations were matched with patients of the same age and disease severity to assess the risk of death. Results: A total of 4,711 patients with confirmed SARS-CoV-2 infection were admitted to one medical system in New York City during a 6-week period. Of these, 581 (12%) had neurologic issues of sufficient concern to warrant neuroimaging. These patients were compared to 1,743 non-neurologic patients with COVID-19 matched for age and disease severity admitted during the same period. Patients with altered mentation (n = 258, p = 0.04, odds ratio [OR] 1.39, confidence interval [CI] 1.04-1.86) or radiologically confirmed stroke (n = 55, p = 0.001, OR 3.1, CI 1.65-5.92) had a higher risk of mortality than age- and severity-matched controls. Conclusion: sThe incidence of altered mentation or stroke on admission predicts a modest but significantly higher risk of in-hospital mortality independent of disease severity. While other biomarker factors also predict mortality, measures to identify and treat such patients may be important in reducing overall mortality of COVID-19.
AB - Objective: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is protean in its manifestations, affecting nearly every organ system. However, nervous system involvement and its effect on disease outcome are poorly characterized. The objective of this study was to determine whether neurologic syndromes are associated with increased risk of inpatient mortality. Methods: A total of 581 hospitalized patients with confirmed SARS-CoV-2 infection, neurologic involvement, and brain imaging were compared to hospitalized non-neurologic patients with coronavirus disease 2019 (COVID-19). Four patterns of neurologic manifestations were identified: acute stroke, new or recrudescent seizures, altered mentation with normal imaging, and neuro-COVID-19 complex. Factors present on admission were analyzed as potential predictors of in-hospital mortality, including sociodemographic variables, preexisting comorbidities, vital signs, laboratory values, and pattern of neurologic manifestations. Significant predictors were incorporated into a disease severity score. Patients with neurologic manifestations were matched with patients of the same age and disease severity to assess the risk of death. Results: A total of 4,711 patients with confirmed SARS-CoV-2 infection were admitted to one medical system in New York City during a 6-week period. Of these, 581 (12%) had neurologic issues of sufficient concern to warrant neuroimaging. These patients were compared to 1,743 non-neurologic patients with COVID-19 matched for age and disease severity admitted during the same period. Patients with altered mentation (n = 258, p = 0.04, odds ratio [OR] 1.39, confidence interval [CI] 1.04-1.86) or radiologically confirmed stroke (n = 55, p = 0.001, OR 3.1, CI 1.65-5.92) had a higher risk of mortality than age- and severity-matched controls. Conclusion: sThe incidence of altered mentation or stroke on admission predicts a modest but significantly higher risk of in-hospital mortality independent of disease severity. While other biomarker factors also predict mortality, measures to identify and treat such patients may be important in reducing overall mortality of COVID-19.
UR - http://www.scopus.com/inward/record.url?scp=85102965022&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85102965022&partnerID=8YFLogxK
U2 - 10.1212/WNL.0000000000011356
DO - 10.1212/WNL.0000000000011356
M3 - Article
C2 - 33443111
AN - SCOPUS:85102965022
SN - 0028-3878
VL - 96
SP - E1527-E1538
JO - Neurology
JF - Neurology
IS - 11
ER -