OBJECTIVE: To report clinical and laboratory characteristics, treatment, and clinical outcomes of patients admitted for neurologic diseases with and without coronavirus disease 2019 (COVID-19). METHODS: In this retrospective, single-center cohort study, we included all adult inpatients with confirmed COVID-19 admitted to a neuro-COVID unit beginning February 21, 2020, who had been discharged or died by April 5, 2020. Demographic, clinical, treatment, and laboratory data were extracted from medical records and compared (false discovery rate corrected) to those of neurologic patients without COVID-19 admitted in the same period. RESULTS: One hundred seventy-three patients were included in this study, of whom 56 were positive and 117 were negative for COVID-19. Patients with COVID-19 were older (77.0 years, interquartile range [IQR] 67.0-83.8 years vs 70.1 years, IQR 52.9-78.6 years, p = 0.006), had a different distribution regarding admission diagnoses, including cerebrovascular disorders (n = 43, 76.8% vs n = 68, 58.1%), and had a higher quick Sequential Organ Failure Assessment (qSOFA) score on admission (0.9, IQR 0.7-1.1 vs 0.5, IQR 0.4-0.6, p = 0.006). In-hospital mortality rates (n = 21, 37.5% vs n = 5, 4.3%, p < 0.001) and incident delirium (n = 15, 26.8% vs n = 9, 7.7%, p = 0.003) were significantly higher in the COVID-19 group. Patients with COVID-19 and without COVID with stroke had similar baseline characteristics, but patients with COVID-19 had higher modified Rankin Scale scores at discharge (5.0, IQR 2.0-6.0 vs 2.0, IQR 1.0-3.0, p < 0.001), with a significantly lower number of patients with a good outcome (n = 11, 25.6% vs n = 48, 70.6%, p < 0.001). In patients with COVID-19, multivariable regressions showed increasing odds of in-hospital death associated with higher qSOFA scores (odds ratio [OR] 4.47, 95% confidence interval [CI] 1.21-16.5, p = 0.025), lower platelet count (OR 0.98, 95% CI 0.97-0.99, p = 0.005), and higher lactate dehydrogenase (OR 1.01, 95% CI 1.00-1.03, p = 0.009) on admission. CONCLUSIONS: Patients with COVID-19 admitted with neurologic disease, including stroke, have a significantly higher in-hospital mortality and incident delirium and higher disability than patients without COVID-19.
OBJECTIVE: To report clinical and laboratory characteristics, treatment, and clinical outcomes of patients admitted for neurologic diseases with and without coronavirus disease 2019 (COVID-19). METHODS: In this retrospective, single-center cohort study, we included all adult inpatients with confirmed COVID-19 admitted to a neuro-COVID unit beginning February 21, 2020, who had been discharged or died by April 5, 2020. Demographic, clinical, treatment, and laboratory data were extracted from medical records and compared (false discovery rate corrected) to those of neurologic patients without COVID-19 admitted in the same period. RESULTS: One hundred seventy-three patients were included in this study, of whom 56 were positive and 117 were negative for COVID-19. Patients with COVID-19 were older (77.0 years, interquartile range [IQR] 67.0-83.8 years vs 70.1 years, IQR 52.9-78.6 years, p = 0.006), had a different distribution regarding admission diagnoses, including cerebrovascular disorders (n = 43, 76.8% vs n = 68, 58.1%), and had a higher quick Sequential Organ Failure Assessment (qSOFA) score on admission (0.9, IQR 0.7-1.1 vs 0.5, IQR 0.4-0.6, p = 0.006). In-hospital mortality rates (n = 21, 37.5% vs n = 5, 4.3%, p < 0.001) and incident delirium (n = 15, 26.8% vs n = 9, 7.7%, p = 0.003) were significantly higher in the COVID-19 group. Patients with COVID-19 and without COVID with stroke had similar baseline characteristics, but patients with COVID-19 had higher modified Rankin Scale scores at discharge (5.0, IQR 2.0-6.0 vs 2.0, IQR 1.0-3.0, p < 0.001), with a significantly lower number of patients with a good outcome (n = 11, 25.6% vs n = 48, 70.6%, p < 0.001). In patients with COVID-19, multivariable regressions showed increasing odds of in-hospital death associated with higher qSOFA scores (odds ratio [OR] 4.47, 95% confidence interval [CI] 1.21-16.5, p = 0.025), lower platelet count (OR 0.98, 95% CI 0.97-0.99, p = 0.005), and higher lactate dehydrogenase (OR 1.01, 95% CI 1.00-1.03, p = 0.009) on admission. CONCLUSIONS:Patients with COVID-19 admitted with neurologic disease, including stroke, have a significantly higher in-hospital mortality and incident delirium and higher disability than patients without COVID-19.
Authors: Thomas H Brannagan; Michaela Auer-Grumbach; John L Berk; Chiara Briani; Vera Bril; Teresa Coelho; Thibaud Damy; Angela Dispenzieri; Brian M Drachman; Nowell Fine; Hanna K Gaggin; Morie Gertz; Julian D Gillmore; Esther Gonzalez; Mazen Hanna; David R Hurwitz; Sami L Khella; Mathew S Maurer; Jose Nativi-Nicolau; Kemi Olugemo; Luis F Quintana; Andrew M Rosen; Hartmut H Schmidt; Jacqueline Shehata; Marcia Waddington-Cruz; Carol Whelan; Frederick L Ruberg Journal: Orphanet J Rare Dis Date: 2021-05-06 Impact factor: 4.123
Authors: Lars Christian Lund; Jesper Hallas; Henrik Nielsen; Anders Koch; Stine Hasling Mogensen; Nikolai Constantin Brun; Christian Fynbo Christiansen; Reimar Wernich Thomsen; Anton Pottegård Journal: Lancet Infect Dis Date: 2021-05-10 Impact factor: 25.071
Authors: Jennifer A Frontera; Sakinah Sabadia; Rebecca Lalchan; Taolin Fang; Brent Flusty; Patricio Millar-Vernetti; Thomas Snyder; Stephen Berger; Dixon Yang; Andre Granger; Nicole Morgan; Palak Patel; Josef Gutman; Kara Melmed; Shashank Agarwal; Matthew Bokhari; Andres Andino; Eduard Valdes; Mirza Omari; Alexandra Kvernland; Kaitlyn Lillemoe; Sherry H-Y Chou; Molly McNett; Raimund Helbok; Shraddha Mainali; Ericka L Fink; Courtney Robertson; Michelle Schober; Jose I Suarez; Wendy Ziai; David Menon; Daniel Friedman; David Friedman; Manisha Holmes; Joshua Huang; Sujata Thawani; Jonathan Howard; Nada Abou-Fayssal; Penina Krieger; Ariane Lewis; Aaron S Lord; Ting Zhou; D Ethan Kahn; Barry M Czeisler; Jose Torres; Shadi Yaghi; Koto Ishida; Erica Scher; Adam de Havenon; Dimitris Placantonakis; Mengling Liu; Thomas Wisniewski; Andrea B Troxel; Laura Balcer; Steven Galetta Journal: Neurology Date: 2020-10-05 Impact factor: 9.910